Lisa dozed, and, when she awoke, the red LEDs on the wall clock read one fifteen a.m. The staff had darkened the room, but she could see the reddish glow of the equipment dials, and hear the clicking and whirring of the respirators, the growling of suction pumps, and the soft discordant beeping of heart monitors. The air smelled of disinfectant, and occasionally noxious odors would intrude, escalating her desire to escape.
Lisa pushed the control button, and lifted the head of the bed to forty-five degrees. Her window faced west, so she could see the lights of the east bay, the two San Francisco bridges, and the city in the distance.
Kay Brightman, a veteran ICU nurse, came to Lisa’s side when she saw her gazing out the floor-to-ceiling window. “It’s beautiful, isn’t it?”
“Yes, but I’d sure like to be anywhere else.”
“How are you feeling, Lisa?”
“I’m tired, but I can’t sleep.”
“I know. It’s hard to sleep in this place. Maybe, if you’re stable overnight, we can move you into one of our private rooms.”
“That would be great. When did Phoebe go home?”
“She watched while you slept, and then left at eleven. She’s a great friend, and an incredible nurse. You’re lucky.”
“It’s hard to feel lucky, right now. Knowing Phoebe, I’m sure you’re under orders.”
“Coming from anyone else, I might get pissed off at her demands and her hands-on involvement, but Phoebe has a way of making us feel like we’re part of a team effort.”
“How’s the baby doing?” Lisa asked.
“You tell me. The monitor shows a stable heart rate and his pulse increases normally when he moves.”
“I don’t feel him moving much.”
“That’s normal at this stage,” Kay said as she turned to the monitor. “Speaking of the devil, here he is.”
Lisa felt him twisting, and smiled. “Hang in there, baby boy.”
No more than forty feet away from Lisa, Carla Watts and Mike were trying to communicate.
They have to hold the alphabet board at the right angle, thought Mike, or I can’t see well enough to indicate which letter I want.
“It’s a ‘P’, right?” Carla Watts, his nurse, asked.
No.
She moved her finger across the board again, until he indicated ‘yes’ with his eyes. “It’s an ‘O’.”
No, Mike blinked, turning red with frustration.
This is impossible, he thought. I can’t do this. It’s not worth the effort.
“I’m trying,” Carla said, equally exasperated. “They promised us a computerized system that monitors your eye movement to allow you to pinpoint to each letter.”
That’s great, Mike thought, if I live so long.
“Let me reposition the board, and we’ll try again,” she said.
It took about twenty minutes until she understood his first word, Carla.
“What?”
This sucks.
“It sucks for me, too,” she replied.
I need to see Lisa.
“I know it’s a big favor, Kay,” Lisa said, “but could you get me on the gurney chair so I can spend some time with Mike?”
“Let me check with Jack.”
She returned a few minutes later. “He said it’s okay. Let’s be careful.”
When they wheeled Lisa into Mike’s room, his nurse, said, “When you guys go home, I’m sending this story into the Katie Couric Show.”
“How’s he doing?” Lisa asked.
“He’s stable, Carla said, but he’s not much of a conversationalist.”
“Carla!” Lisa said in surprise. “I can’t believe you said that.”
Carla surprised herself. “Oh, please, Lisa. You know what I mean. He’s been like a lousy guest on a talk show, giving me one-word answers. It wasn’t long ago that he had that alphabet board going wild. He’s been reticent. Maybe he’s depressed.”
“I’m sorry,” Lisa said. “I should have known better.”
“He did ask for you,” she paused. “And for the baby.”
The nurses arranged for Mike and Lisa to be facing each other. Lisa grasped his left hand.
Lisa shook Mike, and said, “Mike, it’s me. It’s Lisa.”
Mike opened his eyes.
My God, there she is.
“Do you want the alphabet board?”
Yes.
Lisa was unable to hold the board for Mike, so Carla obliged.
How are you? How is my son?
Lisa gave him a sanitized version of her situation.
Are you telling me everything? Please don’t hold back. I’m either a part of this, or I’m not.
