Portal de Periódicos da CAPES

Never say never

2002; Elsevier BV; Volume: 28; Issue: 4 Linguagem: Inglês

10.1067/men.2002.125212

1527-2966

Sheila McFall,

It is March 6, 1978. I am the charge nurse in the labor and delivery department, working the evening shift. Part of my training in the early 1970s was to realize that sometimes tragedies occur here and babies are stillborn, born with anomalies, or simply too ill to resuscitate. When the unexpected occurs, we must be able to respond appropriately to the crisis and know when to call it quits… to know when “enough is enough.” Apgar scores are assessed at 1 and 5 minutes. Occasionally sick babies are given a third Apgar score at 10 minutes. If we are unsuccessful in our endeavors to revive an infant, we must be able to decide when to stop the efforts, being ever mindful that if the resuscitation has not been successful within 5 minutes, the likelihood of maintaining the infant's brain viability is markedly diminished. We are taught to believe there is a good chance the baby may suffer irreparable damage after that time interval. What a heart-wrenching event it would be if we were to learn that the infant we saved turned out to lead a vegetative life, causing unnecessary burden to his or her family as well as to society.I have a young teenager in active labor this evening. I remember the chain of events as if it were yesterday. She is progressing nicely. I ready her for the delivery room. Everything is going smoothly when suddenly the unexpected happens. Her baby is born severely compromised. There are no congenital anomalies. There is no prematurity. There were no overt signs during labor to indicate that this might occur. My new patient is a male, and I know from experience that this is yet another strike against us. Baby girls, not the boys, have traditionally been the vigorous ones when it comes to the fight for life. I call for help immediately and tell my co-worker to get the pediatrician “stat,” knowing full well he is at his home 10 minutes away. There are no ED physicians to call for assistance. This is 1978. The hospital will hire these doctors next year! The obstetrician is tending to the mother… my “other” patient now. I immediately begin to resuscitate the infant as he is handed to me. I repeatedly stimulate, suction, and ambu-bag the baby, but he remains obtunded. His Apgar scores are 1 at 1 minute and 1 at 5 minutes. Chest compressions and mouth-to-mouth resuscitation are repeatedly performed but seem futile. The infant appears lifeless, with deep cyanosis. After several minutes the obstetrician suggests to me that I stop the resuscitative measures. But I can't. I can still auscultate a heart beat, as bradycardic as it feels. My own heart tells me to keep pushing on so I continue my efforts. During the eighth minute, the baby begins to spontaneously breathe with a grunt. He is rushed to our Special Care Nursery in guarded condition, where the pediatrician starts an intravenous line and begins vigorous therapy. Hours later, I hear his family crying in the corridor outside the nursery. His grandmother is thanking the pediatrician for saving his life. I hear him say that he was not here when the baby was delivered and he directs her attention to me, saying, “Thank the nurse over there.” I remember the special chill that went down my spine as she hugged me and I felt her wet tears on my shoulder. “Please God,” I remember thinking, “Please let him be all right.”I became an ED nurse in 1982. One day I recognized this infant's grandmother in the emergency department, and she directed my attention to a beautiful little boy sitting on a pediatric bed. I melted as I looked into D.J.'s big eyes and he smiled at me. She reassured me that he was a smart, active little boy and had been blessed with no deficits. Without question, anyone could see he was the apple of her eye! Again she thanked and hugged me. Again I silently whispered a prayer of thanksgiving to God.After a busy 12-hour work day on March 5, 1999, I found a letter on my ED locker that had arrived for me during the shift. It had been sent by D.J.'s grandmother. She had enclosed a poem about what little boys are made of and she described what she thought doctors and nurses are made of. She went on to say that I had literally breathed the gift of life into her grandson, who has grown into a fine young man. He is presently attending college. His goal is to become a lawyer. The next day, March 6, 1999, I was unbelievably surprised at work when a very special gift for me arrived at the ED desk—a fluffy white teddy bear. The card read: “Twenty-one years ago today you gave us our miracle grandson, D.J. The doctor gave up, but you wouldn't let him die! Thank you for his life. Love, Papa and Grandma.”His grandmother may never fully realize what her lovely gift did for me that day. It reaffirmed how precious life is. That soft, delicate teddy bear bounced softly, reminding me that life was also fragile. No matter how hard we try, sometimes in the emergency department or delivery rooms, or throughout the hospital, the outcomes are not always happy ones. We need to put our best effort forward every day. We should relish our accomplishments and not dwell solely on our failures. Pride will come when we know we have given the best we had to give.And who knows? Maybe D.J. the attorney