Friday, January 30, 2009

The smallest patient

*warning: This post requires kleenex*

I was fresh out of school with a brand new registry card sitting proudly in my wallet when I went on this call. It's a difficult thing for me to write about, so please forgive me if this is fractured...and if you have questions, please ask them. This is cheaper than therapy.

She said she was 20 weeks pregnant, but she hadn't had any pre-natal care except for a positive pregnancy test. This was baby number 5 for her....and at the age of 22, she was swearing it was going to be her last.

She called because she was having spotting and cramping. When Young Stud partner and I got to the house, we had to fight our way past trash bags of dirty diapers and broken toys. My feet were sticking to the tacky carpet as we walked into the living room.

It looked like a tornado had hit it. Every surface had something on it. There were clothes and toys and shoes and bags and plates and cups and the miscellania a house inhabited by small children accumulates over time. The smell of burning hair and grease was all-permeating and my duty pants' shirt and boots smelled like it for the rest of the shift.

The family was assembled on the couch; mom at one end, with her coat already on, ready to go. The kids and a man who I later learned to be her boyfriend and the father of not a fucking one of those kids were at the other end.

We made our introductions and I got a set of vitals on her. Everything seemed to be normal and I had started to write her off in my head as a 'having cramping so I can get an ultrasound and see whether it's a girl or a boy'....until she stood up.

On the couch, there was a patch of blood where she'd been sitting, and a bloom was spreading across the crotch of her shorts.

Ohfuckohfuckohfucknotonmywatch. Oh fuck. We need to go, and we need to go NOW.

We were about 5 minutes away from the ER. Young Stud chose me to sit in the back, being the female EMT on board. I gave a radio report, making sure I mentioned that she was having cramping and significant bleeding, trying to get my point across without frightening my patient. As we pulled into the hospital grounds, she started groaning and saying something was coming out.

I cut up one leg of her daisy dukes, across the crotch and down the other. She wasn't wearing panties and it was clear that yeah, this baby was coming.

I yelled at my Young Stud to stop. He said we were less than 500' from the ER.

"Fuck it. GOGOGOGOGOGOGO!!!!!!!!!!!!!!!!!!!!"

I told her to pant, pant, pant and started panting with her. I threw a sheet over her as the back doors were flung open and we hauled the cot out of the back, she and I panting the whole time.

As we hit the double doors from the ambulance bay, she stopped panting and frowned.

"NO!! C'mon girl, pant! Don't you do it, don't shit" The liquid sound like a water ballon popping told me what I needed to know. I lifted my side of the sheet and saw laying between her legs the smallest human being I have ever seen. Ever.

He was trying to breathe. His whole chest caved in every time he tried to take in a breath.

He was so, so small,, y'all. So small. He fit in my hand, and I have some small-ass hands (I have to wear kids gloves in the winter because adults, even the small ones, are too big).

The nursing staff closed in around her as we walked in and I tried my damndest to give report. I repeated everything I had written on my glove and was trying to be as professional as I could be when I felt a hand on my shoulder.

"NM, c'mon, darlin'. C'mon out here with me" It was Doc Vee, one of the pediatricians. "C'mon, sweetheart. There aint a dang thing you can do now. You did good, you did great...c'mon, darlin'."

We sat in the staff break room and he gave me a cup of the gawd-awful hospital coffee, the stuff that tastes like it's been brewed in a goat's bladder, and a box of kleenex. He asked me what happened and I was wiping my face and telling him when the neonatologist came in to the room.

"How far along did she say she was?" When I told him she said 20 weeks, he shook his head "Aint no way that baby's that big. I'm guessing 18 weeks, tops. I'm sorry, NM. We can't do nothing for him; I don't even have an ET tube small enough for him. Alls we can do it make him and his mama comfy and let the good lord do what he may"

"Can she....can I see him?"

Doc Vee took my hand "I don't think that's the best idea, darlin'. He needs some time with his mama. You did all you can do, and you done good."

Young Stud appeared in the doorway behind the neonatologist. "Y'all right, NM? Dude, that fucking sucked. I'm sorry I put you in the back with her, I just though you being a girl and a mom and all you'd know....well, y'know"

I later learned that she wasn't 20 weeks along, she was 17. She'd fallen down 3 steps earlier in the day, leading the obstetrician to declare that placental abruption was the cause of the miscarriage. I don't like using that word for this case; I don't think he was a miscarriage. I think he was a very small person who just didn't have the capability to survive. He was here, though. He was born. He was alive.

He haunts me.


Chris said...


hope you're OK - must have been hard to write about.

Haven't spoken to you in a while - drop me a text some time, let me know how you're getting on.



medicblog999 said...

Nightmare job, nothing much anyone could have done though! It sounds like you have a lovely doc to support you!
I had one a bit like that too.
Woman, 24 weeks pregnant with twins. Wanting to push!! 14th floor of a block of flats!!!! First twin came out whilst she was on the carry chair coming down in the lift (oh crap, what do I do with this???) en route to a&e she said the other one was coming. I asked her to try and pant and not push but it just popped out. Me by myself in the back, 2 very prem babies. I normally tell whoever is driving to "take it steady" when using blues, but I distinctly remember on this one occassion saying " put your f@$king foot down NOW!!!" As I said, nightmare jobs!!!

randompawses said...

Oh, jeezus, NM, as a mother that had to have been traumatic for you! We both know that sometimes bad things happen . . . but knowing that doesn't always help, does it? You did everything you possibly could, and I'm sure your presence must've been a comfort for that young woman. Sending some cyber-hugs your way....

Chapati said...

Oh honey..hugs!

Epijunky said...

Oh Honey...

I'm without words.

Cheating Death said...

I had to walk away and come back. Right now we're wishing for our little one to come out and see us and it seems like not so long ago we were doing everything in our power to stop it from coming out.

Let me know if you need anything. Keep your chin up. We all know you're a fighter.

Evil Transport Lady said...

Hugs to you NM! I'm terrified of those kind of calls.

Walt Trachim said...

Sweet Jesus.....

I know what you're going through with this one - been there myself. And I agree with you; not a miscarriage. You did the right things, though, regardless. And it sounds like you've got good people around you. That's a blessing in itself.

Even though I haven't gotten to know you (yet) my thoughts are with you.