Birth and Death in Ten Minutes: A Miracle in Room 11 (1/4) By Ruth

(1/4), (2/4), (3/4), (4/4).

14:50 The phone rang on the nightstand, and I sighed while grabbing it. 'Hello.' 'Doctor, they have an emergency in Room 11.' 'Ok, I'm coming.' I put the phone down and exited the oppressive call room, where as the scheduled 'doc-in-the-box' on duty, I was busy frittering away 24 hours of my life. My 11-year-old-son had state exams the next day, and I hoped my 17-year-old daughter would make sure he studied. I knew they would probably watch TV and eat microwave food on the sofa instead.

The role of the 'doc-in-the-box' is to provide attending coverage for the Residents in Labor and Delivery. In 1992, the Residency Review Board (a national organization which sets standards for residency training) mandated 'in-house' coverage. I know they were correct in this decision, but they didn't have to sit in a cell for 24 hours either.

I jogged the short distance to Room 11; assuming that the private patient was delivering while her doctor was unavailable. The other duty of the 'doc-in-the-box' is to cover for the private patients when their doctors aren't immediately available. I didn't know too much about this patient, other than it was her third baby, and she was being induced for some reason. There are 14 Labor Rooms on our unit. I have some that I like better than others, and one I just hate. It's not the size or outfitting of the room, they're all pretty similar. It's not about any numerological theory, although I find all of that interesting. It's about my previous experiences in the various rooms.

For example, Room 8 is small, but I have missed more deliveries while jogging in that direction than any of the other rooms. (Several of the nurses insist the ghost of a baby haunts Room 8). Room 2 is evil, and I try to have my patients placed anywhere else. I had this very difficult delivery in Room 2 many years ago. The mom and baby were ok, but Room 2 still pisses me off. Room 14 is the 'high drama' room, and patients seem to do an amount of screaming that actually exceeds the necessity of the situation.

I burst into Room 11 about 20 seconds after I was called, and saw the large uncovered back of a pregnant woman facing me. Two female residents were standing by this woman's head, their expressions frantic. The patient's buttocks had a lacy pattern of purple mottling where blood was not currently arriving. The thought, 'Holy fuck!! Why is this patient dying?' fired off my neurons about 1 millionth of a nanosecond before the diagnosis popped up: amniotic fluid embolism. This rare diagnosis complicates a very small number of labors, but carries a very high mortality rate. The exact cause is not completely clear, but the clinical pattern of labor inductions and multiparous patients seem to increase the risk.

The two residents looked imploringly at me as I jogged around the bed. 'Doctor, we can't get an airway!' The patient's face was deep red drifting into purple. Her jaw was clenched firmly shut. I began issuing multiple orders and questions simultaneously to the nurse.

Continued .... Next Page (2/4)

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