Life Saved?
Serena Phillips
Word Count 1127
While taking a nap in the call room, my beeper sounded. STAT. TO THE EMERGENCY ROOM FOR A NEWBORN. I snapped awake, pulled on my shoes, clipped the beeper to the waist of my scrub pants and grabbed my white coat, its pockets holding lip gloss, a stethoscope and The Harriet Lane Handbook: A Manual for Pediatric House Officers.
I headed for the stairs, faster than waiting for the elevator. Adrenaline swam through my body, driving away the last vestiges of sleep.
In a few months, when my three years of pediatric training ended, I would become a legitimate doctor, capable of caring for babies and children without supervision, but being called to an emergency still evoked the same dry mouth and stomach roiling it did when I was a medical student. Perhaps more since, as the most experienced pediatrician in the hospital that night, I was in charge.
Fluorescent lights illuminated both mother and infant, separated now for the first time in nine months. The mother, her legs in stirrups covered by a paper drape, likely wondeed why her infant wasn’t crying and hadn’t been placed in her arms. Baby G, gray-blue and limp, lay on a high bed across the room beneath an overhead warmer, normal size and fully formed. I joined the green garbed hospital personnel around his bed.
With a heated towel, I dried and stimulated him, suctioned his mouth and nose to remove birth fluids while the nurse palpated his groin for a heartbeat. “Breathe baby, wake up and live.” He didn’t gasp or move.
My heart accelerated and sweat pooled beneath my breasts. His heart, no bigger than a walnut, beat so slowly it couldn’t pump blood to brain, lungs, or kidneys.
The team knew what followed. They’d done it often, the steps imprinted on their brains. Hands moved to check instrument labels, rip sterile packaging, connect equipment pieces as we attempted to save this infant failing to live in front of our eyes.
The nurse handed me a laryngoscope along with a plastic breathing tube, its outside diameter the size of Baby G’s smallest finger. Slipping the lighted metal blade into his mouth, I positioned it at the back of the throat then snaked the breathing tube over it, past the vocal cords, and down, stopping above where the trachea divides, one part traveling to each lung.
After connecting the tube to the Ambu bag, the respiratory technician (RT) rhythmically compressed it to force oxygen into Baby G’s lungs. His heart rate didn’t increase; he remained gray and limp, unmoving.
With my right second and third fingers, I depressed and released the infant’s breastbone, firm enough to circulate blood, but avoid breaking ribs. After each of my five compressions, the RT pumped two breaths into Baby G’s lungs. And we started again, a dancers’ pas de deux. Breathe, compress, breathe, compress.
Several hours before Baby G’s birth, his mother had arrived at the old downtown hospital, experiencing contractions. As a result of land donation and politics, thirteen years ago a new hospital was built on the city’s northwest side, adjacent to the medical school far from the patients who rely on its services. A month before, the last departments—labor and delivery, newborn nursery and neonatal intensive care moved to the new hospital, leaving only emergency services downtown.
After evaluating the mother, the second-year obstetric resident on call at the emergency room downtown hadn’t realized how far her labor had progressed. He decided to transfer her ten miles north to deliver. Picture the ambulance siren screaming down the expressway while inside, the mother also screaming, tries to push her unborn child down the birth canal. The doctor, who didn't want to deliver the baby in the ambulance, held him inside the mother's body, depriving him of oxygen for twenty minutes or more.
Most infants who experience breathing problems after birth require suctioning, stimulation, warming, and perhaps oxygen. In worse cases, they may need a machine to breathe for hours or days. Only a few require heart stimulating drugs.
Despite oxygen being pumped directly into his lungs, Baby G’s heart wasn't beating sufficiently to pump blood to his vital organs. I ordered adrenaline to speed up his heart and strengthen its contractions.
From a catheter inserted into a belly button vein, the nurse withdrew blood, sent it to the lab. She gave me the results--oxygen level low, carbon dioxide high, acid level a magnitude of abnormal I’d never encountered. The numbers predicted death or brain damage. As the senior pediatrician, the responsibility to save this baby’s life and brain was entirely mine. I questioned whether I could save both.
Physicians are trained to preserve life, despite the cost. I cared for premature infants born with birth defects, who spent hundreds of days hospitalized, endured surgeries, infections, treatments, separated from their mother’s arms, only to be left with an array of physical and mental challenges. Baby G might experience similar problems.
But I couldn’t order the team to stop breathing for him, pumping his heart, or administering drugs. Five minutes had passed since we began with little response. Each additional minute increased the possibility of complications, but I couldn’t stop trying to preserve life.
To neutralize the acid and improve blood flow to Baby G’s brain, I ordered sodium bicarbonate through the belly button vein, another dose of adrenaline, and a second bicarbonate dose. At last, his heart rate accelerated to normal, and the gray pallor receded, replaced by normal newborn ruddiness beneath olive skin tone. A second blood test confirmed improvement.
After adjusting settings on the machine that would breathe for Baby G until he could breathe on his own, I wrote orders for medications, fluids and morning labs. I donned my white coat, a shield against failure, and set off for his mother’s room to tell her the truth–Baby G didn't receive enough oxygen before birth and would need a breathing machine for a time. How long I didn’t know. In the morning, the regular neonatal intensive care team would assume his care. What I didn’t say was, Baby G might never run or play with his friends, speak, or care for himself.
One day, more than a year after I opened my pediatric practice, I received the court summons. Entering a third-floor courtroom, along with the judge, J.G., the plaintiff sat with his parents and attorney. On the other side, sat the defendants, a hospital representative, the OB resident, now in his fourth year, and me, along with our respective attorneys.
He was two years old, in his wheelchair, head torqued to one side, arm movements jerky, purposeless, legs restrained to footrests. Sorry, sorry, sorry. I confess, it was me who saved your life. My success became your failure.
Serena is a retired pediatrician. With her husband and dachshund, she splits time between Texas and Maine. Her Substack newsletter, Family Threads explores what binds families together and drives them apart. She is currently working on a memoir about family estrangement.