“Harvey may have to deliver the baby soon.”
How soon?
“Thirty-four, or thirty-five weeks. I have an abruption. He may not have a choice.”
After Carla left to attend to another patient, Lisa asked, “Have you tried to move?”
Yes.
“Please, try again. Try for me, and for your son. I know you can do it.”
Mike focused all his energy and his attention to his left hand.
Nothing happened.
“Try again, please.”
I’m trying, Mike thought. I’m trying.
At first, Lisa thought that her own hand muscles were contracting, as she felt the slow movement of Mike’s index finger. “Do once more.”
It moved again.
Lisa pushed the call button, and Carla entered the room.
“Is everything okay?”
“He moved his index finger,” Lisa said. “I’m sure of it.”
“I don’t think so. He’s had some muscle spasms, but nobody’s seen any voluntary movement.”
“I asked him to try. He did it. Let me show you.”
“Mike, move your finger again. Please.”
No, he told her.
I can’t. I’m exhausted, he thought.
“Please, Mike,” she said, crying. “Just once more, so Carla can see.”
No, he repeated, and then he closed his eyes.
“He did it, Carla. He moved. It’s not wishful thinking. Please believe me—I’m not crazy.”
Carla smiled, and then said, “It’s time to get you back into bed.”
Something’s wrong, thought Lisa as she awoke from her nap at seven that evening.
“Oh, God,” Lisa said, grasping her back. “My back’s killing me.”
“Where?” Kay asked.
“I’m starting to cramp, to have contractions—Oh, my God, I can’t stand this!”
Kay pushed the start button on the automated blood pressure machine, watching the flashing red LEDs until the machine read 90/50. Lisa’s pulse rate had increased to 130 beats per minute.
“The baby. What’s happening with my baby?”
Kay scanned the recordings, and became alarmed. She looked at Lisa, uncertain about what to say. “His heart rate is slowing with contractions. I’m calling Dr. Russo.”
“Get the lab to draw a blood count and clotting studies,” said Harvey Russo. “Call Jack Byrnes, and have the ultrasound machine brought up to ICU. I’m on my way.”
“What’s happening to me, Kay? I feel awful. Am I bleeding again?”
Kay checked Lisa’s pad, and saw slight reddish staining. “I don’t see any overt bleeding.”
“You mean I could be bleeding inside?”
Kay was about to respond, when the white gauze over the central IV line turned red. When she removed the dressing, blood was oozing from the site. Lisa’s belly now showed diffuse black and blue bruising. Kay covered the site with a new dressing, and a 5-pound sandbag for pressure.
“I’m feeling dizzy, Kay. How’s my blood pressure?”
Kay pushed the start button again. This time, the LEDs read 84/40.
“Did you get Dr. Byrnes?” Kay yelled to the monitor tech.
“He should be here any second,” she replied.
Just then, Jack Byrnes rushed into the ICU. “What�
��s up, Kay?”
Kay reiterated the events of the last hour. “Is she bleeding internally? Is it DIC, again?”
Jack shook his head, and then came to Lisa’s bedside. After he examined her, he asked, “How are you feeling?”
“I feel like shit. Oh, Dr. Byrnes, I’m sorry.”
“Don’t be. It’s a dumb, but necessary question. Are you still cramping? How does your belly feel?”
“I’m having labor pains. I know it. My belly is getting bigger, too.”
Jack held her hands, and said, “Harvey will be here in a moment. We must get that baby out, now.”
“No!” Lisa screamed. “He’s not ready!”
Chapter Sixty-Five (Week 34)
Jack was sitting at the nursing station reviewing Lisa’s labs, when Harvey Russo entered.
“What’s up, Jack?”
“Clinically, she’s bleeding inside the uterus, from her IV sites, and into her skin.” Holding up the lab printout, he continued, “her hemoglobin and blood platelet count are down, and the clotting studies are consistent with disseminated intravascular coagulation. It’s your call, Harvey, but I think we better get that baby out.”
Harvey went to Lisa’s bedside, and held her hands. “We’ve got to deliver this baby.”
