Chapter One
Tuesday 10:30 p.m.
“Come on, they need us now,” urged Michele Black. Her breath was coming in short gasps, her eyes wide in her anxiety. She pounded the elevator button for the third time. Finally, it opened. Kate Harris ran to catch up struggling to cram her hair into the surgical bonnet. Michele laughed nervously because Kate’s auburn hair still streamed out the sides.
“Evening shift should have already been in OB.” Kate hit the button for the second floor and managed to get all her hair into the cap.
“I know. The call came in over 30 minutes ago according to Jack.” Michele pushed and Kate pulled the cart loaded with surgical equipment off the elevator into the obstetric department. Total mayhem greeted them. Nurses and technicians were scurrying in and out of the delivery rooms.
The first rivet of sweat streaked down Kate’s face. Her stomach had a sinking burning feeling as her stress level multiplied. Kate yelled in the direction of the nursing station through the scattering bodies. “Which room?”
“Three. A long time ago,” came the answer from behind the desk.
Pounding down the hall, Kate felt adrenalin quickening her steps. Her stomach tightened more afraid of what they would find. Applying their masks as they went careening into the delivery suite, they found the patient was there along with the OB staff, the obstetrician, and anesthesia. Kate said, “Hello,” in the general direction of the OB nurse, Rachel Wilson, and the laboring mother as Kate put out the sterile packs. Michele skipped her surgical scrub and donned her sterile gown and gloves for the impending cesarean section.
The sterile packs open, Kate began moving around the room falling into the familiar routine of duties, ignoring the obstetrician, Dr. Baker, and his glares. Kate glanced at Rachel and saw her concerned look. Anxious, Kate looked at the mother’s monitor that was running 120 and the transducer on the mother’s abdomen for the baby registered 190. It then fell to 80. Kate blinked her eyes not believing what she had seen but when she reopened them she found the 80 was still being displayed on the digital readout. This was not a routine procedure. She looked at the clock and noted the time. 10:31 p.m. She glanced back over at Rachel who uttered hushed words. “Abruption. And it looks like the placenta has almost completely separated from the uterus.
Finished and ready for the surgery to proceed, Kate went to the patient and asked her name and if she had any allergies. The patient, Mrs. Angela Richardson, answered, “Urrrr…” That was enough for identification, permit, and allergies for Kate. She went back to work.
Kate’s heart went out to the mother as she explained that she was applying cold betadine solution on her abdomen to clean it for surgery. Rachel reached to take the fetal monitor off at the last moment. Rachel caught Kate’s eye as they realized that the ultrasonic transducer had just registered a fall in the fetal heart rate to 60. With Rachel’s hand posed in midair, the monitor screamed in alarm as the rate fell to 0. The transducer disappeared. Kate made a final swipe with the prep solution, and then stepped out of the way.
Michele placed the drapes on as Dr. Baker and an OB technician gowned and gloved in preparation. Simultaneously, the nurse anesthetist was pushing drugs into the IV tubing sending the mother off to sleep. The time was 10:33.
“Nurse, what was the baby’s rate?” asked Dr. Baker as he grabbed the scalpel from Michele.
“Flat just now,” Rachel said as she prepared to receive the dying infant. She knew Baker had known. He just wanted to make a point.
With a nod from the anesthesiologist who was standing by, Dr. Baker wasted no further time but began. He entered the abdomen and the uterus in two cuts, not sparing a moment to ligate bleeding vessels. Everyone geld their breath as the fluid and blood spewed out of the gaping hole. The obstetrician plunged his hands in and with a shove from the technician on top delivered the baby, a girl. 10:34.
Stark white and limp as a rag doll, the baby had meconium stool in her nose and mouth. Michele, ready with the suction bulb restrained herself for with the presence of meconium it was better if the baby didn’t breathe until after she had been suctioned by the neonatologist. Breathing at this point would only aspirate the thick, tarry stool into the baby’s lungs making aeration impossible. Michele flung the baby to Rachel instead. Rachel placed the baby in the open warmer and into the care of Dr. Martin, the neonatologist. Rachel listened for a heart beat. “Nothing.” Rachel proceeded with chest compressions.
