The View from the Vue (35 page)

In 1965, the standard technique for evaluating the well-being of a baby during labor was to listen periodically to its heartbeat through the mother’s abdomen, using an especially sensitive stethoscope. This approach, identical to the procedures of a hundred years earlier, was really less than satisfactory. Listening times were short, usually a minute or less, and during the non-auscultatory intervals of five to fifteen minutes, much damage could and sometimes did occur.

The relative insufficiency of the fetuscope was illustrated by my experience with Lucy Romero and her fetus. Like Marta Garcia, Lucy was nineteen and in labor for the first time. But she was an unusual Bellevue patient in a few respects. First, she spoke flawless English. Second, she was unusually poised and mature. And third, she had a husband with her. This was most unusual of all.

A large number of the obstetrical patients at The Vue had no husbands, period. But even those who were married came to labor alone. Sometimes the husband stayed home with the kids; other times, he was reported to be out drinking with his friends. We were told by the Puerto Rican hospital personnel that it simply was not the custom in the Commonwealth for husbands to wait out labor at the hospital: it was considered weakly sentimental and even a bit unseemly.

In a year as resident in obstetrics and gynecology, I encountered exactly one husband who sat through his wife’s labor, and that was Pedro Romero. He was all of twenty, but like his wife, mature and well spoken. The reason for his exceptional behavior soon became clear: both Pedro and Lucy were not native Puerto Ricans. They had been born and raised on the Lower East Side. Thus they had had full opportunity to absorb all sorts of American customs.

This was before Lamaze had become a household word, though, and Pedro did not actually sit
with
Lucy during her labor. Except for brief visits, husbands and other relatives were not permitted on the labor floor. So Pedro paced the corridor outside labor and delivery while Lucy labored within.

Since she was not far along when she arrived, I told Pedro to put on a gown and come in. I figured it was going to be a long wait. He tiptoed into the labor room, pulled up a chair at Lucy’s bedside, and took her hand. As she had her next contraction, she squeezed his hand and moaned softly. All the color drained out of poor Pedro’s cheeks. As soon as the pain had passed, he stood up. “I think I
will
wait outside, Doctor, if you don’t mind,” he said. “I don’t like to see her having pain.”

After I had ushered him to the corridor, I went back and sat down next to Lucy. It was a slow night. She was my only patient, and for the first time I was feeling like a private obstetrician. I coached her through her contractions and gave her medication when she needed it. Periodically, I checked her progress, and then afterwards, excused myself and went outside to give a report to Pedro. His response was invariable: a smile and “Thank you, Doctor. Sounds like it’s going pretty good.”

As a matter of fact, it
was
going pretty good. Lucy made rapid progress in dilating the cervix, and by six hours after her admission, she was ready to try to push the baby down and out. With each contraction, I encouraged her to push, which she did very well. Between contractions, as she lay back in bed to rest, I listened to the heartbeat of the fetus. It was perfectly regular, and at just the right rate.

A half hour of pushing went by, and the baby was descending right on schedule; I figured that with another fifteen or thirty minutes of work, she’d be ready for an easy delivery. As her latest contraction wore off, I picked up the fetuscope, placed the end of the instrument on her abdomen, and listened.

I couldn’t hear the fetal heartbeat.

My first reaction was confusion; I checked to make certain I was listening in the right place. That issue was easily resolved, because I had marked an X on the belly at the spot where the heart sounds could be heard most easily. Then I moved the scope around, but I still couldn’t hear anything. Even allowing for the possibility that the baby had moved significantly lower in the birth canal didn’t help.

Meanwhile, another contraction had begun. Lucy pushed with all her might. When the contraction passed, I listened again. All I got was the same deafening silence.

Now my mind was made up. I knew that babies born without heartbeats can sometimes be revived, and I also knew that Lucy’s baby was low enough in the pelvis that it could be safely delivered with forceps. Quickly I explained the situation to Lucy as I simultaneously began to move her toward the delivery room. I thought about giving a report to Pedro, but decided against the idea, mostly because I didn’t want to take the time.

The nurse put Lucy up for delivery, and as rapidly as I could, I applied the forceps to the baby’s head. Then I cut an episiotomy sufficient to permit passage of one of Mr. Mack’s largest. The baby practically fell out into my hands. My heart was playing a drum roll.

