Saturday, November 18, 2006

Lost and Found

Imagine it: there you are, asleep in your own room. It's completely dark, the temperature is perfect, and there is no place else that you feel more safe. A soothing lub-dub creates a gentle background noise that lets you block everything else out and go back to sleep. Your heart rate begins to slow, as you drift off...

Suddenly, the room shifts, and the pressure in the room itself begins to increase. A white light pierces the room from just behind you. It blinds you with a harsh intensity that you've never seen before. The very wall of your room is splitting open. You want to scream, but you can't. Not yet. There is a sudden burst of air against your skin, and giant rubber tentacles clamp over your head and drag you out of your room... surely, to certain death.

And suddenly, there it is. You can scream, and you do. With all of your might. The noise is overwhelming. You suddenly realize that you are completely soaked. And naked. And it's freezing. The tentacles are moving all about, and before you know it, you've been grasped by your shoulders and feet--not unlike a pig on a spit-- and passed over to a warm, dry bed. The tentacles use warm, white cloths to dry you off, but the noise is still there. It is deafening. You scream and scream and scream, but you're lost. You don't know where your room is. It is gone.


That's how my morning started on Friday, only my hands were one of the sets of rubber tentacles.

6:30 am- It started when we walked by the OB triage room. Normally, heart tones on external fetal monitors tick away at a staccato pace. This one was about half what it should have been-- it was just above the pace of a second hand. The patient had been scheduled for a cesarean section at 7:30. The slow heart rate was a sign that the baby might not be getting enough oxygen-supplying blood via the placenta. We repositioned the patient and gave her oxygen, but there was no improvement in the baby's heart rate.

6:45 am- I'm scrubbing in at the OR

6:50 am- The first incision was being made.

6:54 am- The baby is out, and "just fine".

Although I've scrubbed more c-sections than I can recall, this was only my second "crash" c-section. My responsibilities are minimal as a resident in the OR, so I can just stand there, hand things back and forth, suction up blood/fluid, cut sutures, and help with the closing. I really like scrubbing in because you get to see a lot, without being the one under pressure.

This surgery was interesting to me because unlike all of the other ones, they did a vertical incision on the skin, but did the regular, low-transverse incision on the uterus. It's always fascinating to me to see the variance in practices of different doctors. This particular obstetrician believes he can get the baby out faster using a vertical incision.

Even more interesting, was that during the case, the scrub tech asked the doctor where a particular pair of forceps was. He had dropped one pair on the floor in all of the rush, and was using a second pair. However, the third forceps was nowhere to be found. Nowhere. Much cursing ensued. It is part of the tech's job to count the equipment before, during, and after each case. As there was no time beforehand, the pre-packaged kit was opened and used without counting. A similar problem had happened last week when the same forceps was missing from the kit.

He couldn't be sure that the forceps had not been included in the kit. All we knew was that we didn't have it. It could have never been included, or it could be lodged somewhere in the bedding, the patient's abdomen, or her newly sewn-up uterus. Bad times. Much more cursing ensued. Threats to file a formal complaint against the packaging service were voiced.

Then, I said very quietly, "I guess we need an x-ray."

"X-ray!" he bellowed. "I want x-ray in here now!"

While we waited for the x-ray to show up on the computer in the OR, he performed the tubal ligation, and we started closing. The x-ray confirmed our suspicion. There were no forceps in the patient; they simply had not been in the kit.

The rest of the day was uneventful. Today I'm back for a 24-hour shift. I'm kind of lounging right now. My work is done. I'm just waiting for the next mess to begin. None of the other residents wanted to scrub the case yesterday. It was the best part of my day. I guess I am an adrenaline junkie. Today, mama and baby are still looking great.


Chris said...

You did an excellent job getting your reader to empathize with your subject, the baby, in the set up. You should have been a writer, Kate.

That seems to be a recurring theme with you, empathy. Not a bad trait to have, huh?

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ru said...

I knew I could count on your common sense to save the day:)

I like the way you told the story from an infant's perspective. You had me going for a while, trying to figure out what was going on.