Twenty-one years ago, I saved a life. Yes, I have helped many women over the years, perhaps changed their life in some way, but this one time … this one time, there is no doubt in my mind, I saved this baby’s life. Now, 21 years later, this “baby,” a junior in college interested in marketing sits before me on an exam table, asking me ordinary questions about her birth control pill. Little does she know of the extraordinary moment she came into the world, a moment I’m reminded of whenever I see her. But today, as we chat about school, her boyfriend, her busy spring break, I am struck by my memory and how things could have been so different if I didn’t trust my intuition. I am also reminded of who I was then and how medicine has changed. Twenty-one years ago, I was in a thriving OB/GYN practice. I was the first woman in an all-male group, and it was easy to build my practice quickly. Fresh out of residency, I was eager to be busy and enjoyed my work. Twenty-one years ago, I was confident and assured and had a strong network of support in the office and at the hospital. These people knew me well and worked with me often. Twenty-one years ago, pregnancy and delivering babies made sense to me; it was intuitive and visceral. Along with all my knowledge accumulated over four years of medical school and four years of residency in OB/GYN, I also developed a “feel” for when things were right or not. Twenty-one years ago, I trusted my gut instincts. Twenty-one years ago, I will never forget the phone call to my partner. I was at the office, and he was at the hospital. “I’m sending in a patient who needs to be delivered immediately; the baby does not look good.” This story begins nearly 22 years ago when a bright young woman came into my office, pregnant for the first time. She was excited in her laid-back way. “Cool,” she said nonchalantly when I showed her the baby on her first ultrasound. She was healthy and knowledgeable and most of her visits she had no questions or pregnancy issues. So we would just chat about life and the changes this baby would bring to her world. As her baby grew inside her, she maintained such grace and ease. The only issue she had was that her blood type was A negative. Because of the negative part of her blood type, or RH negative, she received RhoGAM at the beginning of her third trimester to avoid forming antibodies to her baby if her baby was RH positive (something we wouldn’t know until the time of delivery). But, on that day 21 years ago, something seemed different to her. She sensed her baby wasn’t moving like usual and came to the office. I put a fetal heart rate monitor on her belly to perform a nonstress test and watched for 30 minutes. On first blush, the baby’s heart rate looked “OK” — the baby’s heart rate showed some accelerations which is reassuring, but instead of a luminous mountain of an increased heart rate, it was more of a small hill. And, in between, the usual jagged up and down of normal heart rate variability was not there — instead, there were long, flat sand dune-like undulations. “Maybe this baby is in a sleep cycle,” I thought to myself. But something nagged at me to look more. So, I decided to take the time to look at the baby with the ultrasound. In its warm bath of amniotic fluid, the baby just laid there. For 30 minutes I watched, and that baby barely moved. This languid baby sent a chill down my spine. “Your baby may just be napping at the moment,” I told my patient calmly. But I just knew something was wrong — I had a sense this motionless baby was in trouble. “But you need to go to the hospital now,” I added. On arrival to the hospital, my patient was quickly brought into triage. Within minutes, it was obvious the baby’s heart rate was now showing clear signs of distress. My partner told the patient she needed to have an emergency cesarean section. Seeing the seriousness in his eyes, she nodded in agreement — my sober tone earlier had already alerted her to this possibility. She was quickly readied for the C-section and brought back to the OR. After she received her spinal, my partner began, hurriedly opening each layer until he saw the uterus. When he entered the uterus, he was surprised to find the amniotic fluid not clear but bloody. He quickly delivered the baby that was limp and floppy. The baby was handed to the neonatologist in the room and resuscitated. The baby ultimately needed a blood transfusion before she finally stabilized. The remainder of the C-section went smoothly, but the danger for my patient was not over. The blood in the amniotic fluid indicated there had been a large bleed between her and her baby — nearly costing the baby her life. It also meant my patient was exposed to a large amount of her daughter’s blood — she would need extra RhoGAM so as not to form antibodies. Unfortunately, there would never be enough RhoGAM to counter such a huge bleed. With her next pregnancy a couple years later, her blood work showed she was forming antibodies to this new baby as if it was a hazardous foreign body to her. Sadly, even with close surveillance, her baby died in utero. Over the years, she had several failed pregnancies due to this blood issue, but ultimately, through the aid of a specialist, she was finally able to carry one more healthy pregnancy. Twenty-one years later, I look at this young, vital woman and wonder if the same outcome would have happened today. Medicine has changed immensely over her lifetime. More specifically, the time I am able to spend with each patient has diminished. Most days, I feel rushed as I fit in as many patients as possible within my office hours. And equally as rushed are patients squeezing in their doctor appointments during their lunch break or before picking their children from school. Fortunately, many things I do each day are fairly routine for me, and I can efficiently care for my patients. But sometimes, I need extra time to research a medication I’m unfamiliar with, consult a partner for a rash I’ve never seen or talk to a family member about their elderly mother. And sometimes, I need to sit and watch a baby on an ultrasound I’m concerned about. So here I sit, 21 years later, with my young patient and wonder if I would have taken the time needed to sit and watch her as I did, and recognize the dire situation she was in. In my heart of hearts, I can’t imagine not. But it is scary that I even wonder. Andrea Eisenberg is a obstetrician-gynecologist who blogs at Secret Life of an OB/GYN. Source