As it turned out, so was the baby’s heart. The kid came out howling; it couldn’t have been in better condition. I put it into the bassinet and then spent the next forty-five minutes sewing Lucy’s bottom back together.

Why hadn’t I heard the heartbeat? I still can’t be sure. It’s possible, but very unlikely, that the heart really had stopped and that the shock of the forceps application and pull started it up again. It’s much more probable that the baby actually had moved within the uterus so as to shift the point of transmission of the heartbeat, and I simply had failed to place the fetuscope in the proper place.

It was weeks before Lucy could sit without a foam cushion under her, but she didn’t care, because she figured it had been necessary to save her baby. As much as I tried to explain that I had probably just been mistaken, she didn’t listen.

Neither did Pedro. Lucy told her husband of my wondrous deed, and the next evening, he came looking for me. He brushed aside my explanation, thanked me emotionally, and shook my hand. As he did, he tried to slip me a ten-dollar bill.

That was too much. I handed back the money and told him I had enjoyed caring for his wife and really didn’t feel right taking his money. Pedro looked hurt, but then said quickly, “Do you ride a bike?”

That took me back a little. I admitted that I occasionally did.

“Good,” said Pedro. “I’m the manager of a bike store down on Twelfth Street, I want to give you a bike, a nice ten-speed racer. My boss’ll give me the bike free, so it won’t cost me anything.”

If I looked as I felt, I looked highly dubious.

“If you don’t let me,” said Pedro firmly, drawing himself up to his full height, “I will be very insulted.”

I gave up and said I’d accept the gift, and thanked him.

“Oh, don’t thank me,” said Pedro. “It’s the least I can do, after you saved my son’s life.”

I sighed. Right behind both temples, my head began to pound.

There must be thousands of women who are as convinced as Lucy was that prompt action by their obstetricians saved their babies’ lives after the heartbeat had “stopped.” As a conservative estimate, I’d guess that 99 percent of them are as wrong as she was. On the other hand, there have to be many more thousands of women who never took their babies home because the heartbeat really did stop, and it was not detected soon enough. Today many fewer of these errors occur, thanks to the development of sophisticated electronic monitors which provide a continuous recording of heartbeat via electrodes applied to the fetal scalp. The very earliest irregularity of the heartbeat becomes immediately obvious and, where necessary, delivery by forceps extraction or caesarean section can be carried out before excessive deterioration of the fetal condition has occurred.

With all the caesareans now being performed, a readily accessible operating room is a necessity. Consequently, most modern labor and delivery suites have their own operating rooms as an integral part of the unit.

This was not the case, however, at The Vue in 1965. The only operating rooms in the hospital were located up in a different tower from the one containing the labor suite. Therefore, to get from one place to the other, we had to take an elevator down to the main floor, go through the corridors to the base of the second tower, and then take another elevator up. On the face of it, this doesn’t sound like an overwhelming burden, but elevator service being what it wasn’t, the trip often took fifteen or twenty minutes. One day I timed it at thirty-three. On that occasion, the elevator down from the labor suite passed our floor six times before the operator condescended to stop for us.

The inevitable delay was annoying, but usually not significant. In doing most caesarean sections, a half hour one way or the other didn’t matter. But this was not invariably true. Sometimes there were indications that the baby was in trouble and should be delivered immediately. In other cases delay would have hazarded the life of the mother, for example when unstoppable uterine hemorrhage was taking place.

Thus, once again thrown upon his ingenuity, the Bellevue house officer was forced to solve yet another problem in makeshift, but semi-workable fashion. We had learned that a doorway in the operating suite led directly out onto the roof. The next crucial bit of data was the fact that a similar portal opened to the roof from the top floor of the tower containing the labor suite. We added up two and two and arrived at the conclusion that we could cut out one of the elevator trips. All that was necessary was to run the patient on her stretcher across the open rooftop of Bellevue Hospital.

About ten o’clock of an April morning, a woman whose name I never did get the chance to learn was admitted in labor. As I prepared to examine her, her bag of waters ruptured with a bang sufficient to spray amniotic fluid all over the opposite wall.

