The Intern Blues(121)

It was a baby who had been born two days ago with severe malformations. At first we weren’t sure what the baby had, but we knew it was something really bad. She was very abnormal-looking; she had a loud heart murmur; and she didn’t respond to anything, including pain. Bob Marion came to see her and said the baby had trisomy 13. [This is a disorder caused by an extra copy of chromosome thirteen. Children with trisomy 13 have so many malformations, both internally and externally, that almost all die within the first few months of life.] He told us we shouldn’t do anything heroic to try to prolong life, so we didn’t, we just let the baby be and kept her comfortable. It took her over twenty-four hours to die; she waited until everybody else had gone home, so it was only me and a senior resident who was cross-covering.

The baby’s heart just stopped beating. One of the nurses called me over and told me she was dead. I listened and didn’t hear any heart sounds. At least she chose a reasonable time to die; it was about eight-thirty. At least the nurses didn’t have to wake me up at four in the morning to declare her.

The mother was out on the postpartum ward and I went out to her room to tell her. She was really upset. Bob Marion and Ed Norris, our attending, had talked to her a few times since the baby had been born, so she knew what was wrong and that it was only a matter of time, but still she got very upset when I told her. It was really sad. She’s thirty-nine years old and this was her first pregnancy. I sat with her for about a half hour, trying to calm her down. She told me she really wanted this baby, that she had had a lot of trouble getting pregnant and had gotten to the point where she didn’t think she’d ever be able to conceive. And then, just when she had just about given up hope, she became pregnant with this baby, who turned out to have trisomy 13. I had absolutely no idea what to say to her. What can you say at a time like that? I don’t even want to think about it, especially not now. So that wasn’t the easiest thing in the world to deal with.

The rest of the night wasn’t bad, though. I even got a few hours of sleep. Most of the preemies behaved themselves and didn’t do anything stupid while I was on. Still, all night, I kept thinking about that mother. And so even though it should have been an easy night, it wasn’t.

Friday, April 11, 1986

Yesterday was the official opening of the neonatal intensive-care unit on 7 South. The unit’s actually been open for months now, but that’s beside the point. They had this big celebration, and Mayor Koch, a group of other officials from the city, and all these reporters were here. Ed, our attending, who’s the director of the nursery, took the mayor on a tour and showed him some of the six-hundred-grammers. The mayor was, to say the least, a little put off by the appearance of some of our patients. He didn’t volunteer to kiss any of them, the way most politicians kiss babies.

I was on last night, and I had a terrible night. At about 1:00 A.M., we got a call from the DR that they had this woman who had just walked in off the street who was ready to deliver and had had no prenatal care. They weren’t even sure when her LMP [last menstrual period] was, but they thought the baby might be about twenty-six weeks. Luckily, I was on with Enid Bolger, who’s the senior in the unit this month. Enid also happens to be very good. We went running down to the delivery room just as the baby was coming out. It was tiny! I was positive it was too small to survive. Enid thought so, too, so we just gave it some oxygen and didn’t do much else. It was only about eleven and a half inches long, so it was probably about twenty-three weeks [about three weeks too early for the baby to live independently outside the uterus]. But the baby came out with a heart rate, so we had to take it back to the ICU and wait for it to die.

That was pretty bad, but it could have been worse. Enid was very good about it; she didn’t go crazy, like some of the other residents do. Some people would have done everything: intubated it, put it on a respirator, started IVs. But it wouldn’t have accomplished anything. That baby never had a chance. It weighed only 520 grams [about one pound, two ounces]. So it was good to have someone like Enid in charge; I agreed with her completely in how this baby was managed. When the heart finally stopped beating, Enid and I went down and talked to the mother. She didn’t seem too upset. I don’t think she had really thought of it as a baby yet. I’m not even sure if she had realized she was pregnant before that day. She has three children at home. I don’t know, I’m fairly sure it was for the best.

But I didn’t get much sleep, and I’ve now had two deaths in one week. That’s a lot, even if you’re expecting the baby to die. I hope my luck changes.