When A Child Is Born
Author: Laura McGregor @drlauramcgregor
17/1/18
When a child is born in YOUR Emergency Department, regardless of your training experience (which is likely to be pretty minimal let’s face it) you are probably going to be, moderately to severely, apprehensive. If you are fortunate you’ll have obstetrics and neonates on site and happy to assist you. If you are less fortunate, or chose to work in a ‘specialty light’ district general hospital cos you like the challenge, ahem, then with any luck, the aforementioned child will arrive in the car park, safely after one or two pushes, shoot into it’s (terrified) father’s arms and you can look heroic when you, well, when you do pretty much nothing apart from wrap the well pink wriggling term baby in a cosy blanket and put a hat on it. Nice work.
The good thing is that, most often, these babies (like your favourite registrar on a nightshift) are the ones that are in a rush to arrive, get started almost without you even noticing and are quite prepared to do most of the hard work for themselves. They are equally unlikely to require any assistance from you, and even if they are covered in blood and mucus (their own or that of others), they will only cry briefly (but effectively) and then crack on with seemingly reckless abandon…… as long as they are fed every few hours…. (fingers crossed the similarity ends RIGHT THERE and your favourite nightshift registrar does not need a pampers nappy or a hug from their mum to ‘settle’…… with that said, I’m going to halt this analogy).
This clinical entity is just slightly different to when your OWN child is born. Just a tad.
As a pregnant ED doctor, trainee, consultant, staff grade, whoever you are….. you have entered a new realm of fatiguing, formidable, ferocious, fragrant and frightening life. Men-folk, and any non-pregnant ED doctors, don’t feel left out, this rule also applies to you if are an ED doctor and your partner is ‘with child/up the duff’. For that matter, it also goes for those adopting small peeps, looking after their elderly or sick peeps, bereaved when one of their peeps has died, or actually not well themselves, or…. and I’ve heard this is completely true, those getting a new puppy.
Whatever semblance of work-life balance you thought you had is oot the windae.
Personally speaking, I was not very good at the whole pregnancy thing. I wasn’t very good at the ‘getting pregnant bit’ and by that I ONLY mean it took about a year of ‘concentrated effort’ (a.k.a. the good old days). I was not very good at being pregnant (HATED it start to finish truth be told) and as for ‘the finish’, the joys of labour itself, I think I would rather DIE like Oberyn Martell in Game of Thrones, shortly after that fateful moment when he (rather foolishly let’s be honest) mockingly uses a spear to hit Gregor on the butt….. THAN EVER do labour or an emergency csection ever again. Yup, I’m sure of it, death by an eyeball squooshing is the winner for me every time. And then there is the having a small baby to look after conundrum..….
“I’ve done nightshifts in ED all my life… I’ll be fine”
I went back to work after 6 months. It was tough as I had left my brain and most of my dignity and patience somewhere in the maternity theatre at our local maternity unit, but actually I felt better, and truly, happier getting back to work. Obviously THEN I had to deal with the guilt of being a selfish working mother (eye roll) and beat myself up mentally after every nursery drop off (tears, baby’s and mine). BUT the truth was, getting back to ED, where mostly A + B + hard work = C, was far, far, far easier for me than life with a newborn where-
A + B + hard work = S or 12 or xy3 and the rules were going to change tomorrow anyway, so try to keep up. I learned a lot about sleep (or lack of it) and developing a ‘daily routine’ (or lack of it) - the word ‘routine’ becomes about as popular in new parent circles as the word ‘quiet’ when you’ve had a lovely shift and the standby phone goes,… twice in a row….when you have just put your M&S spag bol in the microwave in the staff room and hit start.
I had been back at work for 10 days, when our neighbour’s 3-year-old child had a cardiac arrest. I was at home and I hadn’t known there was a failing bystander paediatric resuscitation attempt ongoing on my neighbour’s doorstep until I heard my husband SCREAMING from our front door and I thrust our baby from my arms into his and ran onto the street.
It wasn’t until after the pulse returned, the IO was inserted, there were a few gasping breaths from my little neighbour, the blue light ambulance had sped to our local children’s hospital and I had handed over care to a large, wonderful and well-prepared paediatric resus team, that I realised I was only wearing wet socks, that were far too big for me and slapping of the resus corridor floor, and non-matching maternity pyjamas, with no bra. Added to that, I didn’t have my mobile phone and any semblance of any memory of any phone number of any relative was evidently left behind with the brain cells I had lost indefinitely during labour.
It was almost 2 years later when I was woken in the early hours of a Monday morning oncall shift by our ED charge nurse to say a pregnant patient was en route by ambulance to our ED having suddenly suffered a respiratory arrest. Shortly after arrival cardiac arrest ensued and a preterm neonate was delivered by perimortem caesarean section in the resus room by a relatively junior ED doctor and general surgical junior trainee. That child has just had their first birthday, at home, where they live with their dad and grandparents.
I have told you all of these personal and patient stories for a few reasons, perhaps not that obvious in the telling.
1
If you are returning to the ED after time out, for whatever the reason, you will probably be worried and potentially doubting yourself. Please don’t. A lot of what we do as good ED clinicians is almost visceral I think. You will remember more than you think you do and that might be at the time when you are least prepared. I promise that you will remember how to do your job well and your confidence will grow as a result.
2
Please, wherever you work, keep training and learning with your team and ensure you are prepared for these high acuity, low occurrence - HALO events. Those who know me, know I enjoy teaching, simulation training and clinical human factors work. I don’t say it lightly at all, that the regular simulated practice of neonatal, paediatric and obstetric resuscitation that I do as an educational coordinator at scschf.org made a huge difference to me on a personal clinical skill level both alone on my street and in our resus room with suddenly two very sick patients at once. Work with your local specialist teams in these clinical and educational fields, and learn from them. They will learn from you too. If you want to come and join us at the sim centre any time please take a look at our website in my little list of references. You would be really welcome.
3
Look after your head. I wanted to write in a relatively light-hearted fashion about sleep deprivation, parenthood and challenging clinical cases but there is a serious side to this too. I see my now 6-year-old neighbour and family regularly, her mother and I chat in the street BUT for a very, very long time I tormented myself wondering had I done the right thing for that family as I witnessed from a distance a family life that was changed forever by an accident and a little person who will never truly be the same again. Also, as the anniversary of the ED events came round I found myself ruminating over the first birthday party of a child who was born on the same day their mother died and never got to meet her. In our specialty I know I am not alone in having sad stories to share in black and white text, that does not make me special, nor does feeling tired, overwhelmed, challenged daily and never seemingly getting the balance right. I have sought out the very important help that I needed from friends, colleagues, family and other healthcare professionals in order to keep my head healthy. Please, please do the same.
4
There is always something good to be found in the midst of the disaster. When I recently noticed a colleague writing on social media,
“Does anyone's dept have a return to work programme? Or does anyone in EM recommend any refresher courses?.......When you've only ever had 2 weeks in a row off work 11 months feels like a long time to waltz back in and crack on as normal!”
I thought, “what a great idea”, and our first RETURN to EM course is now being held on Friday 23rd March 2018. First of it’s kind in the UK and lots of wonderful EM colleagues have got on board to help deliver this one day symposium, I think it will be great…… if you have been out of ED for a while and would like to ‘Revise Everything That U Really Need’ then please do come along and join us.
There will no doubt be plenty more stories to share that day too....
References
https://scschf.org/course-category/specialty/emergency-medicine/