Friday, October 10, 2008

In the Middle of the Night

It's time for my husband's annual "man weekend" with his high school buddies. For almost a decade, he and his friends find a cabin in the woods somewhere and behave (I am assuming from the pictures) as 10 year olds...that drink. Junk food, video games, and staying up way too late are part and parcel of the festivities. They look forward to it every year, and I'm happy to have him go. (The wives have a "girl weekend" in the spring, just to be fair.) So when I found out that he would be out of town for a weeknight (when I am on call for my patients), I thought to my naive little self, what's the worst that could happen? Ha. Ha. HA!

So I went about my regular single parenting duties in the evening relatively unscathed. Picked up the kids, got dinner on the table while Bean protested loudly that it wasn't fast enough for him, wrestled two squirmy kids through bathtime, and got everyone tucked in by a reasonable time. Then I prayed really hard that I could make it through the next 12 hours without having to leave the house. The peace lasted roughly 3 hours. The first warning bell came as a page from triage. A 38 weeker, possible early labor, contractions 20 minutes apart. The triage nurse said she was pretty sure the patient was "not doing anything" but we decided to observe her and let her walk for an hour. My second warning came at 1 am. The patient had indeed changed her cervix from 1 to 3 cm. A definite keeper. "Ok," I pleaded with the nurse, "PLEASE keep her comfy and pregnant for the next 5 hours so I don't have to pack my kids up in the middle of the night to come to the hospital." The nurse was fairly confident that the patient was not contracting regularly, and could probably coast until morning. I settled into an uneasy rest...until 2:30 am. I returned the page, thinking that I was going to have to drag in to cover for the patient's epidural. Imagine my surprise and dismay when the nurse answered the phone with "She's 9!"

Shit. Shit. Shit. It was off to the races...throwing on scrubs, rousting the kids up in their PJs, and flying down the highway in the middle of the night. "At least it will be fast," I chanted to myself as I sped to the hospital. I deposited the kids with one of the nurses and stepped into the delivery room just before 3 am. The patient was completely dilated and ready to push. She hadn't even had a chance to get *any* pain medicine, epidural or otherwise, due to how quickly she had progressed. So, the patient started to push, and *then* all hell broke loose. The first push sent the fetal heart tones down to the 30s. Ummm, surely that wasn't right! I placed a scalp lead to get an accurate tracing...still in the 40s-50s. Scalp stim...up to the 60s. Oxygen, reposition, knee chest. Nothing would bring the rate back up. The baby was at zero station. Too far up for vacuum or forceps. We tried a few pushes, but the head wasn't descending fast enough and the heart beat was a slow tick, tick, tick of a baby running out of time. After a quick verbal consent, we called the OR to let them know we were coming down for a crash section. "We aren't ready!" they said. They had another case going and needed to call in a team. "No time for that," I said, "This baby needs to come out now."

We ran the patient to the OR. The staff assembled a rag-tag team of recovery room nurses, opened the crash section cart, and haphazardly prepped. There was no time for a foley or to count instruments. Every second felt like an hour, though only 5 minutes had passed from calling the section to draping the patient. The patient went to sleep, and we got the baby out in less than a minute from the skin incision. She looked like a *million bucks*! She squalled as soon as she left the womb. She was pink! and happy! and had Apgars of 8 and 9! and didn't look at all like her strip suggested. I had truly feared the worst, the last terminal decel that I had seen like that, the baby had anoxic seizures after delivery. Luckily, this baby was great. The collective sigh of relief was audible in the room as I placed her on the warmer. The rest of the surgery proceeded smoothly, and I was happy to let the family know how well she had done.

As for the kids? I ran back up to labor and delivery to find them happily snacking on graham crackers and juice. CindyLou was entertaining the whole floor, and she kept saying how she wanted to be a doctor "just like mommy." (Oy.) We got them gathered together, I thanked the nurses profusely, and drove back home. "I like to go to your work, Mommy" Cindy Lou chirped, "It's still *night time*!" Once at home, the kids went back to bed without a fuss, and I crashed into the best 2 hours of sleep of my life.

