Miracle Baby

“I never feared about my skills because I put in the work. Work ethic eliminates fear.  So, if you put forth the work, what are you fearing? You know what you're capable of doing and what you're not.” - Michael Jordan

Putting that education to the test! 

I was 4 years into my pediatric practice when I started to feel restless and uninspired.  I missed the thrill and complexity of cases that I had been involved in during Residency. I had contemplated fellowship in an intensive care specialty, but had decided that the physician:patient relationship in a primary care setting is what I valued most.

It was 12/5/2000.  I was just finishing my rounds in the newborn nursery, prior to reporting to the clinic when one of my FP partners came bursting out of a delivery room, shouting for a STAT C-Section! As we ran to change into our scrubs, he alerted me to the emergency – Vasa Previa!

He had just performed a routine artificial rupture of membranes on an otherwise healthy, primiparous, married woman. During this blind procedure, a low-lying placental artery that had developed across the cervical os, was inadvertently ruptured, resulting in immediate hemorrhaging and drop in fetal heart rate.  

This joyous occasion suddenly turned into a flurry of emergency response activity that left the family huddled in the room crying.  Onlookers stood wide-eyed with their backs against the wall as the mother and equipment were whisked down the hall to the OR at mock speed!  BTW: This maternal-fetal emergency has a less than 10% survival rate for the infant! 

Everyone anxiously took their places - prepped, well-trained, and primed to respond.  Six people were there for the baby alone. We had each put forth the work to be prepared for this critical moment, but we each feared, “Will our efforts be sufficient to save this precious life today?!”  Our teamwork skills would be put to the test!

With the most aggressive surgical incision and uterine extraction I have ever seen, the OB pulled out a limp, pale, and lifeless baby girl.  I had seen plenty of cyanotic babies, but this one had nearly exsanguinated, and almost felt cold to the touch. 

As someone did chest compressions, I urged the FP to put in interosseous lines while I intubated this beautiful child.  She was clearly hypovolemic, and we needed to start the fluid resuscitation quickly; before I was going to be able to place umbilical lines. 

Though we both hesitated at the thought, we agreed, saying, “We just did this in NRP training, it’s just like the chicken bone.  She has 2 arms and 2 legs, we will use all of them if we have to, let’s GO!”  He was successful on the 2^nd attempt and the fluid resuscitation began, first with NS, then the first round of medications, all while chest compressions rocked her lifeless body. 

My adrenals squeezed out more molecules of catecholamines than they had ever produced!  The sweat poured out of me more than in any athletic competition I had ever participated in; and I had been a catcher all the way through college, often having played in > 100-degree heat.  I had to change my sterile gown/gloves three times so I could feel my fingers.  It’s hard to place umbilical lines when your gloves are filled with sweat!

Seconds after the short UVC was in and taped, the nurse exclaimed, “The blood is here!”  I could have kissed her.  In addition to drawing up the meds, she had astutely ordered the O- while I was intently staring down the baby’s tiny trachea!   

We methodically went through the resuscitation efforts, for what seemed like forever; and to no apparent avail!  Though every resuscitation guideline stated we should have stopped our prolonged, futile efforts - I was not going to give up on our sweet little angel. Heck, we even tried bicarb! I just kept talking to her and encouraging her to keep fighting!  “Come on baby, your mommy and daddy are waiting to see you.  Come on baby!” I prayed. 

Needless to say, we emptied the entire code cart on her until finally, just when we were about to give up, someone exclaimed, “we have a heart rate!”  It was 41 minutes from the time we had lost heart tones in utero!  I was so shocked and amped up that I couldn’t even hear it.  There was a sinus rhythm present on the monitor and others confirmed it was true!  Unfortunately, it was FAR beyond the 20-minute APGAR mark, which gave her a score of 2!  She had not moved a muscle other than an occasional agonal breath.  She had a very poor prognosis, and everyone knew it! 

The team had worked beautifully together and with guarded hope, they asked, “What should we do now?” The catecholamines were still surging through my body and my head was swirling, as I tried to understand the nature of the question and reassess the situation. 

I then realized that we had lost all vascular access.  There had been so many hands reaching across her 7# body, that we had, unfortunately, knocked out the lines.  The cart was now empty and we had given her all the fluid that she could safely receive without causing cerebral edema.  She would likely already suffer this (and worse) due to the prolonged hypoxia!

So other than being embarrassed, I wasn’t going to worry about further attempts at iv access now, as I knew Children’s would want control of their own lines going forward. 

I felt so elated and filled with despair all at the same time.  It was like I was in a time warp.  I looked around the room, at each worried and exhausted face.  I saw used sterile drapes, gowns, gloves, blood, and tubing strewn about the OR floor; it looked like a war zone. Then I finally noticed that the OR crew had wheeled the mother out of the room, long ago.  “WOW, what time is it?” I asked. 

The answer was so surreal that it took me a moment to regain my bearings and control my shaking, in order to respond to their original question. “Well, we better call Children’s, get her upstairs, warmed up, and prepared for transport!”

The PCP and I tearfully explained our efforts to the family. We apologetically stated that we had done everything we could to save their baby!  They asked all the relevant questions, but we were of course hesitant to give a prognosis.  The only thing we could be sure of was that it was extremely guarded, and it would be a difficult road ahead!

