The phone rang from the birthing center. "Crash section. No heartbeat. Please send the team."
So I did. And I went with them. An extra pair of hands or three comes in handy when you're trying to do everything at once.
By the time the OB handed over the baby, everything was in place. ET tube cut, drugs drawn up, umbilical line ready to go.
She was beautiful. At least I think she may have been a girl. I didn't really look. I was too focused on what I was doing at the time.
No heartbeat.
Dry the baby. Get her off the wet towels.
Bag-mask ventilation.
No heartbeat.
Chest compressions.
No heartbeat.
ET tube in place. Breath sounds equal. Placement checked with CO2 detector.
Epinephrine down the endotracheal tube while the doc placed the UV line (a tube into the large vein in the umbilical cord).
No heartbeat.
One minute APGAR 0
Two minute APGAR 0 -- no heartbeat. No respiratory effort. No muscle tone. No reflex response. Deathly pale.
Epinephrine via the UV catheter -- "Careful. Don't tug on it."
No heartbeat.
Saline for volume expansion. More epinephrine.
No heartbeat.
Coordination of effort could not have been more perfect. We followed the Neonatal Resuscitation Protocol to the letter.
Including the part that suggests that you should consider discontinuing resuscitation efforts if there are still no signs of life after 10 minutes of "continuous and adequate" resuscitation efforts. I don't much like that part, but I agree with it.
She was a beautiful baby. At least I think she was a girl, but she never had a heartbeat. Not while we worked on her.
On days like that, I don't much like my job. I love the people who work with me, though. I value their expertise and their compassion. I particularly appreciate their ability to support one another and to remind each other that no matter how perfect our efforts, the final outcome is sometimes completely beyond our control.
Showing posts with label Death. Show all posts
Showing posts with label Death. Show all posts
Sunday, September 21, 2008
Tuesday, December 27, 2005
Hello, Baby! Goodbye.
23 weeks, male, mom had prolonged rupture of membranes and chorioamnionitis - an infection of the fetal membranes and amniotic fluid. It doesn't get much more grim than that in the NICU. This baby has about as much chance as a snowball in Death Valley in August. The perinatologist's recommendation was that we simply do nothing. The parents want us to do "everything possible" and that's what we are going to do. The parents cannot possibly understand what "everything possible" means - or why we do it reluctantly, but with all possible skill.
It's not my favorite part of the job, this fending off death for a few hours until there is simply no more to do. Even more difficult is facing the parents and trying not to destroy their hope -- but trying harder still not to offer them hope that simply does not exist. They want so much for me to say "yes" when they ask if the baby is doing better now. He's not really. He looks it, but I've seen the lab results. I know about the unofficial, but devastating head sonogram - the docs haven't shared that with them just yet, so I dance quickly away from that minefield.
I see the dark spots - the petechiae and hematomas that result from the overwhelming infection that has destroyed most of his clotting factors and platelets. We're replacing fluids, platelets, red cells, electrolytes - but not as fast as they're leaking through his gelatinous skin and being destroyed by the infection. I handle his tiny limbs as gently as possible so as not to cause any more damage, but I must turn him frequently, because lying too still causes his head to flatten. I titrate his dopamine and give more boluses of saline solution and sodium bicarbonate to sustain his blood pressure and reverse the acidosis that will surely kill him if it is not corrected, but I know that his serum sodium is rapidly rising -- approaching dangerous levels and soon there will be no more to do.
An aunt comments that this place is filled with angels. I pause a moment and realize that she is right. It is alway so when one of these little ones hovers between life and death. Perhaps it is always so and I am most aware of it at such times.
With great reluctance, I try to start an IV in veins almost smaller than the catheter, because we must give insulin now, and it's not compatible with the fluids in the existing IV lines. I call the doctor to do it, because I cannot bear to try a second time when my first attempt fails. She is as reluctant as I, but there is no one to whom she can pass this. She succeeds on the second attempt and we are able to continue our efforts to postpone the inevitable.
