This is the fourth chapter in a series published by Lee Milligan, MD, SVP and CIO at Asante, during which he shares true stories from his time as a physician. The anecdote below focuses an experience he had while working the ER on New Year’s Day.
Working the New Year’s Day ER shift is a chore all emergency doctors must do at some point. It’s a mixed blessing. It’s no fun getting up at 5:30 after New Year’s Eve. On the other hand, there is a scarcity of bureaucracy that only happens during major holidays. You can feel it on the drive in; the parking lots are emptier, fewer office lights are on, and the normal congestion of people is certainly minimized. At some point, you realize this is going to be a different kind of day.
On this particular New Year’s Day, I was blessed to be working with one of my favorite charge nurses, Sabrina. She is a street-smart, EQ-savvy nurse who applies logic consistently in the face of emotional tsunamis. In short, when the shit hits the fan, this is the charge nurse you want to be on shift. She and I have children who are the same age, so we usually spend the first few minutes of the shift sharing stories of birthday parties, tantrums and socially acceptable disciplinary techniques. This day was no different. She told me that her daughter had recently taken a boyfriend at the age of 5. We laughed until we were interrupted by the dispatch radio.
“Asante Rogue Regional, do you read?” Usually this is the normal communications check that we perform daily, but the dispatch operator’s tense voice told me differently. “Yes, dispatch, we read loud and clear,” Sabrina said. “We have a situation,” the operator responded. Sabrina swung her chair around and gave me a look that said, get ready. “Rogue, you should prepare for an imminent child delivery” came next. Sabrina responded, “Via ambulance?” There was a momentary pause, followed by “No, private transport. The husband called 911 a few minutes ago and stated that his wife is 9 months pregnant and in active labor in his passenger’s seat. He is headed to your hospital full speed. He seemed scared. Be careful.”
As a physician, you sometimes find yourself questioning why you chose your specialty. You wonder if all the challenges that come with this line of work are worth it. You sometimes dream of pursuing other specialties. Not this day. A true ER doc wants to be the one in the saddle when this craziness lands. He or she wants to be the one who is tasked with making sense out of nonsense. This day, that doc was me.
Sabrina and I ran to the trauma bay. We commandeered a portable gurney, putting equipment we thought made sense on top. We had blankets, clamps, scissors, oxygen mask and portable suction. Then we rolled.
We weren’t sure where they would show up. Pushing the gurney through the ambulance bay, we figured this was the most logical place to wait. As the automatic doors opened, we witnessed the beauty of freshly fallen snow. There was a silent purity to that instant. Each snowflake fell slowly and seemed to pick its own spot to land. At one point, I could make out the shape of each one. We stood in silence, feeling the internal peace that can happen only when one is experiencing natural phenomena, and waited for the medical insanity to unfold. We didn’t have to wait long.
We heard a vehicle skid around a corner and accelerate up the ramp. A small compact car rapidly approached, then braked as the driver steered toward the ER bay doors. Sabrina and I stood there, knowing what he was trying to do, yet recognizing that his actions were putting us both at physical risk. We each took several steps backward as his car slid to a stop over the ice. He reached over his wife’s belly, pulled on the door handle, then extended his leg and kicked the passenger door. The door flung open. His wife was sitting low in the passenger seat with her legs high in the air, supported by the dashboard. Her skirt was hiked up to her waist, and it was clear that the baby was crowning. I was already wearing my medium-sized, non-latex gloves. When the door opened, I ran to the passenger side of the car and slid on my knees as I held my hands below her pelvis. She screamed, and her baby girl slid out of the birth canal. I was able to blunt the fall and stop the baby from crashing to the pavement. But that was it.
The freezing air seemed to shock the newborn. She lay there without making a sound, her skin a pale blue. I clamped the umbilical cord x 2 and then cut with Metzenbaum scissors. This allowed us to put the baby on the first gurney and quickly get her wheeled to a trauma bay. Waiting there was a heat-lamp warmer, more RNs and a few ED techs. Sabrina put the baby under the lamp and began to stimulate her. The ED techs provided oxygen. Soon, the baby made a noise — a good sign as far as neonates go — then pinked up and began to move.
The exhausted mother still had the placenta inside her, so we moved her into trauma bay #1 and birthed the placenta over the next 20 minutes. She actually fell asleep for a short bit, then awoke asking to see her baby. While I was attending to the mother’s needs, I began to wonder myself how the baby was doing. I got up from my chair and walked the few feet to the second trauma bay. There I saw a happy, pink, smiling baby who was longing to be with her everything. It was there that I witnessed something that likely will stay with me for a long time.
Mom reached for her newborn and began to cry. Sob, really. First her arms, then the rest of her body began to shake. She wept with a smile on her face that seemed to communicate love in its purest form. She didn’t care who saw or what was said; in her mind, connecting with that baby was the only thing that mattered in that moment.
When she finally touched her baby girl, it seemed nearly magical. Both mom and baby fell into a trance-like state. Mom picked her up and, looking past all of us, stared out beyond the ambulance bay. Baby girl closed her eyes halfway and relaxed. Together they seemed, in a word, whole. As medical practitioners, Sabrina and I paused momentarily and wondered what we had to offer — though in truth, we knew we couldn’t offer much. Everything each patient needed was being fulfilled by the other.
I turned to Sabrina and, recognizing what a terrific effort she had made, I thanked her. She didn’t respond at first. She looked happy, but elsewhere. She was soaking it in. Then, in a moment of clarity, she turned to me and said something like, “This is why we do this.” I nodded gently, turning toward the other stacks of patient charts waiting to be seen. As I contemplated her words and began to organize my thoughts, dispatch broke through. From a distance I heard, “Rogue, Level I trauma en-route, 39-year-old rollover passenger with blunt trauma…”