Kate threw another package of surgical sponges onto Michele’s back table, then left to assist with the baby girl. She grabbed up the laryngoscope, slapped a small blade on and handed it to the doctor. Kate then dove under the warmer and pulled up a large suction endotracheal tube and attached the suction to the end of it and handed it over. Dr. Martin took the tube and inserted it into the baby’s respiratory tract. Suctioning, he pulled the tube back out bringing the thick fecal matter with it. The procedure was done several times until the results were virtually clear. A new tube, smaller in size was inserted for more permanent placement and ventilation with O2 by an ambu bag began.
Rachel doing chest compressions noticed the baby pinking up. She stopped the sternal massage and listened to the chest with a stethoscope, hopeful. “We have a heart beat.”
Dr. Martin continuing to ventilate the baby, smiled. The tension in the room lessened with a big sigh of relief. “Are we ready to transport, nurse?”
“Yes,” Rachel said.
“Okay. What are we waiting for?”
“Not a thing.” Rachel started pulling the baby warmer out of the delivery room and on toward the neonatal intensive care unit. Dr. Martin brought up the rear still administrating O2 to the baby.
Still fighting the remaining tension, the room stayed subdued. Kate took a moment to turn down the thermostat so the room would cool off now that the neonate was out of the room. Turning back to the operation, Kate caught Michele’s eye and raised her eyebrows indicating to Michele that she had Kate’s attention.
“I’ll take another 0 chromic suture,” said Michele.
Kate nodding in reply opened the suture pack onto the surgical table and accepted the cord blood from Michele. Seeing that the caesarean section was proceeding now in a routine manner, Kate turned her attention to her paper work. Writing in the chart was difficult with her hands shaking. Her stomach was on fire now from the excitement. Kate couldn’t take much more. Noting the start times of anesthesia, surgery and delivery Kate had no idea how long the baby’s placenta was not attached to the uterus. If everything went okay, the baby would recover from the assault to her system the lack of circulation and oxygen had caused. It was out of delivery room personnel’s hands and into Dr. Martin’s and the sky pilots.
“Dr. Baker, fetal distress or placental abruption for the preop diagnosis?”
“Both,” he said looking over at her with sweat still ringing his face. Kate moved to wipe the perspiration from his face to prevent it from falling into the wound. “Thanks. What took you two so long to get down here?”
“Evening shift should have come down before we even came on duty,” said Michele. “I’m disgusted with them. They do this all the time and Janice, the evening shift charge nurse, lets them.”
“I know Janice. It doesn’t seem like she would do something like that. Okay, I just hope the baby is okay,” said Dr. Baker.
“There weren’t any instrument or sponge counts done. We need an x-ray to make sure everything is out,” said Kate. “I’ve already called radiology.”
“That’s fine.” Finished closing the incision Dr. Baker applied dressings and silk tape. He stepped away from the operating room table and picked up Angela Richardson’s chart. He leaned against the tiled wall to write orders.
X-ray technicians rolled in with their portable machine. The nurse anesthetist assisted the techs in positioning the patient to get the film done. They put the x-ray on the view box. Kate looked it over for any spare instruments or abdominal sponges. “Looks good. Wake her up.” Kate said to the nurse anesthetist. “I’ll need the name of the radiologist who officially reads the firm for my paperwork, please.”
“I already know that it will be Dr. Reed because he is the only one in the building at this time of night.”
“Thanks.”
The drapes were removed revealing the mother once more. Already her brow was creased with pain as she emerged from the anesthesia. Kate tended the mother with the anesthetist. Putting her hands on the mother’s abdomen she massaged the uterus trying to expel any remaining clots. Though she was trying to be gentle it was painful for the patient. OB staff no longer needed elsewhere, entered to help, freeing Michele and Kate to leave.
Share
Print
Save