I leave in the morning knowing that he will not be there when I return less than 12 hours later. My husband asks how I feel about this baby dying. My answer: I'm sad for his family, but happy that he has moved on to a better place.
It's not my favorite part of the job, this fending off death for a few hours until there is simply no more to do. Even more difficult is facing the parents and trying not to destroy their hope -- but trying harder still not to offer them hope that simply does not exist. They want so much for me to say "yes" when they ask if the baby is doing better now. He's not really. He looks it, but I've seen the lab results. I know about the unofficial, but devastating head sonogram - the docs haven't shared that with them just yet, so I dance quickly away from that minefield.
I see the dark spots - the petechiae and hematomas that result from the overwhelming infection that has destroyed most of his clotting factors and platelets. We're replacing fluids, platelets, red cells, electrolytes - but not as fast as they're leaking through his gelatinous skin and being destroyed by the infection. I handle his tiny limbs as gently as possible so as not to cause any more damage, but I must turn him frequently, because lying too still causes his head to flatten. I titrate his dopamine and give more boluses of saline solution and sodium bicarbonate to sustain his blood pressure and reverse the acidosis that will surely kill him if it is not corrected, but I know that his serum sodium is rapidly rising -- approaching dangerous levels and soon there will be no more to do.
An aunt comments that this place is filled with angels. I pause a moment and realize that she is right. It is alway so when one of these little ones hovers between life and death. Perhaps it is always so and I am most aware of it at such times.
With great reluctance, I try to start an IV in veins almost smaller than the catheter, because we must give insulin now, and it's not compatible with the fluids in the existing IV lines. I call the doctor to do it, because I cannot bear to try a second time when my first attempt fails. She is as reluctant as I, but there is no one to whom she can pass this. She succeeds on the second attempt and we are able to continue our efforts to postpone the inevitable.
I leave in the morning knowing that he will not be there when I return less than 12 hours later. My husband asks how I feel about this baby dying. My answer: I'm sad for his family, but happy that he has moved on to a better place.
Wednesday, June 15, 2005
A quiet night
NPC 24 weeks, FDIU. Ominous words appearing on the monitor screen listing the patients in the birthing center.
NPC - no prenatal care at 24 weeks gestation. That's not terribly uncommon in our part of town. Some of our moms show up for their first prenatal visit fully dilated at term.
FDIU - fetal death in utero.
The nurse from the birthing center called for our help. The baby had died some time prior to 24 weeks and she needed a more accurate weight than they could get on their scales. Could she use one of our scales?
Sure, come on over.
340 grams - about 11 ounces.
Do you think the baby has some kind of syndrome?
He looks pretty odd, but he was breech and the cervix had trapped the head for over an hour.
No, I don't think it's a syndrome, but I don't think we should take pictures for the mom to keep either.
We need some kind of memento. Footprints?
Tiny footprints - and perfect palmprints. Both smaller than my fingertip. Think she'll notice that I missed a toe on that left foot?
Probably. Now I wish we'd tried again. It was a quiet night.
NPC - no prenatal care at 24 weeks gestation. That's not terribly uncommon in our part of town. Some of our moms show up for their first prenatal visit fully dilated at term.
FDIU - fetal death in utero.
The nurse from the birthing center called for our help. The baby had died some time prior to 24 weeks and she needed a more accurate weight than they could get on their scales. Could she use one of our scales?
Sure, come on over.
340 grams - about 11 ounces.
Do you think the baby has some kind of syndrome?
He looks pretty odd, but he was breech and the cervix had trapped the head for over an hour.
No, I don't think it's a syndrome, but I don't think we should take pictures for the mom to keep either.
We need some kind of memento. Footprints?
Tiny footprints - and perfect palmprints. Both smaller than my fingertip. Think she'll notice that I missed a toe on that left foot?
Probably. Now I wish we'd tried again. It was a quiet night.
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