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What's This?

I looked up from my computer to see the nurse wheeling in a new patient.  She breathlessly said, “I think I’m in labor”.  Now, women in the initial stages of labor are not unusual in the ED— we usually confirm that they’re not literally having their baby in the ER, and send our fastest tech to sprint them up to Labor and Delivery.  Except that tonight, I was  at one of my medical center’s small satellite hospitals – with no Labor and Delivery.

Still, if she wasn’t yet in labor, we could whisk her to the nearest major center (5 miles away) in an ambulance.  No problem. I prepared for a quick exam– except that when I lifted the sheet, I saw the tip of a baby’s head.
She was crowning.
This was happening NOW.
Our charge nurse, Katherine [names changed]- a veteran unflappable ER nurse with a British accent who was as yet unaware of this fact – proceeded matter-of-factly with the routine eval.  “Do you have AHHLergies?”
“KATHERINE?” I said pointedly, trying my best to get the nurse’s attention without alarming my patient, “Can you give me suction, please? NOW?”.  The very slight edge to my voice did the job – and in a split second she looked up, recognition on her face.  With nothing but a very proper “Oh.”, she switched gears.
I hadn’t worked too many shifts at this hospital – and didn’t know what other doctors were there at night.  “I need Obstetrics…or pediatrics…or anesthesia….do we have any in house?”, I called out to the secretary.  Another nurse quickly put a gown and sterile gloves onto me.  The secretary stuck her head in– “There is no one available for obstetrics or pediatrics”.   I was on my own. This was what I had trained to do.
Another push, and the head was out. But then I saw what every physician fears–the umbilical cord wrapped tightly twice  around the baby’s neck.
I had to get the cord off.  It had to come off RIGHT NOW.   No. No No.  NOT. TODAY.  Please.
As the only physician in the room, I knew that my behavior would dictate the tone of the room.  I couldn’t let the mother know.   I could not let my concern show.  So, with my best pretend soothing voice, I heard myself say “That’s great.  You’re doing such a good job.  Now breathe in and stop pushing for just a second”.  Furiously, my fingers worked to maneuver the cord over the head.  The nurses saw the cord too, and for a few moments- even while we all did our roles – we all held our breaths.
As I was maneuvering the cord, the hands of a remarkable and experienced nurse brought the suction that I had requested, and quickly suctioned the baby’s mouth and nose.  I have never been so relieved to have another teammate.  We had this together.
SLIP.  the cord was off of the neck.  Thank you. THANK YOU With another push, the front shoulder was out, and then quickly, the second.  It’s a girl! Rub her.  She’s pink, and now’s she’s crying.  Thank God.
The father suddenly appeared at the doorway, having had to park the car and get the patient registered.  Just in time.  “Hey Dad, do you want to cut the cord?”, I asked, a huge smile on my face.  He appeared shocked, confused, thrilled.   He stepped up, and CLIP!  Then the nurse that had been at my side wrapped up the beautiful, miraculous, magical little baby, and carried her to the mother.
I walked out of the room, and saw a sight – every other patient in the ER – from the lady with a broken arm to the gentleman that had been boarding in the ER for 3 days while waiting a psychiatric hospitalization – they all were listening outside their rooms.  And they all started clapping.
And why not? What a moment of pure joy.  The ER sees a lot of tragedy – many times when we in the ER simply cannot fight the path set in place.
Tonight? Tonight was not one of those nights.
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