In the Dead of Night
That night, I reported to the L&D floor just like any other night that week. It started off normally with the usual sign-out with the residents and then checking the OR board to see if there were any cases to cover. I noticed a D&C up for grabs so I took it, expecting this night to be like any other. All I could think about was the best perk of being on night shift, which was around midnight, I would accompany the intern to the nursery and we would be among and possibly get to hold the newly-born babies. Words cannot express the joy that seeing and holding these newborns can bring to someone, especially after a stressful day.
As the night progressed, I had returned to the floor after my case and stood waiting in the event that any of our patients in the birthing rooms were about to deliver. The night was quiet thus far, but then, around 11:30 pm, a change was about to be upon us.
A patient arrived from the ED who was presented with "her water broke an hour ago," abdominal cramping, and absence of fetal movements. Now this would be a normal occurrence if she was in her 39th week or so but unfortunately, she was in her 17th week of pregnancy. She appeared distressed but in my mind, I doubt she knew what this could potentially mean for her fetus. So she was moved up to Labor & Delivery to be assessed and taken care of.
Our attending then went in to see the patient. She gently explained that the fetus was no longer viable and that we would have to deliver it tonight in order to prevent any further complications. As expected, the patient began sobbing, not as much as I had expected but I guess she hadn't fully comprehended the reality of the situation yet. We administered the drug Oxytocin in order to initiate expulsion of the fetus. Everything seemed to be going as routinely as could be expected.
An hour later, the patient began screaming and wailing uncontrollably. Perhaps it was due to the contractions she was experiencing or the fact that the reality had hit her. She'd had a change of heart and requested that we do a Dilatation & Evacuation to deliver the fetus as she did not want to be awake to see her unborn child. We acknowledged her request but it was beginning to look like a race against time as the strength of her contractions increased, which could mean that the fetus could be out at any moment. We placed a call to OR to have a room ready for us.
Unfortunately for us, our attending was in a C-section. We sent a message to the attending and wasted no time in moving the patient from her room to the OR. We rushed to her room and promptly moved her onto the stretcher to be transported. She could not help but continue sobbing and howling as the intense pain she was going through physically and mentally was plastered across her face. Her husband kept up with us, all the while trying to comfort her but deep down, I knew that he was going through the same emotional pain as she was.
We made it to the OR and moved the patient, still writhing in pain, to the operating bed. However, our attending was nowhere to be found. We sent another message to the other OR where the C-section was happening and were told that it was wrapping up.
Luck was not on our side that night, as another problem presented itself. During the assessment by the anesthesia team, they found out that the patient had been chewing gum prior to being moved to the OR. This presented a problem because this increased the aspiration risk when the patient is intubated. Great; yet another problem.
Our attending finally made it down, and after discussion with the anesthesia team, we decided to do the procedure regardless, since this was an emergent case. The resident and attending went outside to begin scrubbing and to be gowned up. Unfortunately, there was not enough room to accommodate three people at the site of the operation so I stood to the side, assisting in whatever way I could.
Then the procedure began and upon initial palpation, we realized that the fetus' hand could be felt inside the vagina. Then it happened; the fetus was pulled out and placed on the mayo table. There it was, an unborn baby, red and moist, no bigger than the size of an ipad, lying motionless on the blue towel. I stared at it, unable to pull my gaze away from it. My mind raced with all the thoughts of what this fetus could have been, how unfortunate it was that it met its end this way and also the existential nature of it all. It was shocking; even as a medical student, this was not something I saw every day. In fact, I'd never seen it before.
I wasn't the only one paralyzed by the sight. The scrub tech and the circulating nurse were also in awe of what was before them. I guessed that this might have been their first time witnessing this, too. A rush of sadness went through me as I tried to imagine what the mother would have felt seeing her newly-born child in this manner, the gravity of it, especially in comparison to the love and excitement she must have felt when she first got the news she was pregnant. Now, all of that joy had been washed away, for largely unknown reasons. I totally understood why she had asked to be asleep. Perhaps this way, she could try again and not be haunted by the image of her first unsuccessful pregnancy.
I wish I could say that this was an uncommon occurrence but for the population around this hospital, many patients have had unsuccessful pregnancies, maybe not this dramatic or with such a well-developed fetus, but certainly resulting in a surgery to remove any products of conception that were perhaps implanted incorrectly or did not have the correct conditions to grow.
The surgery was a success and the placenta was removed, albeit in parts, but certainly the risk was over. The patient was taken to the recovery room where she spent the night and left the next day.
For us in the medical field, we are all too familiar with death, whether it be to someone who lived 80 years or someone who had not had the chance to live at all. It remains our duty to prevent these occurrences from happening and do our best to ensure that patients and their families do not go through it alone. We tend towards sharing the burden of our patients as it is the only way to connect with them and really help them lead the best lives they can. It isn't by any stretch an easy task, but it is one that everyone in our field has accepted from the time they don their white coat.