Meanwhile, my clinic nurse was doing the best she could to reschedule my patients because though I hadn’t responded to her pages, she knew something bad was happening as there were 2 doctors out on the same emergency.  I didn’t return to the clinic until late afternoon, only to find that she had accurately assessed a cyanotic, cachectic, 4-month-old infant, who had presented for her first well-child visit. The nurse noted that the baby wasn’t distressed, seemed to breastfeed well physically, but certainly wasn’t gaining weight, and didn’t look healthy.  She convinced the first-time mother to wait 3 hours to see me, and even ordered the CXR and EKG!  She was right – the baby had a serious cyanotic congenital heart disease and we transferred her to Children’s shortly thereafter.  Then I was paged back to the newborn nursery to end the day with a sepsis workup on another newborn. 

WHEW!  I had only seen 3 patients that entire 12-hour shift!   It was the toughest but most rewarding day of my (eventual 25-year) career. Any doubts about my role, efficacy or purpose as a primary care pediatrician were washed away.  I gained a new appreciation for the fact that “I never needed to fear about my skills because I had put in the work.”

 SO WHAT HAPPENED to the First Baby – whom I’ll call Sarah!???

The Neonatologist was very concerned about Sarah’s presentation on admission to the NICU.  “I’m not sure I’ve seen a neurological exam like this,” she sadly admitted.  “I know,” I cried, “we did everything we could!” 

It was Advent, and as I sat crying in the Wednesday night service, I prayed hard for this little cherub, “Please God, please save this baby!”  Two days later, the Neonatologist called and said, “You’re not going to believe this!”  I assumed the worst of course, given what I knew about her statistical prognosis; I assumed that Sarah had died.  “NOPE,” said the attending! 

She excitedly reported that they had successfully prevented Sarah from having seizures despite not being selected for the brain cooling protocol.  Her head US was normal – without evidence of a bleed!  Her abdominal US was normal, and all her labs were normalizing, including just a mild DIC.  They were hoping to extubate her, (and they did so the very next day).  I couldn’t believe what I was hearing, an undeniable miracle and answer to my desperate prayer! 

Sarah’s only setback was learning to suckle, but after that, she progressed far beyond all medical expectations!  Her PCP continued to give me updates every time he saw her in the clinic.  Sarah was walking at her one-year birthday party, hosted by the hospital.  All the staff were amazed at her recovery and the fact that she appeared to have no long-term deficits!   

When Sarah was 10 years old, the OB and I presented this case at an open hospital board meeting, to emphasize the importance of maintaining a fully qualified, staffed, and equipped OB department in our struggling, small-town, rural hospital.  It was standing-room-only, extending far out into the hallway, as this was a huge decision for our community. 

I don’t typically have difficulty with public speaking, but I struggled that night because it felt like I was reliving it all over again. It was intense! My heart was pounding as I told of Sarah’s early beginnings just a few yards from where we were meeting that night!  I was so proud to be presenting this incredible overcomer story, yet so angry over the impending board decision.  I was trembling and I couldn’t read the Resuscitation Note through my tears!  The whole place was on the edge of their seats.  As the drama unfolded, I could see tears streaming down most of the attendees’ faces as well.

Then I did the unthinkable!  Sarah and her family were quietly sitting in the corner of the room.  I hadn’t seen them prior to the start of the meeting and did not have their permission to call on them during the meeting.  I decided to make a bold, grand-finale statement that would stick in the minds of the onlookers forever! 

I said to the board, “In case you are having difficulty appreciating the relevance of this extremely rare and critical situation, I would like you to hear directly from the patient."  PAUSE for effect!  "I would like to introduce to you…. Miss Sarah (Last Name).” 

As I said her name, I dramatically reeled and pointed to the surprised family.  Without even being prompted, Sarah proudly stood up with a huge smile on her face. It was like we had rehearsed it!  

“Sarah, how old are you?” I asked. “I’m 10 years old and in the 5^th grade.”  Then I asked, “What is your reading level?”  “Seventh grade,” she answered.  “What is your math level?”  “Seventh grade,” she exclaimed as she stood even taller, exuding more confidence and prowess than I had ever witnessed in such a young child!

There was an audible gasp in the room. As everyone wiped their tears of joy, I said, “Thank you, Sarah, we are all so very proud of you!”  The crowd erupted into a standing ovation, with whistles and cheers that continued for several minutes, all except for the Board Members. 

When it finally quieted down, I turned back to the Board and said, “Ladies and gentlemen, Sarah is the reason you need to keep this maternity ward open and thriving.  You will still have deliveries here whether you have a functioning department or not.  They will present to your ER, in the hallway, in the elevator, or in the parking lot.  You must have qualified staff to manage these life-threatening scenarios!  As you have just witnessed, it MATTERS! 

This baby, who had a < 10% chance of survival has not only beaten ALL the odds, but has no deficits, and is 2 years ahead of her peers in reading and math performance measures. She IS a medical miracle, and she will always be a part of me and the people on the team that day!!”  And I sat down!  Can you say, “Drop the MIC!?”  

There wasn’t a dry eye in the place.  I’m not sure anyone had a productive, board-related thought after that!  Yeah, there was a lot of awkward, stammering, and stuttering going on, because the Board had been given instructions on how they were to vote, but I know they were conflicted.  Nothing was going to curb their decision and certainly nothing meaningful was accomplished after that performance! 

Unfortunately, they voted against the agenda item that the medical staff was trying to support.  It was incredibly frustrating, BUT we had done our jobs and the entire community knew it!

Take Away:   

We are all witnesses to the plethora of challenges within our medical system.  Now, more than ever, is the time for medical professionals to get involved in the leadership aspect of our careers; to Stand Up and Stand Out for what we believe in order to effect positive change.

Not sure how to go about that?  Not sure if you have what it takes or have the bandwidth to commit to doing so?  Let’s talk about the basics; I can guide you on where to take it from there! 

Book a call today!