A lot of Blood, a little needle, and a life saved-An Amazing Childbirth Story

In a near death story of a mom and a baby we find a reminder that little things can make a big difference-

She had been hospitalized for a month, placed on bed rest for complete placenta previa. Instead of implanting higher up in the uterus, the placenta was low, completely covering the opening of the cervix. This was a potentially deadly situation for both mom and baby. Once labor started and the cervix began to open massive bleeding would occur.

Once the condition was diagnosed at 24 weeks of pregnancy the waiting began. She was placed on bed rest to stave off any contractions and cervical dilation and was to remain in the hospital until she either reached 36 weeks of pregnancy or the bleeding started. Either way the baby would be delivered by c-section, as a vaginal delivery was impossible.

I was the intern on the OB floor, responsible for rounding on each patient every day, performing deliveries and assisting on c-sections when needed. I came to know her well, as would be expected when a doctor sees a patient every day for a month. The first month had been uneventful, with no bleeding at all. We we all optimistic that things would go well. She had made it to 28 weeks, and each day that passed brought another day of maturity for the baby and an increased chance at survival.

Everything change in a moment. It was just after lunch. I had just changed from surgical scrubs into shirt and tie for my outpatient clinic that afternoon when I heard a nurse call out from the patient's room, "Dr. Barrett, she's bleeding!"

I hurried into the room. The patient lay on her back, a bedpan filled with blood between her legs. Unsure of how much blood there was, I grabbed the water pitcher from the bedside, dumped it out in the sink and poured in the contents of the bed pan. 500 cc of blood, a half of a liter. In less than 2 minutes she had lost over a unit of blood. I turned back to the patient, and watched as blood began spurting out between her legs. It was even worse than I feared. She was going to bleed to death in a matter of minutes.

I had one nurse place an urgent call for the obstetrician and another nurse call for the anesthesiologist. What else could I do? I surveyed the room and saw her single IV line. I remembered from somewhere in my training that when treating a patient in shock it was important to have at least two IV lines inserted so fluids could be rapidly administered. I turned back to the nurse, "I need a second IV, large needle, NOW!" The nurse got to work and a second line was quickly in place and fluid poured in. Moments later the anesthesiologist arrived and took over the case. I watched helplessly as they wheeled her away, the combination of my inexperience and clinic responsibilities excluding me from the operating room. I paused to whisper a prayer and went to the clinic, fearful for mom and baby. Things did not look good.

As soon as my clinic shift was over I hurried back to the hospital to check on her status. The anesthesiologist was at the nurse's station completing paperwork when I arrived. "Hey, Bart! She made it! 16 units of blood, 10 packs of platelets, but she made it, and so did the baby." I let out a sigh of relief.

She went on, "Oh, and great job getting that second IV started. She went downhill so fast that without it we would have lost her. It made all the difference."

Her words caught me off guard. I had a hard time believing that something so simple could be so important. Yet, according to her, a single needle was instrumental in saving her life.

A little thing made a big difference. I didn't think I had done much but when the time came to save her life, and the life of her child, everyone, including me, had played a part. Nurses, surgeons, anesthesiologists, lab technicians, blood bank employees, and me, a green intern, all had contributed.

It is easy to overlook bit players, but they can be important, including the bit players in the Greatest Childbirth Story ever. This Christmas, as you read the Christmas story, take some time to consider all of those who had a part in the story. Shepherds, angels, Mary, Joseph and the wise men, all had a role in the story of the amazing birth of the Savior.

A final note- Nine years ago I received an email from name I did not recognize. It read, "you do not know me, but 15 years ago, you saved the life of my sister and my mother. I just wanted to say thank you and let you know that we have not forgotten what you did for our family."

All because of a needle.

- Bart

This is part 2 of 6 of the Christmas series "Amazing Childbirth Stories". It was first posted to years ago. I am sharing it again this Christmas season. Subscribe to the blog to have the future posts delivered to your inbox! Enjoy the stories? Please share with your friends on Facebook or other social media by clicking one of the share buttons. Comments and questions are always welcome.

