and it wouldn’t be the last.
It was my intern year of residency, I think. All 3 years sort of blur together and my memories overlap in astonishingly non-temporal ways. I was pregnant which means it was either July – September of my intern year or else August – March of my 3rd year. Who knows now.
I was on an OB rotation, which in our very small residency at Idaho State University, often meant several days of call in a row, which then meant we lived at the hospital those days. I was pregnant a lot in residency. So much so, that many nurses stations at Bannock Regional Medical Center had a bottle of Maalox in the cupboard with my name on it. I’d waddle through the station in a daze at night and take a swig on my way to an admission, a delivery, the call room or…well, who knew. I had my first baby in my 3rd year of medical school and then my second and third in my first and third years of residency. I do not recommend this plan. But I do strongly recommend being a mom (and that is never actually convenient no matter what your circumstances).
I was tired and had heartburn and a baby foot jammed up in my liver. OB called and I rolled out of the bed in the call room, brushed my teeth and made my way to Labor & Delivery. A young Hispanic couple was waiting in the room anxiously. She was 19 and he about 20 and they were holding hands while the nurse checked the baby’s heartbeat. Smiles were thin as we all heard the strong 15o beat per minute cadence of a little life inside her womb. Usually, relief would wash over the couple when that heartbeat suddenly swooshed through the anxious silence of the labor room. Especially when the pregnancy was only 20 weeks along. But not so much for this couple.
I left and found the ultrasound machine and rolled it into the room. Exposing her small belly, I gooped it up with gel and began rolling the probe over her uterus. Bladder first, roll up and, whoops – there she was! She was jumping around in her bubble like a little grasshopper – scrawny legs twitching and pushing to move around. The moment of joy was brief and the mama gripped the papa’s hand tighter and began to cry. He bent his head and kissed her hand.
After a quick, gentle speculum exam, my face was grim and I quickly left the room to make some calls. The nurse switched the bed into trendelenberg position (head down, feet up) and they waited. Knowing the anxiety and sadness in the couple, the nurse just followed the baby girl around in her uterine gymnastics with the ultrasound so the parents could see her some more.
My calls to Salt Lake City were futile. At 20 weeks, no one would take the transfer because it was too early (21 weeks was the earliest they’d accept). I took a swig of my Maalox and consulted my OB preceptor by phone. The patient was in labor, the membranes bulging out of a 4-5 cm dilated cervix. There was no stopping it – a cerclage had not been placed and the cervix was going to fully dilate and the baby deliver tonight. This was this mama’s 3rd loss to incompetent cervix, all around the 20 week mark. She worked in the fields as a migrant laborer and while there was a clinic in her small town some 75 miles from our hospital, no cerclage had been done despite her history.
I walked back into the room helplessly and my face spoke all the Spanish they needed. This little daughter was not going to survive either. L&D nurses are a special lot. Most of the time their job is to help a family in a painful but joyous time. But not always. When things go bad in L&D it is tragic and heartbreaking. These nurses are a combination of tough coaches, comforting grandmas and astute clinicians. Seeing my face the nurse spoke softly in Spanish to the patients while I took the ultrasound probe and continued watching the little girl zipping around, blissfully unaware.
Within an hour the room was packed with family and friends. Word had gone out and they all knew the situation. We left the ultrasound machine in the room and the nurse went in and out periodically to check up on the little gal and to let the family see their granddaughter, niece, cousin, daughter. I waited with dread in the nurses station. I had never delivered a stillborn or had a baby not survive. My heartburn was intractable.
Inevitably, the nurse came out and called for the peds team and had me come into the room. Her water had broken. Several minutes later a perfectly formed tiny girl, about the length of a sharpie pen, was delivered into my hands. She didn’t cry but I could see her heart pumping beneath her thin chest wall. She squirmed and stretched and took a breath. I dried her off and we wrapped her up and put her little cap on, handing her gently to her parents.
There were no dry eyes in the room. The nurse and I both cried, the peds team cried and the family cried. The only one who didn’t cry was the baby. She continued to try to breath and snuggled up against her mama’s chest and was warmed by the kisses and love of everyone there.
It took about 30 minutes for her to die. She was held, loved, kissed, blessed, adored, protected for her entire life by a family who dearly wanted her. Even today, 20 years later, I cry writing about this little girl and can still see her perfect face under the tiny cap knitted by LDS grandmas. Her life was so short and her parents so sad to see her go. But as far as lives go, hers was better than many who survive longer.