Not my best day

It started out pretty well. Zoë was up before 5am crying nonspecifically, but I managed to get her back to sleep until 5:30, which is my typical wake up time these days. She re-woke sweetly with a "Daddy, I'm ready to get up now." So we did. She played while I readied myself, then we came downstairs for the usual routine: coffee, cereal, the drawn-out cereal-or-waffles decision, and feeding of the impatient animals.

Then, at about 6:15am, the pager. I figured it was an obstetric patient in labor, but that didn't make sense; I'd be there in a half-hour anyway, so why page? Bad news. The patient whose baby I had delivered last week was in the intensive care unit: unresponsive, intubated, unstable. Two minutes later I was in the car, fearing the worst.

Briefly, my patient delivered a lovely baby boy last Friday evening. The labor had been complicated by some high blood pressures and extremity swelling, causing us to evaluate her for pre-ecclampsia, but the tests were negative so we elected to press on with a normal delivery. I had to use a vacuum to get the baby out, in the end, but all went well...until yesterday.

At risk of blathering on, I'll just say that headache and leg swelling got worse, and by early this morning, she was also febrile and in severe respiratory distress. ER, intubation, ICU. My colleagues were just finishing up her orders when I arrived.

Moments like this make me wish I was doing almost every job I've ever been fired from. I had no words to comfort my patient's husband, and no idea what had gone wrong in the thirty-six hours since I'd last seen my patient. I'm again at the moment of blather, so I'll rein it in.

Her picture looks a lot like pre-ecclampsia AND some kind of infection--certainly something with a big respiratory hit. We don't much like AND kinds of pictures in medicine; they disturb our desire for parsimony. We would much prefer to say that one thing went kerflooey and spoiled a bunch of other things that were going well. In this case, it appears to be a couple of inciting events.

The good news is that she did well today, all things considered. She did not die. At 7am, that wasn't so certain. She's sick. I'm hoping tomorrow morning to see a little improvement.

I have rarely felt worse than I did this morning standing at my patient's bedside in the ICU, wondering what I could have done to keep this terrible thing from happening. I don't ever want to feel that way again.

I stopped on the way home for a bit of Irish whiskey (the Protestant variety, after some debate), perhaps as a way of escape, as my theatrical training would suggest, or maybe to commune with my father, who would know what to say to me now if he were here. Turns out Brooke knew what to say. So did Zoë: "Daddy!!"

It is approaching 10pm, and I'm to be up again early. I'm off to bed once I set up the coffee maker and put a pill in the stupid cat's throat, but I needed a moment to reflect on the day. I'll go read myself to sleep now with a review of the blood supply to the cerebellum in my old clinically-oriented anatomy book.

Tomorrow will be better, right?