25 weeks and 5 days 550 g twins……..yeah holy snark.
Originally published at Perches in the Soul. You can comment here or there.
My first delivery as a pediatrician. I was pretty excited even though I knew this was the worst kind of delivery.
C-section. 25 weeks 5 days. Mom has preeclampsia to the point that she has uncontrollable hypertension, elevated LFTs, etc. The only cure is to get the babies out. The babies are 25 weeks 5 and have twin-twin transfusion syndrome. We were on rounds when the OB found us. My attending was like really, really…you realize that has like a 90% or so mortality rate, the babies die of heart failure half the time and with the extreme prematurity and that…the odds are astoundingly low that they will survive .
The parents wanted us to be as aggressive as possible. Long awaited twins…
So in the OR, I naturally did less than nothing because well the babies were dying (and I was pushed aside as a very green intern) as soon as they hit the warmers, quickly intubated and some chest compressions and the little hearts fluttered on back up to normal ranges.
Dad comes over and takes pictures and is texting on his cell phone. I stare down at my patient who really could try to die at any minute. And I look back at the Dad and his proud eyes and I can’t help but wonder that for all our attempts to explain it, how much does he understand? And what is he imagining? His babies growing up? Because barring miracles these babies won’t make it out of the NICU and they certainly if they do will be members of my tribe. Does he know that? Would I make the same decision he did?
I got to put in the UV and UA lines on one of the twins. It was amazing. I felt like a rockstar. And then I looked back down at the little one at her chest rising and falling and I realized that she belonged to someone. How quickly I forget what matters? How quickly I buy into the poor outcome theory. How quickly that I forget that at one point in my life I was set aside as a poor outcome. Yes there are some babies we should not resuscitate and who knows maybe this is one of those. But its still someone’s baby and who am I to make the decision for a parent?
I congratulate the Dad ….its still his child…his first born child. And earlier we told them that we might not even be able to resuscitate the baby and now here she is surviving. Hope is a powerful thing and I of all people should not crush it.