An Obstetrician’s Horrible Week
Desiree Bley, an OB-GYN in Portland, OR, describes a series of emergencies, fetal deaths and extremely ill patients she recently encountered.
Much of the national conversation surrounding the maternal health crisis centers on the mothers’ experiences. But what happens to doctors who are caught in the middle of the crisis? Desiree Bley, MD is an OB-GYN in Portland, OR who frequently contributes her expertise to EMC’s blog. When we ran into her in the market, wearing her scrubs and fresh from work at the hospital, she was unable to hold back tears. She and her partners had just experienced a run of emergencies, fetal deaths and extremely ill patients, like nothing any of them had ever seen before. It knocked the wind out of her and her colleagues. We know Desiree and know that her practice is the best in the business. She’s beyond caring, highly skilled and completely professional. She’s also personal and bonds deeply with her patients. When we asked if she’d share what she’d gone through recently, she said she would. As Desiree said, “It was a very, very bad week.”
EMC: How did this bad week start?
Desiree: I had a patient in the hospital with pre-term labor and 20-week twins. It was the middle of the night and she got up to go to the bathroom and delivered one of the babies when she stood up. It just fell out. We ran in to help, but he was already born. He was extremely preterm and died right away. We got her back to the bed, took care of the cord and wrapped the baby up in a little blanket for mom to hold. She’d been carrying two boys and the other one stayed inside. The cord retracted and her cervix closed up and she’s still pregnant. It’s crazy. That’s the kind of stuff we read about and never see in real practice. It’s just sad. He was a perfect little tiny guy. Little teeny tiny feet the size of the tip of my pinky and tiny little hands. His brother is still inside and hanging on.
Then what happened?
Right around the same time, we had someone walk in with a cord accident. My partner delivered that one, but our whole practice feels the impact. It was a term fetal demise. The patient and the baby had been fine until all of a sudden, she wasn’t. There’s just no way around grief like that. Then the other night, I’d just been to the Pearl Jam concert. It was my night off and about one in the morning when I got home and the phone rings. It’s labor and delivery saying, “The lady with twins you’re inducing is here. You need to come over.” I was planning on inducing her because Twin B was a little squeaker with a two-vessel cord. I’d been watching her for a while and finally told her we have to go in and get this little guy. She was 36 weeks and 2 days but Twin B was shrinking instead of growing while Twin A, the brother, was still growing. It was a case of poor allocation of resources. Twin A was a little more successful at taking what he needed to grow and B had that two-vessel cord so he just wasn’t as good at it. The patient showed up on the unit early and I knew that if we left that little guy inside, well, God, I just couldn’t take another fetal death. We delivered them. The little man is in the nursery, stable, feeding and growing and his parents were able to take the bigger baby home.
Was that the worst of it?
Oh no, wait for it. There was more. We’ve had four severe HELLP Syndrome cases (a life-threatening pregnancy complication usually considered a variant of preeclampsia that occurs in the late stages of pregnancy or after delivery) in our maternity unit recently. You just don’t see that much normally. Our hospital had three women go through the ICU this week for hemorrhaging. One first time mother had a hysterectomy to save her from bleeding to death. It wasn’t my patient, but still…we feel it. We’re seeing a hell of a lot of HELLP syndrome all of a sudden. We don’t know what triggers this. We don’t have any proper blood tests or biopsies or risk factors. It’s just weird. We had a midwife from a local birth center call in to consult about a patient. She said, “Our patient just doesn’t feel well.” We already knew the patient a little because her baby was breech. My partner tried to do a version on her a few days earlier. She’d had labs drawn and everything was fine, but she just felt a little punk. They’d checked her blood pressure, pushed on her belly, checked the baby and nothing was abnormal. The patient had an appointment with us nine hours later to make a plan for delivering her baby when she presented in the emergency room having passed out and not feeling the baby move. What was wrong with her? She was in severe HELLP syndrome and bleeding into her abdomen. The baby was dead. Mom was in shock. We’d seen this patient just a couple days before and she was fine. Her baby was fine. All her labs were normal. There were no signs. She went from, “I just don’t feel very good,” to bleeding into her liver to rupturing her liver and being in severe DIC. It was ravenously fast. We don’t know what caused it. HELLP syndrome is on the spectrum of preeclampsia but at some point, the processes diverge. With preeclampsia, we all recognize the swelling, headaches, blood pressure, and proteinuria. She didn’t present with any of that. In fact she didn’t even have elevated blood pressures until after she delivered. Then they went up, probably because her heart was pumping as hard as it could trying to circulate what little blood she had left.
Did she live?
We did a C-section because her platelets were 60,000 and dropping. Her liver enzymes were screaming high and her baby was dead. This was a full term baby. Mom is alive.
How is the mother doing?
She hasn’t even begun to process the fact that she almost died. I just held her hand and said, “Honey I don’t even know how your heart is still beating. I don’t know how you don’t just quit being in that moment.” I don’t know how moms do that. Women are amazing. She sent me a picture of her baby’s footprints with a note saying, “Thank you for saving my mommy’s life.” This couple is very gracious. They get it that she’s lucky to be alive. The husband knows he’s lucky to have not lost his wife and his child.
What does that do to you and your partner?
All these losses happened in such a compressed period of time. I just can’t stop crying. My partner is getting counseling. We’re devastated. We’re both having nightmares. It makes me afraid to go to work. It makes going to work a little less safe because you just don’t know what’s going to hit you. I was on call this weekend thinking, Oh God, please. Just don’t let anything else happen. I can’t take it. We’re there to deliver and protect, not to do ICU medicine and to bury. We’ve seen too many women in the ICU lately and too many babies going to the morgue.