7 Lessons From San Bernardino

Families have been shattered by the loss of fathers, mothers, sons and daughters. Survivors will carry forever the scars of the attack. The community is united in its desire to find out why and how the attack occurred and to prevent it from happening again. With this in mind I share some of the lessons we need to learn from this tragedy. While they may seem obvious the comments of our leaders suggest they may be ignored.

 1-      There are evil people in this world, and they are here. We have long lived our lives comfortable in the illusion that terror attacks and mindless killings were for places like Israel and Iran. Those illusions have been shattered by the Islamist’s brutal attack.

2-      Our government is incapable of rooting out potential attackers. The female attacker gave false information on her visa and was a known member of one of the most radical Mosques in the world. She was “screened” when she was allowed into the country and passed through easily. She was not on any watch list. Something to remember the next time we are told not to worry because the government conducts a “rigorous” screening process for all who wish to come here.

3-      Political correctness has no place in a battle against terror. A neighbor who saw suspicious behavior did not report it for fear of being considered racist. Continuing the absurd policies that make a 90 year old grandmother as likely to be stopped at an airport as a 30 year old single man of Arab descent makes no sense. Not all Muslims are radical, but the overwhelming majority of terrorists are today. We need to live in this reality.

4-      Gun laws don’t work to prevent mass killings. California has the toughest gun laws in the country. The gun laws being put forth by the president already exist in California and they did nothing. We all want to make the nation safer and it does us no good to be focusing on regulations that have already been proven useless.

5-      Law enforcement was unable to stop these attacks. Police were at the scene within four minutes. In those four minutes there were over 30 casualties. The sad saying that “When seconds matter, the police are minutes away,” was proven true. As much as we hate to admit it, in circumstances such as this only an armed citizen, already present, is in a place to make a difference. 

6-      Police officers displayed sacrificial bravery. The officer who told the evacuating citizens that he would “take a bullet” for them has been deservedly praised.

7-      This will happen again. Our world has changed forever.

- Bart

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Authenticity and Transparency are Overrated

I do not understand modern Christian values. When it comes to what is acceptable in the church I feel like a moral Rip Van Winkle, as if I fell asleep twenty years ago and have awakened to a whole new way of doing things.

The church I grew up in valued character, godliness and (gasp) holiness. People were supposed to do the right things, believe the right things and say the right things. We were wretched sinners and we knew it, but our goal was to be less wretched with each passing day. We worked to be different, to be better. Foul language was foul, revealing clothes were inappropriate, and crudeness was crude. No one talked about “being true to yourself” because ourselves were sinful and not worth being true too.

Everything has changed.

I listened recently to the podcast of a prominent Christian teacher. In the podcast he and a friend were talking about the struggles and challenges they had faced in their lives. They shared stories of loss and suffering that were real. In the midst of these stories their values were revealed. They spoke of other Christians with an air of condescension, castigating those who responded to their struggles with what they considered clichéd and shallow platitudes. They implied that these people were less Christian and less loving. They did not consider those well-meaning but misspeaking people simply mistaken, they considered them wrong and hurtful and deserving of being called out.

Profanity was also a part of the podcast. Proudly and without apology the pastor and his friend used language that was unprofessional and crude. It was clear that they had no problem using this language and that they thought it was silly for anyone to take offense. What was also clear was that they had no aspirations to improve the content of their speech. The social mores and standards followed by people like me were to them artificial and outdated and not worth following.

How could this happen? How could people who purport to be spiritual leaders be so lacking in grace and honor?

The answer is found in the comments people posted about the podcast. In the comments the speakers were repeatedly praised for being “transparent” and “authentic.” Transparency and authenticity seem to have become the most important values in "modern" churches. Because we are all sinners what is most important is not dealing with our sin but accepting our sinfulness. Because we all struggle what matters is sharing your failings, not recounting victories. Because Jesus accepts us as we are what is important is loving ourselves as we are.

As warm and affirming as this sounds, it is not what God desires. While God understands our brokenness and our sinfulness, He did not send His Son to die so we could remain in our fallen condition. Jesus died that we might have new life, not that we feel comfortable in our old lives.

