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Dead Baby

Sally TruedSally Trued

Here is the image that still comes to me sometimes in that foggy in-between state from wakefulness to sleep or from sleep to wakefulness. I am standing with my hands pressed against the glass window, looking into the trauma room. My pregnant belly is pushed up so hard against the wall below the window that it is difficult to take a deep breath. As I look into the bright fluorescent-lit room, I see in the far corner against the green tile wall, a woman on a stretcher holding a still bundle in her arms, and I can faintly hear her low, soft voice singing in a foreign language—maybe chanting—but her face is buried in the bundle so I cannot actually see her lips moving.  Then she burrows into the pink bundle and brings out a tiny hand which she holds to her cheek, and for a moment I am confused by what seems to be movement of the baby's hand itself.  She gently tucks the hand back under the blanket and continues to sing softly, her eyes closed.

It is Christmas Eve twelve years ago, evening shift, and the ER is the last place I want to be.  I am due to deliver in three weeks my third child, and I feel more tired than I have ever been in my forty-one years.  The humming rhythm of the ER is low-key tonight and I am lulled into thinking I will make it through my last four shift hours without too much trouble. But then I hear the EMS radio go off and catch the words “auto accident, multiple injured” and “pediatric arrest” and I have a terrible premonition that this one will be particularly bad.

And it is. The family from Korea was out shopping; the father was driving their car. He is a new student in grad school here; he pulled carefully out from a store parking lot onto a busy highway, but somehow he missed the car coming from his left which hit them at 50 mph, crushing the driver's side and the rear seat behind, where his 8-month old daughter was buckled into her baby seat. The father is seriously injured, the baby in arrest. The young mother and her four-year-old son, on the opposite side of the impact, are able to get out of the car. The mother crawls into the back seat, pulls her daughter out, and is sitting on the curb rocking her when the paramedics arrive. She will not let them take the child out of her arms until they finally force her to release her pulseless, apneic baby into their care.

The resuscitations are versions of the same story most of us who have been in the ER for years are familiar with. I end up working on the father, who develops one of the most dramatic, impressive and bloody tension pneumothoraces I'd ever seen, whose hemoglobin drops precipitously, who came in talking and then suddenly isn't, and who goes to the operating room emergently, only to die. The baby girl is resuscitated well beyond the usual time, every consult called, every suggestion acted upon, and still is dead. The little boy is uninjured but terrified, with unblinking eyes and will only say “Mama” over and over.  The mother has mild abdominal tenderness that will require a CT but is refusing everything until she can see her daughter.

No one wants to tell her.

As the attending in the ER, I find that I am to deliver the news that while they were happily out shopping a few hours ago, now half her family is dead. The elderly and kindly chaplain offers to go with me.  I pick up the little boy in my arms, his legs curled painfully and tightly around my belly, and we enter the mother's cubicle. At the sight of my face, the mother howls eerily, and she refuses to take her son who is crying and holding his arms out to her. She shakes her head back and forth continually as I begin to talk---there is no change as I mention her husband, but when I tell her of her daughter, she is wild with jabbering grief.

Not long after, I am called back to her bedside. Though not fluent in English, her request is clear: She asks that she be able to see her daughter again. What? Sshe wants me to bring her baby back from the orgue so she can hold her?  She looks from stretcher level at my belly—for a moment I am frightened—then she reaches out gently and strokes my belly. Her slim fingers flutter in confusion for a moment, then she looks up at me and states, “It is a girl”.  I nod.

I call the Nursing Supervisor, an immensely competent and efficient woman. There is disbelief in her voice.  I want her to return the dead baby from the morgue to the ER so the mother can hold it? The body has been down there for awhile. I must call the hospital administrator, the Risk Management administrator, the hospital lawyer, and the on-call attending for Pathology, and I do. All are silenced in their objections with the sheer, simple grief of the request.

The mother is wheeled from her cubicle into the trauma room, now clean and empty. The curtains are drawn across the windows except for one panel facing the nursing station.  She waits quietly, eyes closed, for her baby to be brought to her. The Nursing Supervisor has cleaned the baby up, and wrapped her in a pink blanket. As she enters the back door of the ER, the cacophony silences. As she passes by, a nurse crosses herself, and then I see a baby girl sleeping, black eyelashes swept across her cheeks, perfect mouth slightly open. With no change in her expression, the mother takes her baby in her arms and settles back on the nearly-upright stretcher. She leans her face into the pink bundle. I hear the rhythm of her singing, answered by the quiet beating of my hearts.

Sally Trued MD, MPH '80, earned the MPH from Johns Hopkins soon after she finished a residency in Emergency Medicine at Johns Hopkins. "This is a story about one of the most profoundly sad and moving experiences I had working as an emergency physician," writes Trued, who left clinical medicine several years ago and now works in public health in New York.



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