This patient who in the recent past has affected my life most profoundly never actually took a breath on this planet.
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I received his mother, AA, to a room on our floor shortly after midnight one night. She had presented to ER at 15+ weeks gestation with ruptured membranes and intermittent lady partsl bleeding; the OB staff suspected chorioamnionitis as the culprit. Rather than risk the infection becoming overwhelming, the decision was made to do a dilatation and evacuation later on in the morning. She was accompanied by her mother and father; her baby's father was at home.
I settled AA into her room, showed her how to use the call bell, and let her and her parents know that I was there if she needed anything. Her assessment was within what I would have expected for an early second-trimester rupture of membranes. She had received 1000mcg of Cytotec in the Emergency Department and had received 2mg of Morphine IV for pain prior to arrival on the floor. She was not in any pain and I was hoping she would be able to sleep a little before going to the OR for her procedure, as this was her first pregnancy.
About 20 minutes later, AA's father came rushing out of the room and asking someone to go to the room immediately; the only words he could get out were "the baby". I knew instantly what was happening. I got her into bed (she had gotten up to void), called for help, and could see her baby's tiny legs hanging from her lady parts. We got the OB resident to the room and she delivered the baby. Five minutes later, the placenta was delivered as well.
Throughout the entire situation, AA was amazingly calm. I talked to her as soothingly as I could and reassured her that she would be taken care of. The OB resident was very professional and reassuring to the mother, and I had great colleagues who helped me more than I can articulate.
After the delivery, I asked AA if she wanted to see her baby, and she said that she did. AA's mother did not want to see the baby, nor did she want her daughter to. When things calmed down, we talked about this some more. AA's mother asked me if the baby was well-formed, and I said that he (she delivered a little boy) was, albeit he was very tiny and his eyelids were still fused. She continued to be adamant that no one should see the baby.
This opened up an opportunity for us to talk about the grief process. I made it clear that we would not force anyone to do anything, but that often, families experiencing a fetal loss are greatly helped by seeing the baby that they have loved and cherished. Having something concrete to grieve so often helps them incorporate that soul into their lives in a meaningful way. I think, though, that more than anything, this lady was afraid that the baby was grossly malformed and did not want to see that. I think this because once we talked about how he looked, she seemed more comfortable with the idea of her daughter seeing the baby, though she herself still did not want to. That was okay by me, as long as AA got to see the child she had tried to four years to conceive.
I weighed, measured, and took pictures and footprints of this baby for her, and told her that whenever she was ready, I would bring him to her. She was ready right then; I got the baby and before handing him to her, described him once more so she knew what to expect. She cradled her son and touched him, and her eyes welled up with tears. I could tell she wanted to be alone with him. I left the room and allowed them their time and space to say goodbye. I felt very privileged to be able to give that to her.
What I will remember most, however, is this baby's father. He came after AA's parents had gone home, and after AA was finished holding her baby. I was in the room going over some paperwork stuff with them, and it hit me: I need to offer him the opportunity to see his baby if he wants. To the surprise of both of us, he said yes without a second's hesitation. I gave him the choice of bringing the baby to the room or having him come with me to where the baby was. He wanted to come with me. I'm not sure why, but I guess it doesn't really matter.
I took him into the room where his son lay wrapped in a tiny blanket, and let him know it was ok to open the blanket and touch the baby. Almost immediately, this strong, macho, man's-man burst into tears. He asked me to leave; I was happy too and told him to please take as long as he needed. I stood far enough outside the room to be available but not intrusive. I heard the sound of his weeping in the hallway and it was one of the most heartbreaking sounds I have ever heard. Tears began to roll down my cheeks in front of God and everybody, and there was not a thing I could do to stop it. I didn't really want to anyway.
Shortly thereafter, the baby's father came out and allowed as how he was finished saying goodbye. I walked him back to AA's room so they could be alone together and went to prepare the baby to be taken down to pathology. If I live to be a hundred, I don't think I will ever forget what I saw when I walked back into that room. Beside the body of this beautiful tiny boy were wet marks from the tears that his father had cried.
Daddies lose babies too, and I am forever grateful to the baby that taught me that.