will some day battle medical-legal issues. I trust he will be on our side!! It is March 6, 1978. I am the charge nurse in the labor and delivery department, working the evening shift. Part of my training in the early 1970s was to realize that sometimes tragedies occur here and babies are stillborn, born with anomalies, or simply too ill to resuscitate. When the unexpected occurs, we must be able to respond appropriately to the crisis and know when to call it quits… to know when “enough is enough.” Apgar scores are assessed at 1 and 5 minutes. Occasionally sick babies are given a third Apgar score at 10 minutes. If we are unsuccessful in our endeavors to revive an infant, we must be able to decide when to stop the efforts, being ever mindful that if the resuscitation has not been successful within 5 minutes, the likelihood of maintaining the infant's brain viability is markedly diminished. We are taught to believe there is a good chance the baby may suffer irreparable damage after that time interval. What a heart-wrenching event it would be if we were to learn that the infant we saved turned out to lead a vegetative life, causing unnecessary burden to his or her family as well as to society. I have a young teenager in active labor this evening. I remember the chain of events as if it were yesterday. She is progressing nicely. I ready her for the delivery room. Everything is going smoothly when suddenly the unexpected happens. Her baby is born severely compromised. There are no congenital anomalies. There is no prematurity. There were no overt signs during labor to indicate that this might occur. My new patient is a male, and I know from experience that this is yet another strike against us. Baby girls, not the boys, have traditionally been the vigorous ones when it comes to the fight for life. I call for help immediately and tell my co-worker to get the pediatrician “stat,” knowing full well he is at his home 10 minutes away. There are no ED physicians to call for assistance. This is 1978. The hospital will hire these doctors next year! The obstetrician is tending to the mother… my “other” patient now. I immediately begin to resuscitate the infant as he is handed to me. I repeatedly stimulate, suction, and ambu-bag the baby, but he remains obtunded. His Apgar scores are 1 at 1 minute and 1 at 5 minutes. Chest compressions and mouth-to-mouth resuscitation are repeatedly performed but seem futile. The infant appears lifeless, with deep cyanosis. After several minutes the obstetrician suggests to me that I stop the resuscitative measures. But I can't. I can still auscultate a heart beat, as bradycardic as it feels. My own heart tells me to keep pushing on so I continue my efforts. During the eighth minute, the baby begins to spontaneously breathe with a grunt. He is rushed to our Special Care Nursery in guarded condition, where the pediatrician starts an intravenous line and begins vigorous therapy. Hours later, I hear his family crying in the corridor outside the nursery. His grandmother is thanking the pediatrician for saving his life. I hear him say that he was not here when the baby was delivered and he directs her attention to me, saying, “Thank the nurse over there.” I remember the special chill that went down my spine as she hugged me and I felt her wet tears on my shoulder. “Please God,” I remember thinking, “Please let him be all right.” I became an ED nurse in 1982. One day I recognized this infant's grandmother in the emergency department, and she directed my attention to a beautiful little boy sitting on a pediatric bed. I melted as I looked into D.J.'s big eyes and he smiled at me. She reassured me that he was a smart, active little boy and had been blessed with no deficits. Without question, anyone could see he was the apple of her eye! Again she thanked and hugged me. Again I silently whispered a prayer of thanksgiving to God. After a busy 12-hour work day on March 5, 1999, I found a letter on my ED locker that had arrived for me during the shift. It had been sent by D.J.'s grandmother. She had enclosed a poem about what little boys are made of and she described what she thought doctors and nurses are made of. She went on to say that I had literally breathed the gift of life into her grandson, who has grown into a fine young man. He is presently attending college. His goal is to become a lawyer. The next day, March 6, 1999, I was unbelievably surprised at work when a very special gift for me arrived at the ED desk—a fluffy white teddy bear. The card read: “Twenty-one years ago today you gave us our miracle grandson, D.J. The doctor gave up, but you wouldn't let him die! Thank you for his life. Love, Papa and Grandma.” His grandmother may never fully realize what her lovely gift did for me that day. It reaffirmed how precious life is. That soft, delicate teddy bear bounced softly, reminding me that life was also fragile. No matter how hard we try, sometimes in the emergency department or delivery rooms, or throughout the hospital, the outcomes are not always happy ones. We need to put our best effort forward every day. We should relish our accomplishments and not dwell solely on our failures. Pride will come when we know we have given the best we had to give. And who knows? Maybe D.J. the attorney will some day battle medical-legal issues. I trust he will be on our side!!