Heart Tones

I just arrived home one early evening when I received a call from the hospital’s Emergency Department. On the other line was the Emergency Room physician who said that he needs my help on a patient that he was admitting to the ICU. After hearing the severity of the situation, I knew I had to come back to the hospital. At least it was still early and not in the unholy hour of the night.

Our patient was a woman in her late 20’s, who was brought in by the ambulance after having a prolonged seizure. Her family noted that after the seizure, she was not breathing at all. Her family started CPR and called 911. When the emergency responders arrived, they continued the resuscitation efforts and worked on her for more than 15 minutes before a stable cardiac rhythm was established.

When I arrived at the hospital, the patient was already in the ICU. She was unresponsive, intubated and hooked to a mechanical ventilator. After examining the patient and placing orders, I assisted my medical resident placed a large triple lumen catheter for IV access in the patient’s jugular vein for better management.

Not too long after, two more doctors came to the room to evaluate the patient. They brought along a heart monitor, not for the patient herself, but for the “other” patient involved.

Other patient? Yes, our primary patient was 36 weeks pregnant.

I have noted that once in a while our patient was going into a “stiffened posture.” This posturing is a tell-tale sign of a probable brain injury. To be certain, we consulted a Neurologist who came in several minutes later to assess the patient as well.

With two lives hanging in a balance, the Neurologist, the two OB-GYN physicians, and me, arrived on a decision that an emergent Caesarian delivery was necessary.

All along during our discussions inside the room, on the background, we can hear the baby’s heart tones from the fetal doppler: blup-blup-blup-blup-blup-blup-blup-blup……

*******

I entered the ICU room and the patient was lying motionless in her bed. Taped in the railing of the bed was a paper with a footprint of her newborn baby.

It had been seven days since my patient had the seizure and the subsequent cardiac arrest. Seven days since she had the caesarean section and delivered her baby. Seven days, and she had not waken up.

As I performed a thorough neurologic testing with prodding and certain maneuvers, she did not respond at all. Does she know that I was examining her? Does she know that her family was all worried and praying for her? Does she even know that she had delivered a beautiful baby boy?

Sadly to say, she has no idea at all. For she was gone. And the only things that were keeping her “artificially” alive were medications and machines.

Life is precious, yet so fragile. One moment you are a picture of health with all the promise of joy and life, then the next moment you are dangling by a thread with nothing but loss and despair. May we value and appreciate every fleeting moment of our lives.

We met with the patient’s family in the consultation room outside the ICU. They were obviously distraught and heartbroken. After explaining the facts to them, including the EEG (brain wave tracings) and brain MRI results, we gave them the grim news. The chances of a meaningful recovery was nil.

Amid the crying and whimpering, the family related to me that they just wanted to have the patient’s baby brought to her ICU room to have some time to be with her. Then, they will take her off life support.

Before coming out of the consultation room, we gave the patient’s family a token in a small box. A keepsake for her baby.

*******

In a lonely nursery, a baby was being lulled to sleep by a rhythmic sound coming from a small box hanging in his crib. It was a recorded heart tones of her mother. A mother he will never get to know.

Lub-dub lub-dub lub-dub lub-dub lub-dub………

 (*image from the net)