It seems some have cast aside those passages of scripture that call us to be better, that call us to aspire to be more like Jesus not only in love and kindness but also in words and character. I believe that we need to remember that God calls us to be better than we are. As Paul wrote to his disciple Timothy-

“Set an example for the believers in speech, in life, in love, in faith and in purity.” 1 Tim 4:12-13

The God who calls his people to “Be Holy, for I am Holy” wants his people to break free from the world’s practices and desires, to be well-rounded people of faith who, in every area of their lives, strive for the excellence displayed in Jesus. The apostle Paul said it well in another of his letters-

"Finally, brothers, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable — if anything is excellent or praiseworthy — think about such things. Whatever you have learned or received or heard from me, or seen in me — put it into practice." Phil 4:8-9 NIV

Authenticity and transparency are of no value in and of themselves. There is no praise due those who are authentically crude and transparently selfish. We need to pursue lives that are authentically and transparently good, pure, just, holy, loving and godly. We need to be better.

-          Bart

Thanks for reading. Coming in a few days is the second Amazing Childbirth Story, a series of posts leading up to the birth of Christ. You can be sure not to miss posts by subscribing to the blog (posts will arrive in your inbox). Please share the blog with others by clicking on one of the social media icons below. 

6 amazing childbirth stories

Reflecting back on amazing birth stories seems appropriate as we approach the day we celebrate the most amazing birth ever. Here is the first of 6 of these stories-

It was 1991. I had been a doctor for 15 months, only 3 months of which I had spent delivering babies. I had delivered about 50 babies and been involved in 30 or so C-sections. Not exactly a long and glowing resume.

Nevertheless, I was the resident physician covering the labor and delivery unit. There were experienced Obstetricians on call who were less than 30 minutes away and occasionally in the hospital, but if and when an emergency happened I was the designated first responder.

Although I was inexperienced, I had worked hard learning protocols for emergencies in childbirth. I was determined- If there ever was a bad outcome, it would not be because I wasn't ready.

It was mid afternoon when the call came from the emergency room. The charge nurse answered the call, her face quickly turning serious.

“Bart,” she said, “We have a 27 weeker coming in by ambulance with a prolapsed cord.”

I headed for the elevator that would take me to the emergency room on the first floor. In the 3 minutes it took me to descend I reviewed what I knew. A cord prolapse meant that the amniotic membrane (Bag of waters) had ruptured, and that as the fluid flowed out it had carried the umbilical cord with it outside of the vagina. If the head descended (as it does in labor) the cord would be pinched and the blood supply cut off. The baby could die. The woman was also 27 weeks pregnant, 3 months early, only a few weeks past the age of development where babies can survive outside the womb. If we could save the baby, it would have a difficult road ahead of it.

The elevator door opened and I hurried into the ER, past the nurses station and into Trauma Room 1, where an ER doctor, several nurses and EMTs scurried around the patient, measuring vital signs. The ER doctor saw me come in, “I didn't feel a pulse in the umbilical cord,” he said, implying that the baby may already be gone. (Only later did I consider how frightening those words must have been to the mother).

I was the youngest and least experienced person in the room, but I called to a nurse- “Get me a doppler!” (the ultrasound device for listening to a baby's heart beat.) The nurse applied the device to the mother's abdomen, and the rapid sounds of a heart beat were audible above the commotion.

“Heart rate 140!” the nurse called in my direction. I barked out another order, “What is the mom's pulse?” I wanted to make sure it was not 140 as it would be a grave error to perform an emergency C-section only to discover that the baby was gone and the pulse we heard was the mother's.

“Mom's pulse is 90!” replied the nurse.

“Let's go- now!” I said and grabbed the rail on the gurney. The ER doctor watched as I took over, more than a little surprised at me taking charge. A few nurses joined me and we headed for the elevator to the OB floor. When we arrived on the floor the charge nurse was waiting for us. She had grabbed an OB as he was walking by the nurse's station and then called for an anesthesiologist. They were standing at the door of the operating room, ready. We wheeled the mom straight into the OR and started the C-section in minutes. The baby was delivered just 17 minutes from the time the mother had first arrived in the emergency room. The neonatologist (high risk baby doctor) was on the scene and the baby was stabilized. Both mom and baby were okay.

Two days later the mom was visited by the director of my Family Practice residency program. He learned that she worked at UCLA Medical Center in a specialty department and did not have a high regard for Family doctors, for one of her first questions was, “How did a second year Family Practice resident know what to do like that?”