I put on a glove and examined the patient, and to my horror discovered that the worst had happened. With the rupture of the amniotic sac, the umbilical cord had prolapsed from the uterus into the vagina. I could easily feel three or four loops of it there.

I counted the pulsations in the cord at 130 beats per minute, a normal rate. But the danger existed that the baby’s head might descend into the pelvis, compress the cord, and cut off the baby’s supply of blood and oxygen from the placenta. Therefore I briefly explained the situation to the patient, apologized in advance, and extended my intravaginal hand tonsilward, to keep the baby’s head high and off the cord. Then, at the top of my lungs, I bellowed out the two words that produce a frenzy in every delivery room in Christendom:

“PROLAPSED CORD!”

Nurses, doctors, and aides materialized as if by spontaneous generation. No one said a word; the routine was down pat. One nurse hastily shaved the patient’s abdomen. A resident scanned the prenatal record for any information that might be worrisome in regard to the upcoming section. Another resident passed a tube into the patient’s stomach to suck out the food and gastric juice that might otherwise enter the lungs during administration of anesthesia. Someone else called to alert the operating room. And through it all, I stood with my hand holding up the fetal head.

The chief resident strode into the room and took in the frantic scene. “What’s the heart rate?” he said brusquely.

“I’m getting 130 a minute and steady,” I said.

“Good,” he said. “Let’s go.”

The shaving nurse swiped at a few stray strands of pubic hair.

“Come on,” the chief barked. “I said, let’s move it.”

A hideous thought began to dawn on me. “How am I going to keep the head up, running alongside the stretcher?” I asked.

“You can’t,” the chief answered. “It’s impossible. Get up on the stretcher and lie down.”

I looked first at the patient and then back at the chief. “There’s no…room next to her on the stretcher,” I faltered.

“Then I guess you’ll have to get on top of her,” said the chief.

I stood frozen in place. Was he pulling my leg?

“Come on, God damn it, get up there,” roared the chief. “Or do you want to wait till the cord stops pulsating?” His tone was harsh, but there was a little smile around the corners of his mouth. Who says fraternity initiations are dead?

I climbed aboard my incredulous patient, set my hand and arm firmly in position, and the nurse covered the two of us with a sheet. Then the chief and the senior resident wheeled the stretcher out of the labor suite and into the corridor. At every turn, I swayed and rocked perilously, but falling off was not my central worry. I just prayed I wouldn’t see anyone I knew.

The senior resident pushed the emergency buzzer on the elevator, and not more than four minutes later the doors opened and we were being whisked to the top of the tower. My rigidly held forearm was beginning to throb in syncopation with the beating of the cord.

We flew off the elevator and began our journey across the roof. We shot around a corner, the sheet blew off, and I threw my free hand around the patient’s neck or I’d have been a goner. That’s when it happened. There was a gang of workmen scraping paint off the wall, and as we went past, they dropped their scrapers and stared at us in a unit. A cigar fell out of one gaping mouth.

A breathless “Jesus Fuckin’ Christ!” floated after us as we zoomed through the doorway and into the operating area. The senior resident snickered and the chief guffawed. I didn’t even smile, if for no reason other than I was in agony. Spasms of pain were shooting up from my wrist to my armpit.

As they shifted the patient to the operating table, I was able to get off her and stand up, but I still had to keep my hand in place, lest the head descend. If truth be known, by that time, I no longer cared whether the head descended, stayed in place, or even flew around in concentric circles. I even felt a little sorry I had started the whole thing. I was afraid my whole arm was going to fall off, and afraid that it might not. Compared to my assignment, that little Dutch boy at the dike had a picnic.

But I stayed in place until the other residents cut the woman open and extracted the screaming baby. At that point I fled out of the operating room even faster than I had come in. Frantically massaging my tingling arm, I headed down the hallway toward the elevator. No power on earth could have gotten me to walk back across the roof, past that platoon of goggling paint-scrapers. I cringed as I thought how I must have looked, lying on top of that woman, with my hand up to the elbow in—my God, I couldn’t stand it! It was weeks before I could again examine a woman who had ruptured her bag of waters without feeling utter panic.