Work

A pitocin induction. Nothing out of the ordinary -- we do lots of those. Day or night, it doesn't really matter. Get scheduled. Come in. Have baby.

Simple enough, right?

Super Bowl Sunday. Which I didn't actually realize until someone emailed me at 4 pm and told me to bring snacks to work, but no matter. Just another night I work. Working nights isn't perfect, but I have a job I like with people I love, so I can't complain. Go to work. Pit induction, third baby. Simple enough.

Report from the day shift. Some ultrasound abnormalities, but nothing really concrete. NICU will come for the delivery, they're not too worried. But my poor patient? Is terrified. The terrible mystery of the unknown...no one can tell her what will happen after the baby arrives. That's the problem with life in the womb -- you don't really have to do too much on your own -- that fancy placenta does most of the work for you.

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Labor the patient. Increase the pitocin. Break water. Place epidural. Push. Decide it's time to head to the OR instead. Have a baby, one way or another. It's very exciting for families -- and it's lovely to be a part of -- but it becomes a little different when it's your job. It's always special, and it's often routine. Deliver a baby, cut the cord, hand the new person over to parents who have been waiting a long time for that moment. And really, do you have any idea how cool new people are?

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It's the middle of the night, the patient is asleep after an epidural and I'm doing paperwork. You have no idea how much paperwork is part of having a baby. I'm watching the monitors at the desk while I do my work, and I can tell that it's time. Wake up the patient, prepare the room, call in the troops...it's time to have a baby.

Three quick pushes and there she is. A tiny little mew of a cry as she pops out. Clamp the cord, hand the dad some scissors. A little snip. And then that fancy placenta isn't doing the work anymore.

Which, in this case, turns out to be a problem. Everyone who wasn't too worried before delivery is now VERY concerned. The patient is sobbing. The family is standing there, not sure what to do, watching the scene before them unfold like something in a foreign movie. They didn't sign up for any of this.

The baby heads to the NICU after a significant amount of effort. Explain to the parents that they are going to stabilize the baby for transfer to another hospital -- which was something that had been discussed before delivery. I go down to check on things and give the parents an update...and the closer look doesn't reveal good things. The specialists that have come in at 2 AM will be out to speak with the parents prior to transfer in a few minutes.

After an hour I go back to the NICU to see what's taking so long. They can't come right now - they're arranging for the helicopter to come for the baby.

While it is not unusual for a baby to be transferred, it is VERY unusual for them to need a helicopter transfer. The hospital that we are sending the baby to is only 15 minutes away, at a normal pace, with traffic. Go in an ambulance and it's a little faster. But still too long. In all of my years, I've only sent one other baby by helicopter.

I return and explain to the parents that the baby is going to need to be transferred a little more rapidly than originally thought, and that I'm going to take them down to see the baby before transfer. There aren't really words to prepare anyone for that -- they haven't seen the baby since delivery, and she is now covered in more wires and tubes than most people can imagine -- all on a 6 lb 14 oz body. She looks chubbier than that, so we wonder if she is short...but it's hard to say.

She isn't stable enough for anyone to stretch her out and measure her length.

I take the parents in. They get to hold the baby for a few minutes before they load her up for transfer. We hate to force people before they are ready, but the mom can't be discharged yet and so she can't go to the new hospital with the baby. And she should hold the baby before they go. We take as many pictures as we can. There are lots of tubes and wires, but she looks just like her dad.

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The baby is loaded up and off for a quick flight -- only four minutes by helicopter, it turns out, from our hospital to the next.

I take the patient to her new room, wish her good luck and tell her to let me know what happens, and that I'll be thinking of her and her new little girl. Although it's hard to look at her, because I've now gotten a good look at the baby. I know the way this story will end.

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When people find out that someone works in labor and delivery, the reaction is almost always the same. "You get to hold babies all night!" And that is always followed by "what a fun job -- you work at the only happy place in the hospital". And both of those statements have some truth to them -- I do spend many nights holding a baby while I do my charting, and I do work at a place that is filled with thrilling, happy moments.

But my response is always the same. When it's good, it is so very, very good. But when it's bad, it's a very, very tough place to be.

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This week is National Congenital Heart Defects Week. An estimated 40,000 babies with CHD are born in the United States each year. An estimated 1.8 million families are affected.