The following is a post I wrote in medical school that I never published.
“C’mon,” my resident called out to me, “Let’s go do something.”
“Ok,” I replied as I half-jogged to catch up with her.
It was a slow night in Labor & Delivery. I wasn’t doing much. Most of the patients I saw that night during Night Float (shift from 5:30 PM – 7:00 AM) were patients in triage with various complaints. Most were women who had been feeling contractions that day. I think most were sent home that night because they weren’t yet in labor. (Labor is defined as contractions plus cervical change. Since they had contractions without dilation of their cervix, they were not going through active labor.)
The resident and I walked to triage. The nurses had told us that there was a patient in triage who was still in the early part of her 2nd trimester. She came in complaining of decreased fetal movement. The experienced ones on the unit didn’t think much of it. They wondered if she had even felt movement before this time as it was early in the pregnancy. But the patient was here; and so we went to see her.
As we walked into the room the nurse was trying to find fetal heart tones with the handheld Doppler Ultrasound device. (A Doppler Ultrasound is a handheld device that allows one to hear the fetal heartbeats.) She muttered something about the equipment in the room not working, about her doppler’s battery running out. She could not pick up any heart sounds; her probes were met with silence. This should have been my first warning sign. The nurse then left the room to allow us to do our exam.
Our patient was lying in her hospital bed. Her husband stood by her side. Their toddler sat in a chair, amusing himself with a toy. The patient explained to us that she understood it was early to feel movement. But she had started feeling movement a couple weeks ago. However she noticed that it was significantly less a few days ago. That day, though, she had felt none. She wondered if it was just because she wasn’t noticing it. After all, we often advise expectant mothers to sit still in a quiet place when they try to do “kick counts” because it is easy to block the movement out when the baby is still small.
The resident fired up the ultrasound machine and started probing. She was going to try to assess for fetal heart rate since the nurse hadn’t been able to with the Doppler.
“There’s the head,” she said as she pointed it out on the screen. She continued moving the probe around, sliding it over the jelly-covered belly. I thought I recognized the chest wall, but I was so bad at looking at ultrasound images that I didn’t think much of it when the resident kept moving.
“I usually find it really quick. But maybe the baby is turned away,” she told the couple. Again, throughout the ultrasound, only silence.
My resident then turned to me, “Can you call Dr. A on the unit? She might be better at this.”
Dr. A was our senior resident — less than a year away from becoming an attending. It made sense that she would be better at this. But this was also my second warning sign.
I left the room, but instead of getting on the phone, calling the unit secretary, and asking for Dr. A, I ran to the unit myself. I didn’t want to waste time. Besides, since I didn’t know the unit’s extension, I figured I could run to Dr. A faster than I could call.
When I returned with to the room with Dr. A, she politely introduced herself and replaced the resident at the ultrasound machine. She took her turn at the machine. Within a minute, though, she turned to the resident and quietly asked her to page the attending physician on call. And there, accompanying the silence, was warning sign number three.
The resident and I walked out. She paged Dr. B. In the hospital, they don’t like paging the attending unless absolutely necessary — especially when it is at night.
I was surprised at how fast Dr. B came. I remember thinking that the call room must be really close.
Dr. B, the resident, and I walked into the patient room. Dr. B introduced herself as the supervising physician and took over for Dr. A at the ultrasound machine. After a little bit she turned and asked us to turn the lights back on.
“I’m sorry,” she began as she looked at the patient and her husband, “there is no heartbeat.”
I don’t know if I still remember the mother’s face. I think I do. But it isn’t a very clear picture in my head. I didn’t want to stare as the tears started streaking down her face so I looked away. It was tough. Labor and delivery is usually a unit of such joy. The patient’s are generally young and healthy. They leave with brand new bundles of joy.
But that night, instead of joy and new life, I came face to face with silence.