Squinting at her name badge, I asked, “GN. What’s that?” Six months into my internship, I’d seen hundreds of students – medical, nursing, anesthesia – parade through 5L, the cramped labor and delivery ward at LA County Hospital.
She smiled. “Graduate Nurse,” she answered, her blue eyes locked on mine.
“That’s what, a graduate student or something?”
Fiddling with a tube, she drew blood into a thin glass rod, preparing to spin a hematocrit. Now glistening red on the inside, she paired it with another at the opposite end of the centrifuge, then closed the cover and hit the button. The familiar whir of the machine starting up softened the sounds in the cramped lab.
“No.” That smile again. “No, I’m waiting to pass my boards.”
“Boards?”
“Nursing. You can’t be an ‘RN’ until you pass them. Even if you’ve finished school.” The machine spun down, the blood cells now separated from the serum. Grabbing the capillary tubes, she placed first one, then the other, into the protractor-like crit reader. “Thirty-two,” she announced. “Pretty good. Your turn.”
I began the process on my blood tubes, expecting her to return to her patient.
“RN,” she said.
“Uhh?” I asked, snapping one of the little tubes before I could fill it with blood I’d drawn from the grand multip who’d arrived, “Red Blanket”, from the ER minutes before.
“We say it means ‘Real Nurse.’ They won’t let me work much on my own until I pass the boards, get my license.”
I looked over. She’d stopped mid-exit, half-turned back towards me, another smile building on her lips, her eyes steady at my gaze.
“Where?”
“What?”
“Where did you go to school?”
“St. Louis. St. Louis University. They had a special one year program if you already had a bachelor’s.” She hesitated, unsure if she should share. “I want to be a midwife. A Nurse Midwife.”
I finally got the machine spinning again. “So, is that where you’re from?” Stray wisps of golden hair tinged with California highlights dangled out from her blue surgical bonnet.
“No, Santa Barbara. I went to UC Santa Barbara. I grew up here in LA.” She looked out the window, then went on, “My sister was at nursing school, told me all about her OB rotation. ‘There’s midwives,’ she said. All at once, I knew.”
“Knew what?”
“Knew that’s what I wanted. To be. So I looked around, to see how fast I could get there. First, nursing school then, midwifery, a master’s degree. Would take forever, I thought. So when I heard about this special program in St. Louis, I jumped. Took a few classes at Santa Monica College – I was an anthropology major at UCSB, didn’t have enough science – and they let me in!”
Fully facing me now, her excitement jetted out between us. Caught up in the wave, I smiled back.
“The other doctors around here, when I tell them, they almost laugh at me. Like my father – he’s a neurosurgeon – they say, ‘What for? Why don’t you just become a doctor, instead of taking work away from us.” Her eyes challenged me. “What do you think, about midwives? Would you want to work with one?”
At that moment, I’d do anything to spend more time with her. “Yeah, that’s a great idea, midwives. They can take care of the normal, the natural things for pregnant women, leave the problems for doctors. I’d work with a midwife.”
She dropped her head is if in thought. Noticing the hematocrit tube still in her hand, she twitched her lips, squinched her nose, and said, “I’ve got to get back to my patient. The junior resident wants to do a c-section, and told the intern to find out if she needs any blood set up.”
“Wait a minute. What’s your na…” Before I could say any more, she’d turned the corner, heading for 5M, the delivery and operating rooms.
My multip progressed quickly. Grayer, the no-nonsense Irish charge nurse, saw her stirring uncomfortably, and grabbed me, saying, “Dr. Truscott, you know these ladies progress half a centimeter with each contraction at this stage. That’s why they sent her up as a Red Blanket.”
“Red Blanket” meant an emergency of some sort – either the baby was in trouble or the mother about to deliver. I’d thought, after several months in the cauldron of LA County hospital’s labor and delivery unit, several hundred deliveries deep into my training, that I’d seen it all. But Miss Grayer was thirty years into her career, which began 7,000 miles away as a midwife, attending births after cycling to clients’ homes. Now she’d taken on the more demanding burden of turning brash young men (and a few women) into competent obstetricians. Using her harsh voice, greying bob-cut hair still covered by her nursing school cap, she ruled her domain without restraint, trusted by the senior residents and attending staff to keep us interns in line while they dealt with the actual medical problems continually flowing through the elevator doors.