The moral of the story? I survived! It could have been the worst case scenario, but we all made it. The kids did fine, the patient did fine, the baby did fine. It could have been a disaster, but it wasn't. I am ever so grateful for that, and never have I been so convinced that I *never* want that to happen again! Scary things do happen in the middle of the night, and sometimes the outcomes are not as good. I'm thankful for the nurses and OR staff that did what they could to make the surgery happen quickly enough. I'm grateful for the compassion the nurses showed to me and my children by caring for them when I had to care for someone else. Most of all, I am so thankful that my kids were able to take it all in stride and go with the flow. They are pretty amazing. I hope you all have a wonderful weekend, and are not bothered by scary things in the middle of the night.


Anonymous said...

Did you figure out what was up causing the decels? Scary! Glad you could get the surgery done quickly! Hope mom doesn't regret a section as this was a true need in this case, it seems like.

Sorry you had an interrupted night!


Anonymous said...

OMG you are hubby would never do this with our kids...but that's why we ARE WOMEN! Ha!

Dragonfly said...

Hope the rest of your weekend goes much more smoothly....

Ciarin said...

You should know it was inevitable. As in, it's inevitable that when you don't feel well it will be the busiest call ever. It's inevitable that you had trouble falling asleep only to have the pager go off 15 minutes after you finally do. It's inevitable that the patient you rush to the hospital for because she is 9cms, will then still be pregnant 3 hours later.

But I am glad it all worked out ok.

Anonymous said...

As an OB nurse who has worked in L&D I have enjoyed reading your blog. You seem like an intelligent, compassionate physician. What I can’t understand is how you could think it appropriate to leave your children in the care of the nurses while you took care of your patient. This was not an instance of unexpected plans, you knew your husband would be away during your weekend of being on call and still made no contingency plans. When I am on call I make sure to have arrangements in place to take care of my children. It is the responsible thing to do. The nurses have their own jobs to do and are not there to babysit your children.

Anonymous said...

Glad all turned out well, but seriously: this is why I used to pay our babysitter to stay at our house the on-call nights my husband was out of town when the doc-lings were little. It didn't cost much and the value in peace of mind was HUGE.

Anonymous said...


Think what your kids will have to say in "show & tell".

lulliloo said...

Holy cow woman! You are amazing! And so are your kids. We decided to live close to family to avoid that situation. In fact we bought an overpriced house across the street from us for my in laws. All my deliveries seem to be between 6pm and 6am and I am grateful not to have to pluck my 1 and 3 yr old kids out of bed each time.

ER's Mom said...

Yeah, my kids love going to L&D. They know EXACTLY where the food stuff is hiding!

3carnations said...

Wow. I'm glad it all worked out. Next year maybe a rule that guys weekend can't be on a weekend that you're on call? :)

Anonymous said...

Note to self..."never complain again when the puppy wakes you up in the middle of the night to pee, it could be a heck of a lot worse" lol Seriously, I'm glad it all turned out okay! :o)

Just me said...

What is there to say other than, "You Go Girl!"

Tempeh said...

Wow, in the space of 6 paragraphs, you made me intensely happy that (1) I am NOT an obstetrician and (2) I have completed childbearing...well, maybe...or at least most of it. Yikes! Glad it all ended well, though. We (mothers, doctors, mother-doctors, all) are stronger than we think.

Anonymous said...

Been there, done that - had to sign off of a PA's patient admitted for gastroenteritis one weekend as a "favor" for a fellow pediatrician. Parked my kids in the doctor's lounge with free reign of the TV and snacks while I went to check in on the little guy. Husband was at boy's weekend - I was trying to be adventurous mom and take kids to the zoo. Caught the GI bug (probably from patient) - stayed up all night puking and had to renig on my kid's outing. My kids took care of me that weekend - they were absolute angels! Won't go loading my plate that full on a boy's weekend in the future!
Happy all of your babies did well during your weekend!

Anonymous said...

AArrggh. My current biggest nightmare is similar. I am pregnant w/ twins and husband is an ICU Doc w/ frequent call. We moved away from family recently and my recurring nightmare/fear is that I will go into labor some night that he's on call. I can't even imagine trying to deal w/ laboring and such with my other 2 kids in the room.

Curdie said...

Whoa, that is a full night. What great nurses to watch your kids for you. And what great kids you have to go with the flow.

