TTA level 1, 3 minutes. the overhead goes off. It is half way through a busy swing shift in the ED. I run over to the trauma bay. The MICN gives report. It’s a traumatic full arrest. Auto vs pedestrian. Significant facial trauma. I mentally prepare myself as I make sure my airway equipment is ready. And then the patient is here, CPR in progress. She looks in her early 30s, blood is streaming from her significant facial trauma. She has no pulse, GCS 1-1-1. I insert in the glideascope, see a bloody oropharynx, but get a chance view of the cords and stick the tube in. Now that airway is secure, I start the rest of my secondary survey. Her pupils are fixed and dilated. A quick cardiac ultrasound by the medical student on the heart shows no cardiac activity. This doesn't look good. The trauma surgery attending asks if anyone has any objections to calling it. We all know further resuscitation would be futile. We stop compressions and stop bagging, and I call it. Time of death, 9:51 PM.
And then my attending notes, does her belly look distended? The trauma attending feels the belly, feels a mass. Is it a fibroid? The medical student still has an ultrasound probe in his hand, and he places it on her suprapubic region. In the uterus is a fetus, with fetal cardiac activity. Bradycardic.
We all spring into action. Restart compressions. Restart bagging. The uterus is at the level of the umbilicus, the fetus must be 23-24 weeks. The trauma attending has a scalpel in his hand, makes a swift cut and within a minute, in the blink of an eye, there is a baby in his hands.
One of the other residents has run over to get the peds ED team. The panda warmer is half way there, still in the hallway. The peds attending grabs the baby and runs with it to the warmer. I run over with them. The baby is blue. We don’t feel a pulse. Asystole on the monitor. We start CPR on the baby. I grab the laryngoscope. I’m not sure if what I am seeing is even cords, stick the tube in, praying that it’s in the right place. There is yellow color change on the colorimetric entitled CO2 monitor. My co-resident is placing an umbilical line. We give epi again and again. We even give surfactant. We code the baby for 20 minutes. And then, by some miracle, we feel a pulse. The NICU team is here at this point, we hand the baby over.
And then it is done. I take a breath. Feels like the first one I’ve taken since this all started.
It’s done. But it’s not. The social worker calls me. She’s found family. She needs me to talk to them
I take another breath. Brace myself. This is the worst part; always the hardest part. The NICU hospitalist comes down. They have withdrawn care on the baby upstairs; it had been hypoxic too long, neurologically devastated with no chance of recovery. So now I will have to inform the family of two deaths. I’ve lost 2 patients. We read about perimortem c-sections as one of those hail mary procedures we prepare for but that most ED physicians never see. You can prepare but you’ll never be prepared for this.
I walk into the family room. There is a partner, the baby’s father. And a mother, a sister, and the 15 year old daughter. The 15 year old daughter is already sitting in the corner wailing. I introduce myself. I have some bad news, I tell them. They all break down. Their screams will haunt my dreams. I’m holding back tears. I must be professional, I must be strong. The patient had 5 other children who are now orphans. The 15 year old daughter shows me a photo of her with her mother. “That is my mom” “what will we do now”. I am so sorry. I don't know what else to say. What else to do. Then my phone rings, it is the nurse. My other patient is vomiting. I walk out. There is still half the shift to go.
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