In her mind, experts in handling OB emergencies had to have a certain pedigree and experience. She knew what their resumes looked like, and they didn't look like mine. She could not believe that the doctor who had acted quickly to save her baby was a mere family practice resident. 

This episode reminds me of the greatest birth story ever- so many people had decided in their minds that the Messiah would come in a certain way, with fanfare and glory. They didn't expect a poor young virgin to give birth in a stable, and as a result they missed it. Isn't that how God works? In unexpected ways and through unexpected people?

-Bart

If you like this story- share it! If you don't want to miss any of these stories, you can subscribe to the blog and get them all in your inbox. Just check the link on the right of the home page, or at the bottom of your mobile screen.  This post was previously posted in 2013.

Worst. Employee. Ever

Working as a receptionist in a medical office can be challenging. A recent employee came up with a unique way of dealing with the stress that comes when the phones got busy. She answered the phone, politely listened to the patient’s concern and then hung up. She didn’t write anything down or enter a note into the chart, didn’t do anything to actually make sure the patient’s needs were addressed. She simply moved on to the next call. She had a similar solution to entering patient insurance information into the system as well. Skipping work was the easiest way to catch up.

It took several weeks for me to discover the problem. When patients began complaining that their calls were not being returned I searched for a cause. It did not occur to me that my new receptionist might not be recording messages. Message taking is such a crucial component of the job that I did not think it possible for someone with years of experience in the medical field to intentionally avoid it.

My blindness to the cause of the problem was in part due to the fact from my limited observations of her work she seemed to be doing well. She was polite, the other employees liked her and she seemed to be keeping up with her duties.

It was not until a few weeks later when I noticed that a phone message had been entered into the chart hours after the office had closed that I investigated the possibility she was not entering messages into the chart at the time a patient called. The delayed message discovery was the clue that led me to consider that the source of the patient complaints might be her. She was off on the day that I discovered the problem and I called an impromptu meeting with my other employees.

A few minutes into the meeting we realized we had a big problem on our hands. Each of us had individually fielded patient complaints about unreturned calls, unaware that the others had done the same. Together we were aware of 15-20 message failures. I wondered if I should counsel her on her performance and warn her that her job was in jeopardy. When the employees told me that had each already done so I knew this was not a matter of her simply making mistakes. The receptionist  clearly did not care enough about our patients to do her job well. I had no choice but to let her go.

That afternoon I sent a message to every patient on our electronic mailing list letting them know that we had discovered an issue with messages not being recorded. I apologized and asked all who had not received responses to messages to let me know. We had 5 replies within the first 24 hours. I was shaken by the news as I realized important medical care might have been delayed. I was grateful that many patients were supportive and understanding of my efforts to rectify the problem.

As shocked and disappointed as I was at the employee’s intentional neglect, subsequent events were more discouraging. The afternoon of her discharge she deposited a duplicated paycheck she had promised to destroy a month earlier, in essence stealing over $1300 from me. I filed a report with the police.

She filed an unemployment claim. My challenge to the claim was initially upheld but later overturned by an administrative judge who concluded that her misconduct was not excessive and ruled her entitled to up to $15,000 of benefits, charged to my account. It seems that in California employers have almost no protections under the law. It has been six months now and the police have yet to file charges. 

What troubles me the most is not the financial loss. The charges to my account will be stretched out over a long period of time and I will be able to absorb them. What troubles me is that I placed my trust in such an untrustworthy person. I had thought that I was a reasonable evaluator of character but in this case I was fooled, which means it will be harder to trust future employees. This is particularly sad for an office that has always had a family feel about it.

My only comfort is in the knowledge that I was a just and fair employer. I paid her an excellent wage, gave her and her family free medical care and advice and even paid for her first few work uniforms. In spite of her breech of trust I will strive to do the same for others God brings my way. The fact that others are unfaithful does not mean that I cannot be. 

Her story reminds me that we love not because others will love us back but because God loves us. We serve because Christ served us. While recognition and appreciation are often lacking in this life, we serve a God who has promised to reward the faithfulness of His people.

- Bart

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