Angels in the ER (21 page)

“Okay,” was the faint response. Hope edged closer to the stretcher, her arms still crossed on her chest.

Lori and I stepped toward the door and then turned back toward the bed.

She leaned close and whispered, “When I called Hope into the triage area from the waiting room, another patient stood up and walked over. She pulled me aside and asked me if I knew anything about Hope. I told her no, and she proceeded to fill me in. She seems to know her, or at least to know
of
her. Hope has been on the street for a while, it seems. She was a straight-A student in high school. Then she met some guy, got pregnant, and her parents kicked her out of the house. They won’t have anything to do with her. She’s lived with some friends, but that hasn’t worked out. And she’s been in and out of the shelters, but she usually just wanders off. It’s strange, but I don’t think we’ve ever seen her here before.”

“What’s the problem today?” I asked Lori.

“It’s hard to say,” she answered, looking down at the bundle in her arms. “She doesn’t make a lot of sense. I think her main concern is that the babies aren’t eating. I just brought them straight back, so I really don’t know yet. I haven’t even taken a look at them.”

“Alright, let’s see what’s going on,” I said to her, stepping back toward the stretcher. “How old did she say the twins were? They are twins, aren’t they?”

“Yes, twins. Girls. And she said they were eight months old,” Lori answered.

Eight months? That couldn’t be right. The baby Lori was carrying was tiny.

She placed the first baby on the stretcher and began carefully lifting the other one from the basket. I unwrapped the child that lay on the stretcher and was stunned. The girl was the appropriate length for an eight-month-old, but she couldn’t weigh more than ten pounds. Later, after we weighed the two of them, we would learn that this baby weighed eight pounds two ounces, a full five pounds less than her twin. She was emaciated, and listlessly rolled her eyes in my direction. She was diapered in a dirty piece of old sheet, the corners held in place with duct tape.

Lori looked over my shoulder and gasped. Then she placed her bundle on the stretcher and quickly unwrapped the second tiny girl. She was naked, dirty, and barely breathing. Lori immediately reached over to the emergency button on the wall and called for help, her voice shaking.

We shifted into a different mode. The second baby was clinging to life, but just barely. Two other nurses came into the room and we rapidly proceeded to resuscitate her. In short order we had secured her airway and had an IV going, and she was under a warming blanket. She was stable, at least for the moment.

One of the pediatricians on staff happened to be in the hospital and had come to the ER to help with this emergency. He was going to admit the child to the Pediatric ICU and had called in one of his partners to help with the first baby. Though her condition was not immediately life-threatening, she was still in a lot of trouble. With things under control, I was able to step out of room 3 and back to the nurses’ station.

Lori was standing at the counter, writing on the chart of the first twin. She looked up as I walked over, obviously shaken and upset.

“What do you think?” she asked me. “Is she going to make it? The second one? I’ve never seen a baby so skinny, so wasted. It’s terrible.”

Lori had three children of her own, a boy and two girls. A moment
ago she’d been focused on the task at hand, an experienced and effective ER nurse. Now she was a mother.

“So tiny,” she whispered to herself.

I sat down, exhausted. An hour of an adrenaline rush will wear you out.

“I’m not sure,” I answered. “She has no reserve, no body fat at all. And what was her temp—96? I thought that’s what you said.”

“Yes,” she replied. “It was 96.2. She was cold.”

“Yeah, she was cold. That either means exposure or an infection somewhere. Neither of which are going to be good. Where is the mother? And what about the other baby?” I asked.

“Hope is in the family room with the police, and the other child has been taken to the Pediatric ICU. She was starting to perk up a little after she got warm and we gave her a little bit of a bottle.” She paused, and then, “And I think someone from DSS is on the way to talk with Hope after the police are finished with her.”

“Hmm. I doubt she will ever see those children again, assuming they live,” I observed.

“You’re right,” Lori agreed. “But you know, Hope is pitiful. I think she’s devastated by this, but something just isn’t registering with her. The look in her eyes is really spooky. She’s just not there.”

“I know what you mean. Is someone from Mental Health going to come down and talk to her?”

“Yes,” she answered. “In the next hour or so.”

We sat quietly for a moment, each of us reflecting on the events of the evening. Then Lori broke the silence. “You know, I had just a minute to talk to Hope when I took her back to the family room. Right before the police got there. I asked her how long her children had not been eating, and she just sort of stared at me. Then she told me her milk had dried up about two or three months ago, and she had started feeding them whole milk. She said they seemed to like it fine, but they weren’t getting as big as she thought they should. And then she just looked at me and said, ‘I didn’t know what to do.’ ”

We fell silent again.

The first twin spent three months in the hospital and then was placed in a foster home. It remains to be seen if she will develop normally. The second twin died after two days in the ICU.

I don’t know what’s become of Hope.

