[Part i here: http://bikrutz.org/triblog/?p=3347
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 about her. 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 fast 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 her 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 back, 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.