“Please, Harvey. Can’t we wait longer, until his lungs have matured?”
“I’m sorry, but there’s too much risk to both you and your baby. He’s showing signs of distress, and if we don’t get him out…”
Just then, Phoebe arrived. She hugged Lisa.
“Harvey going to deliver the baby, now,” Lisa said, sobbing. “We don’t have a choice.”
Phoebe placed her hands on her hips, faced Harvey, and said, “What’s going on?”
Harvey and Jack filled in the details, and Phoebe turned to Lisa. “We’re going to see your son, and I mean soon.”
Jack ordered fresh blood, platelets and other clotting factors in preparation for surgery.
Phoebe held Lisa’s hand until the last moment as they rolled her into the elevator to take her to surgery. “I’m going to keep Nora and the girls company for a while, and then I’ll be down to see you and the baby. I love you, sweetie. I’ll see you soon.” The elevator doors closed.
They moved Lisa into the chilly operating room. The place bustled with scrub nurses and technicians arranging the monitoring equipment and surgical supplies.
Brad Rosin and Sharon Bridges, one of NICU’s most experienced nurses, prepared the incubator for Lisa’s baby.
Brad came over, pulled his mask down, and kissed Lisa on the cheek. “Don’t worry. Sharon’s here. We’re ready. ”
“Please, Brad, I just want him to be healthy.”
“We’re ready to count fingers and toes. Have you given him a name?”
“Aaron, for Mike’s father.”
It took Harvey, Jack, and Brad to hold Lisa in place sitting up with her body curved over a pillow. As Mickey Katz, Brier’s most experienced anesthesiologist, scrubbed Lisa’s back with Betadyne antiseptic, Lisa gasped.
“I’m sorry,” Mickey said. “Normally, we try to keep it warm.”
“It’s okay. I don’t know how long I can sit this way. I’m dizzy.”
“I should have it in a second. If not, I’ll do it while you’re lying on your side.”
“Harvey, I’m feeling…”
“Got it,” Mickey said. “Let her down. I’ll adjust the surgery table to the right position.”
“How are you feeling, Lisa?”
“Getting numb.”
“Good,” Mickey said. “If you have any difficulty breathing, or if anything bothers you, I’m right here.”
“Her blood pressure and the filling pressures in her heart are low, Jack. I’m going to give her a unit of whole blood, if that’s okay?”
Jack nodded. “Better get this show on the road, Harvey.”
Harvey and his partner, Neville McDermott, entered the room, arms raised. The scrub nurse handed each a towel, and helped them with their sterile gowns and gloves.
“Lisa,” Harvey said, “how are we doing?”
“I don’t know about you, Harvey, but I’m about to jump out of my skin.”
“I can ask Mickey to give you something to take the edge off.”
“No thanks. I want to be alert when the baby comes.”
The circulating nurse scrubbed Lisa’s abdomen with a soapy solution, and then Harvey followed with antiseptic and then he draped her belly with sterile green towels. Harvey pinched Lisa’s skin with a forceps, and asked, “Do you feel that?”
“Feel what?” Lisa replied.
Suddenly, Lisa said, “I’m going to be sick,” and then, she vomited.
“Her pressure’s coming down,” Mickey said. “The baby’s showing definite signs of fetal distress. I’m giving more blood, but let’s get that baby out.”
Harvey abandoned his usual Bikini incision, and drew his blade straight down Lisa’s abdomen. The wound bled profusely, as the nurse assistant suctioned the blood away, and he and Neville quickly clamped and tied off the major bleeders.
As a compromise for speed, Harvey made a low horizontal incision in the wall of Lisa’s uterus. Seconds later, Harvey held a tiny, blood-covered baby boy in his hands. He smiled, and said, “It’s a boy! Ten fingers and ten toes—a good start.”
Harvey handed the baby to the nurse, who, in turn, handed him to Brad Rosin.
“Is he okay?” Whispered Lisa from behind the green-sheeted barrier. “Can I see him?”
“He’s small,” he paused, and then continued, “all of 2124 grams. Let’s make sure he’s okay, and then I’ll bring him over.”
