New Dream Job

I told a friend that the ultimate dream job was third-string quarterback on a Superbowl winning team. I said you get a great salary, will never get called in to play and earn a Superbowl ring. He laughed. He said wouldn't you want to play in the game. And I said what for.
Well I think I changed my mind.
See I like attending deliveries. When I get called to a delivery it means that "something is wrong". The nurse or obstetrition is expecting the baby to have problems. So if your having a baby, I guess you don't want to see me enter the room. It is not that I want something to go wrong, it's just that if something is going to go wrong, then I want to be there. You see, I feel very comfortable at what I do. When I walk into that room I can see the nervous expressions from the family, respiratory therapist and nurses. Of course they relax a little now that I am there, but they are still worried.
When a baby is born, the baby has to adapt to life outside of the womb quickly. Lungs, which are filled with fluid after to dry out and fill with air. The heart which has been shunting blood away from the lungs has to redirect it into the lungs. The blood vessels in the lungs which have been clinched tightly closed now must dilate to allow the blood in. No longer getting oxygen or having their blood filtered by Mom, the baby has to make some dramatic changes, all in seconds to minutes. One of my jobs is to help the baby make those changes and I know how to do this.
So the other day at work I get called to attend an emergency c-section. When I show up, they are wheeling mom into the room and there is a lot of bright red blood all over the bed sheets.
The OB looks at me and says "Term, abruption and we can't pick up a fetal heart rate." I have about a minute to prepare because that is how fast a good OB can get a baby out of an awake mother. I ask the nurse to get o-negative blood, saline and epinepherine ready. I prepare an umbilical line ( a plastic IV tube that goes into the vein in the umbilical cord). The baby is handed to us. He is as white as a glass of milk, no movement, no breathing, no detectable heart rate. The resident tries to intubate. This is when you place a plastic tube through the mouth and into the windpipe in order to breath for the baby. She can't see the windpipe because of blood. I ask her to step aside. I ask the nurse to place the umbilical vein catheter in while I intubate. I then suction out the mouth look inside and see a small opening with the vocal cords lining each side. I place the tube into the mouth and though the opening. We start giving breath with a bag. What's the heart rate? Not detectable. Is the umbilical line in? No. Okay start chest compressions. The baby is mainly pale white and still does not move. While I was intubating I got a call from one of the other doctors that I work with. He starts telling me about another patient. I interrupt him to ask him to come down to the help with the resucitation. We are now giving oxygen, but if the heart is not pumping blood to the lungs, we are not being that helpful yet. My partner placed the Umbilical line in while I was managing the breathing. We continue chest compressions. First we give normal saline. We still don't have blood. We ask the OB to draw us blood from the placenta. Normally there should be a couple hundred cc's of blood in a placenta. Word comes back from the OB. The placenta is dry. There is no blood. We give a second dose of saline, followed by epinepherine. We have a heart rate. The baby is seven minutes old. At ten minutes the baby makes a gasp. The blood arrives and we give a bolus of blood. We then move the baby over to the intensive care unit.
Well we saved the baby for the moment but what we did not know at the time is what did we save? Years earlier I would have told you that this baby was too far gone to have any meaningful recovery. But experience has taught me that some babies are plastic. By plastic I mean that they bend rather than break. They recover well beyond what we would ever predict. The following morning, this little guy opens his eyes and is breathing on his own so we take him off of the ventilator. Less than one month later, he leaves our hospital and at the time of discharge he had a completely normal exam. He may still have problems, but he also might not.
I told my partners that I was going to retire, because I will never have a part in saving someone who was so dead again. This baby did not have a heart rate for 7 minutes and did not take a breath for 10.
I don't know how this boy would have done with another physician at his side. Maybe he would have done better, maybe he would have died. But I feel that I had a part in giving him a good chance at life.
So when I hear the call overhead "Code C in Labor and Delivery" do I want to be sitting on the bench.
No way. Coach, put me in. I want to play.