He took a little child and had him stand among them. Taking
him in his arms, he said to them, “Whoever welcomes one of
these little children in my name welcomes me; and whoever
welcomes me does not welcome me but the one who sent me.”

—M
ARK 9:36-37

 10 

The
Still,
Small
Voice

After the earthquake came a fire, but the L
ORD
was not
in the fire. And after the fire came a gentle whisper.

—
1
K
INGS 19:12

S
he began to pace. It was about nine in the morning, and up until this point she had been lying quietly. Back and forth across the room she walked, her bloated belly attesting to the fact that she was full-term, maybe a few days late.

I watched her closely, keeping a reasonable, unintrusive distance. From time to time she looked at me, her dark eyes at once fearful and trusting.

But something was wrong. I was an ER doc and had delivered dozens of babies. And though I wasn’t an obstetrician, I knew something wasn’t right.

She made another pass in front of me, and when she turned I could see a small foot beginning to protrude. Then she walked over and lay down on her side, panting now. Above and behind her, the faces of my four young children were pressed against the panes of the French doors that led onto the screened porch. It was here that Scooter, our miniature dachshund, had chosen to give birth to her first litter.

The kids’ faces were excited and they looked on with anticipation. Barbara stood above them, bent over, hands on her knees. She was excited also, but this was tempered with a measure of anxiety. She was concerned about Scooter, but she needed to protect her own litter as well. This was the toughest but most important audience I had ever had.

Earlier that morning I had called our vet, expressing my concern about Scooter’s slow progress.

“Don’t worry,” she had tried to reassure me. “Dachshunds are notorious for having difficult deliveries. It’s their long, low backs probably. And don’t be surprised if you have a stillborn pup or two. In fact, maybe half won’t make it.”

“What?” I had asked, incredulous. “What am I supposed to do about that?”

“Nothing,” she had answered. “Don’t do anything. Just let nature take its course.”

I was silent, considering what she had just told me. It was contrary to everything in me to just stand by and watch.

“Call me if there’s a problem,” she added. “But everything should be fine.”

She had hung up, and I returned to the porch and Scooter’s pacing, and the faces of my children.

Scooter lay with her back to the French doors, only inches away from the glass. We had tried to make her as comfortable as possible on a couple of folded towels. I stroked her head and neck and tried to encourage her, regretting that I didn’t speak dachshund.

The tiny foot was now more visible, and then there were two. But something wasn’t right. They weren’t moving. Maybe that was normal, but…And then there was the pup. He was tiny, wet, and covered with a glistening membrane that Scooter immediately began to gnaw and bite. I watched with amazement as she nudged and cajoled her firstborn, stimulating the pup and trying to tear away this covering. How did she know to do this? I knew it was instinct, but still, it was amazing.

I glanced up at the kids, and their eyes were big as saucers. They were pointing and giggling and bouncing up and down.

Then I looked at Scooter. She had lain back down, seemingly exhausted, still panting. Another foot began to emerge from her birth canal.

And then I looked at the first pup. He was lying on the towel, completely still, not moving, not breathing. I rubbed him, trying
to stimulate the little guy, trying to get him to breathe. But nothing happened. He was dead. Glancing up at Barbara, I saw the look of concern on her face. And then I looked at the children. They were just staring, no longer giggling and bouncing up and down. They knew something was wrong.

I picked up the pup and moved him out of their sight.

Meanwhile, Scooter had delivered her second puppy. She was again nipping at the amniotic membranes and trying to stimulate this little girl. Nothing. Same as before.

To heck with this.

“Okay, Scooter,” I calmly spoke to her. “Let me see what I can do here.”

I wasn’t sure how she was going to respond, but she just looked up at me with those large, dark eyes and cocked her head. When I reached over and grabbed the pup, she didn’t whimper or make any protective movement. She just lay there, watching me.

The puppy was a tiny, lifeless form in my hand, barely covering my palm. I briefly looked up at the faces pressed to the glass in front of me. Their expressions were wide-eyed and confused. As I watched, my older daughter’s lips began to quiver. That was enough.

Using my thumbs, I peeled the slick and still-wet membrane away from the puppy’s head. Then—and I still can’t believe I did this—I put my mouth over the pup’s nose and mouth and sucked whatever mucus I could get out of her airway. I rubbed her between my hands to try to get some response, but still nothing. Then I put my mouth over hers again and inflated her tiny lungs. Four, maybe five breaths. And then with my right thumb, I began doing chest compressions. I had no idea how fast they needed to be, I just did what felt right. After about thirty seconds I stopped and watched. Still nothing. And then…her tiny head moved, just a little. And her mouth opened, and she took a breath. I rubbed her a little more, and she rolled her head again. This time, after another breath, I heard a faint yip. Scooter heard it too and looked up at me and then at her puppy. Then she lay back down on the towel. There was more work to be done.