Drive-by

This past week, I was on call in the middle of the week. I delivered three babies, which seems like not that many for a 15 hour shift, so why was I so busy? Because despite my best efforts, everybody ended up with more help than I like to give. So I ended up doing a cesarean section for a really unpleasant looking fetal heart tracing as I came on the floor, a vacuum-assisted vaginal delivery in the wee hours of the morn, and then a cesarean section for fever and lack of labor progress right when I was supposed to go home.

And then I remembered another day that was the opposite of that. It went like this.


"Lots of drive-bys tonight", said the nurse.

"What's a drive-by?", I said. "I mean, on the labor floor."

"Oh, you know," she said. "It's a patient who just comes in, and... delivers. No anesthesia, no labs, no nothing. Just: blam."

"That's the best kind of delivery." I say. "I mean, assuming everything is healthy and term."

"That's a big assumption around here." she says, and we both laugh a little, because it's true.
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I came out of the operating room at around 2 am, looking for a resident. "Listen, I need a pathology form for Patient X..." He's halfway down the hall as I am talking to him, and I trail off.
.
"Um, yeah. We have something. It's Dr.Other's turn for a walk-in patient, so this new patient doesn't belong to you, but it sounds urgent. They're coming right out of triage."

I see the intern walking/running down the hall.
What's up? I say.
Um, I don't know? She's fully dilated and no records, just came in by ambulance.
Gestational age?
She...isn't sure. She says she only had two or three visits, but they told her she was four or five months, and that was two weeks ago.
Goddamn it. Is she vertex*?
Yes. Vertex. I checked by ultrasound.
Is she viable? What was the fundal height? Was it above the maternal umbilicus?
I don't know...I think so.
Is there a fetal heart rate?
Yes, I think so. I mean, yes. There was in triage

Peds. Get peds NOW. Tell them unknown gestational age, precipitous delivery, no steroids, no antibiotics, STAT. I need the fellow and the PA, not just the resident.

I walk into Labor Room 6, pulling on gloves as I do. It's not my patient, but I'm here until Dr. Other gets downstairs. The room is chaos; the patient has her legs up and is arching her back. It looks like she's crowning. The fetal heart is on the monitor, in starts and stops, but is over 100 beats per minutes. The heart rate falls as she starts to contract. I go up to her,and her eyes are wild, scared. I give her my hand. I tell her we will take care of everything, she just needs to push.

Dr.Other comes into the room; I leave the patient to brief her. I'm fine, she says. Go settle your patient from the OR.

I step out, passing the pediatric team as they run into the room. They are setting up a warmer, and respiratory equipment, and getting ready to intubate. They lay out 5 different tubes, since we don't know what size this baby will be.

I'm sorry, I say to them. She just rolled in. We didn't have much of a chance to...
We know, they say. We'll deal.
You always do, I say. We'll all deal.

I go out. I start to fill out my paperwork. I feel nauseous. What is she? 24 weeks? 26 weeks? Will this kid even have a shot? There is so much we could have done if she hadn't been a drive-by.

There's a big rush in that room; it's only been about 60 seconds since I left,so I stick my head past the curtain in Room 6. Dr. Other smiles at me. Baby's out, she says. 2700 grams**. We're gonna be ok.

I feel like I might cry, or shout, or hit something from relief, or is it anger? I duck out of the room fast; I sit at the nursing station pretending to fill out my pathology form. I look down, and realize I'm still wearing delivery gloves.

*Vertex = slang for baby-is-head-down. We should really say cephalic.
**Almost 6 pounds of baby goodness