I'm really happy the baby was fine, too.

Lisa said...

Wow! That sounds like an exciting night.

Anonymous said...

Great story! Glad it came out like it did; I was holding my breath for a minute.


Anonymous said...

As someone who had a full term stillbirth, I am amazed that your "most of all" grateful is not that the baby was alive and well. Surely if you are on call, you don't have time to pack up your kids before getting to the hospital? It seems to me like the baby and her mother were very very lucky.

dr. whoo? said...

Hi Dawn~

No, there was no obvious reason found for the terminal deceleration. No cord, no abruption...nothing! Luckily, kiddo did great, so that was the best outcome one could hope for.

noble pig~ Ha! Is right. I wouldn't have done it, if I had the choice. I just didn't.

dragonfly~ Thankfully, I was not on call for the whole weekend Mr. Whoo was away. Just that one (fateful) Thursday night. Thank goodness!!

ciarin~ You are right, I should have known, if it *can* happen, it *will* happen. Such is the nature of the profession. I'm glad it worked out, too

Milly~ Thank you for the compliments, and for the reprimand. You are right, I should have contigency plans. Alas (and, reading back through my blog I see I failed to mention) my backup emergency babysitter had been admitted to the hospital for cellulitis that very afternoon, leaving me little notice or ability to make other childcare arrangements. I wasn't on call for the whole weekend, just that one weeknight. I thought I could wing it, and I got burned.

As for the nurses, I certainly didn't expect them to neglect their duties to babysit my children. Several actually volunteered to watch the kids when I called back about the laboring patient. They knew I was flying solo.

Mine was the only laboring patient that night, and there wasn't a lot going on on the floor. If I'm to be specific, it was the LPNs that watched over the kids, not the RNs, but all of them were playing with them. Fortunately for me, it was done without a second thought or hint of resentment.

anon 10/12~ I know. I now have a second back up babysitter available, should the situation arise again.

liz ditz~ Ugh, I know! My daughter absolutely loved it all. She said she wanted to be a doctor like mommy after this little middle of the night jaunt. She thought it was a blast.

lulliloo~ This is the reason we are moving closer to family, so as to never have to do this ever again!

er's mom~ Oh yes, much food and snack consumption to be had at the hospital!

3 carnations~ I wasn't on call for the weekend, but unfortunately guy's weekend has started leaking over to the weekdays prior, as well. Next year, we'll be living near family, and I'll be sure not to be on call that weekday or weekend.

momof5~ Ha! Yes, it could always be worse.

a and z's mom~ Thanks. It is an experience I hope never to repeat. :)

tempeh~ Ha ha! Rub it in, why don't you? You are right, we are stronger than we realize.

mwas~ What a story! :) Glad to know that I'm not the only one out there. The rest of the weekend was restful by comparison.

the mommy doctor~ Oh, honey, that *is* a nightmare waiting to happen. I'm sending good labor vibes for you! At least he would be in the same hospital with you, right?

curdiemer~ It was *great* that the baby was ok. That was the best thing that came out of that night.

lisa~ More excitement than I wanted, certainly.

Christina~ I was holding my breath, too! Hindsight makes it a much better story than when I was living it out, for sure!

anon 10/24~ First of all, I am so very sorry to hear about your loss. No loss is easy, but I couldn't even begin to comprehend the pain of a term stillbirth. That being said, *of course* I was thrilled beyond belief that the baby came out ok, sorry if that didn't translate properly. If it isn't obvious, my job to keep baby and mother safe is first priority, even over my own family, many, many times. I have a feeling that your personal experiences may have just heightened your sensitivity to my wording.

As for "packing up my kids" before getting to the hospital? Not much to it. Pick kids up out of bed, put socks and shoes on 4 year old, get in the car. Probably added about 3-5 minutes of extra prep time, and I live within 20 minutes of the hospital. I agree that mom and baby were lucky. It could always be worse.

Lara said...

I am in complete awe of you, my friend. You're incredible. In a good way.

Prisca: said...

WOW! You are amazing!!!!!!!

Anonymous said...

This is an amazing post! I'm currently a 4th year med student applying for Ob/Gyn residency. I hope that I'll be able to handle a situation such this, the way you did once I'm done with training.