During intern orientation a few months ago, they promised we would never be alone in the hospital. And they were right. Until they weren’t. It’s hard to see colors in the dark — that’s why he looks blue. That’s strange; it almost seems like his chest is not moving. I must be overreacting. Everything is fine. My right hand began flicking his foot. Yell for help. This baby is a healthy newborn. Call a code. Interns are never alone. Yell. Code. Mask. Healthy newborns don’t turn blue. Scream. Bag. Pulse. Feel. Flick. Stop. There is no time to be afraid. Flick. At 1:47 p.m., I left the pediatric resident newborn nursery workroom. At 1:49 p.m., I offered congratulations to brand-new parents when the baby’s dad interrupted. He wanted to know if the baby should be crying. I moved closer to where mom was holding the baby against her chest and smiled at the sleeping baby. I moved closer still and an icy chill brushed the back of my neck. Something’s wrong. His mom shifted, now revealing his entire face and left arm. Blue. Not swimming in a cold pool too long blue around the lips, or even the minutes-old newborn with blue-tinged hands and feet. This three-hour-old infant was dark blue. Almost gray. This baby was blue. Yes — he is definitely supposed to be crying. This previously perfect baby remained unnaturally still as I quickly transferred him to the plastic bassinet and unwrapped the many blankets. One hand went for his pulse, then to rest on his chest, and the other on his foot. Flick. Flick. Flick. The nurse I called came running into the room and began attaching wires and monitors. Flick. Flick. Flick. I think he moved. We felt for a pulse and were rewarded with the faint throbbing under the skin pushing against our fingers. I think he moved. At 1:52 p.m., he squeaked. A few seconds later, he cried a full, angry howl that instantly became my favorite sound in the world. Finally, he was breathing. Finally, my attending walked into the room. And finally, I could feel my heart thumping in my throat. Terror burned down my spine as my mind realized it was no longer responsible for keeping the blue baby alive. The baby who was not supposed to be blue, with the intern who was not supposed to be alone. At 4 p.m., at the end of my shift, I stumbled to the parking garage behind the hospital and almost tripped on the steps as tears clouded my vision. Everything inside of me shattered as I climbed step by step to my car. Did I decide not to press the code button because I was scared of calling my first code, or was I confident that most newborns recovered with stimulation and a few minutes of bag-mask ventilation? Did I freeze? I kept tapping the baby’s foot because I knew I had to stimulate him. Unless I kept tapping him because I was frozen to the spot? It felt more like three hours, not just three minutes. How much time did I waste just staring at the baby in his mom’s arms? And how is everyone still going about their regular day? How can they not see? See that I wasn’t prepared? See that everything has changed? That it can never be the same? The confident intern who walked into that hospital room is only now, weeks later, beginning to reconcile with the person who walked out. Sometimes that person is the terrified girl whose eyes fought tears for days after the blue baby turned pink. The person who felt broken though everyone urged her to feel proud. Other times, she is a pediatric resident who trusts her mind to remain clear, keeping the panic at bay for as long as necessary. This woman will always know where to find the code button and a bag-mask. At orientation, I learned who to call in an emergency, plus three or four alternates. I learned how to escalate care so help will arrive almost instantly Months later in a dark patient room at the end of the hall, I learned that the “almost” makes “instantly” seem like a lifetime and “just a phone call away” inherently involves “away.” Recognizing a sick patient is an essential skill because someone has to walk in first. Yell for help. Call the code. They promised us we would never be alone — until I was. And a part of me always will be. Ashira Klein is a pediatric resident. Source