“What’s his scoring on the APGAR scale?” Lisa asked.
“It’s low,” Brad said, “but give us a few minutes then we’ll see if his score is any better.”
“Harvey, how is my baby?”
“I’m sorry, Lisa,” Brad said. “We’re taking him to NICU.”
“No, Harvey, please my baby. Let me see him before it’s too late!”
Brad paused at the head of the surgery table. Lisa looked at the tiny infant, and reached out to touch him.
“Don’t, Lisa. No time,” Brad said, as he and Sharon wheeled the incubator through the door.
“Harvey,” Mickey said. “Lisa’s crashing. Her pressure’s down to 54/30—she’s going to code if we don’t do something. Harvey—Jack—” cried Mickey, as he pushed the code blue button, and the throbbing sound of the alarm echoed through the surgical suite.
PART III
Chapter Sixty-Six
As Brad and Sharon wheeled the incubator to the elevator, they kept their eyes on Lisa’s baby.
Brad felt his abdomen tightening as he watched the tiny red-pink newborn struggle to breathe. The space between the ribs retracted with each breath and the baby grunted and struggled to breathe. His lips were now blue.
Sharon felt sick as she alternately stared at the baby, and watched the red numbers on the elevator as it slowly descended into the basement where they waited.
When the elevator stopped at the second floor, Brad shouted, “God damn these fucking elevators!”
Finally, the elevator arrived, and Sharon inserted her key into the control panel so that nothing would stop them on their way to the 4th floor, and the NICU.
As they entered the NICU, Sharon shouted, “He’s not breathing—he stopped breathing.”
Brad placed the tiny oxygen mask over the baby’s face, and delivered several small breaths. “Get ready to intubate this baby, and then get a chest x-ray and blood gases.”
After a short prayer, Brad inserted the small tube into the baby’s trachea, breathed for him several times more, and then attached the end of the tube to the ventilator.
The pulsating code blue alarm continued to resound through the operating room.
Harvey had his hands poised over Lisa’s chest, ready to perform external cardiac massage.
“Can’t you do something about that
damned code blue alarm?” Harvey yelled. “It’s driving me crazy.”
After the circulating nurse silenced the alarm, Mickey Katz, the anesthesiologist, said, “Hold it a minute, Harvey. Her tracing shows a rapid, but regular beat. I’m taking her blood pressure. Can you feel a pulse?”
Harvey reached to Lisa’s groin, held it over her femoral artery for a moment, and then moved his hand to her neck. After what seemed a lifetime to all in the room, he said, “Yes. I can feel a weak pulse. What’s her pressure?”
“It’s 60 over nothing,” Mickey said.
“Pump that blood in as fast as it will go,” Jack Byrnes said. “I’m getting a Dopamine infusion ready to raise her pressure, if the blood doesn’t do it.”
Harvey had packed the open incision with sterile towels to apply pressure to the uterus with both hands.
After five minutes, Lisa’s pressure stabilized at 84/50. Her pulse raced at 160 beats per minute.
“What’s going on?” Jack asked.
“She’s bleeding. I’m controlling it with pressure, but we must get back in to take a look.”
“Wait until this unit of blood is in, then go ahead,” Jack said.
As Harvey released the pressure on the towels and removed them, the incision boiled over with dark blood. “Suction the blood, Neville. We gotta find the source of the bleeding, or I may have to perform a hysterectomy.”
The room became silent.
“Harvey,” Mickey said, “with her clotting problems, her instability, and the size of her uterus, do you really want to try a hysterectomy?”
“No, God damn it, but if we can’t get this under control, she’s going to bleed out.”
“Jack?” Harvey pleaded.
“Let me load her up with fresh clotting factors,” Jack said, “and let’s see if the bleeding stops. Nobody wants a woman of this age to lose her uterus, so let’s try everything.”
“If that doesn’t work,” Harvey said, “I’ll try to get control of the major blood vessel to her pelvis, and then we’ll get the uterus out as quickly as possible.”
“There’s one other possibility,” Jack said.
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