My patient, typical of the population we saw on 5L, was a native of Mexico, arriving in advanced labor to prevent any chance of being sent back across the border to “el rancho”. Most of them had delivered several babies at home prior coming to the hospital, and probably knew more about childbirth then the newly-minted doctors ostensibly there to care for them. This lady – let’s call her “Maria Garcia”, as that’s the name fully 20 percent of them gave the admitting clerk – was quiet, silently hiding any indication of the pain she might be having from whatever uterine activity had dilated her cervix to seven centimeters. Knowing that, I should have realised that after six more contractions, maybe 15 to 20 minutes, she’d be ready to deliver. Grayer had observed that, instead of hovering near my patient where I should have been, I’d been flirting with that blue-eyed, headstrong nurse in the hematocrit room. She should have let me suffer the indignity of returning to find the baby lying in a pool of amniotic fluid between Maria’s legs, but her midwife’s antennae sensed something. Maybe the abdomen was a little bigger than usual, maybe Maria’s moans with each contraction came through on some hidden wavelength only Grayer was tuned in to, I don’t know. But the crusty charge nurse swiftly urged me to push the bed out of the four-patient labor room, across the central hall towards an open delivery “suite”.
“Nurse Hanna!” she ordered as we swept by the GN I’d just spoken to in the hematocrit room several minutes earlier. “Follow us! We need a set-up STAT in room 2!”
Wide eyes full of either excitement or fear, she glanced once behind her at the doors swinging closed to the operating room she’d just exited, and then scurried ahead to open those of Room 2. She tore the cover sheet off the delivery pack while Grayer lowered the foot of the delivery table and I swung the bed parallel to it, urging Maria to slide over. She looked up at me as if I were crazy, but Grayer gave her no option, yanking on her arm while I pushed her hips, Meanwhile, Nurse Hanna installed the stirrups and placed Maria’s legs in them, knees resting in the bare metal cups.
I turned to start washing my hands, but Grayer hollered, “Dr. Truscott! Don’t ever turn your back to the perineum when the patient is on the table!”
Pivoting around, I noticed that, yes, Maria’s perineum was indeed bulging, dark wavy hair wet with mucous peeking through her vulva.
Grayer persisted, “See, she’s already crowning a fifty-cent piece. No time!” As she spoke, Maria’s contraction ended, and the baby’s head shot back and up, no longer a force threatening to exit into our world.
I pulled on a mask, covering my mouth and nose, tying the slender paper straps across my head and neck. At the same time, I felt my gown being tied securely around my neck and waist. Soft, sure hands briefly touched mine above my shoulders, then gave me a quick double tap to indicate they’d finished and I was secure. I turned around, and looked once again into those blue eyes, smiling with admiration, re-assurance, or amusement, I was not sure which.
Whipping drapes over her legs and abdomen, I looked up at Maria, who started to squint, hold her breath, and groan as she felt the next wave hit her.
“Empuja con todas sus fuerzas!” I hollered, as she shook her head, grabbed nurse Hanna’s arm, and grunted with the effort. The baby’s head seemed to pop out effortlessly, but immediately withdrew, facing sideways towards Grayer. I grabbed it, one hand at each ear, and started to push downward. Nothing. The baby was firmly wedged in place, not going back inside, but not coming out either. I pulled again, harder, this time aiming back and in as well as down.
“Shoulder dystocia…” Grayer murmured. She edged towards me, ready to intervene.
I’d been delivering babies since I was a third-year medical student, and had seen several of these emergencies. Usually with a fat infant, the upper shoulder gets stuck behind the mother’s pubic bone while the head remains trapped by the outer opening of the birth canal, the lower shoulder wedged against the mother’s spine. It’s a true emergency; the pressure is enough to stop the baby from taking its first breath, and prevent the blood from flowing through the neck out of the brain, but not enough to stop the arteries from pumping new blood in. Quickly, the baby went from pasty white to sickening purple as the blood backed up, threatening to squish the fragile contents inside the skull. I had at most 90 seconds to get the baby the rest of the way out.
I’d already tried the first maneuver, changing the angle of birth, with no result. Next, Grayer jumped onto the delivery table next to Maria, and pushed with both hands and all her weight just above the pubis while I tried pulling once again. Nothing, the baby getting darker by the second. Nurse Hanna was transfixed, a vacant stare hiding the terror she must have felt inside.
I sighed deeply, reached in under the baby’s lower shoulder, found the arm, and pulled on the elbow to sweep it across the face. At first, harsh resistance, then a sudden snap. I knew I’d broken the baby’s humerus. Immediately, a flaccid arm flopped out. The baby seemed to drop towards the floor, and fell into my hands. Nurse Hanna woke up, and sucked the baby’s mouth out with a small blue bulb syringe. Grayer slowly sank back to the floor, brushed off her skirt saying, “You two have this under control now,” and left the room while the blond GN and I looked at each other over our masks and the now screaming infant.
“Cheryl.” She said.
“Huh?” In my panic, I’d forgotten all about her.
“Cheryl. My name’s Cheryl.”