November 16, 2015


Sometimes your best is not enough.

Sometimes your best is not enough and the hand that holds the knife and cuts through skin and flesh and muscle is not enough, and what hurts more than anything is the hopelessness of knowing that you did everything you could. Doing everything you could doesn't feel good enough when the outcome was bad.

A stat c-section is a gamble, a Hail Mary pass, the last option when all other roads lead to disaster. It's not something undertaken lightly; it's never something we want to do. It galvanizes everyone to action and leaves hearts pounding for an hour afterward. From the moment someone flies out of the room to yell "Call anesthesia stat!" until the baby practically flies into the arms of the pediatrician, it's a headlong race against a clock where a baby's slow heartbeat ticks off seconds.

Most of the time, we get lucky. Babies are resilient; the wonders of medicine are enough to produce miracles more consistently than saints. But even with ultrasound and advanced fetal testing and genetics we cannot predict the things that take that resiliency away. We cannot predict the cord that wraps too tightly around a neck; even if we could, we can't do anything about it. We cannot predict - sometimes we cannot even name - what causes tiny kicks to cease without warning.

Sometimes, the fastest time is not fast enough. When the heart slows to a crawl and you can see its movement stop, seven minutes is a lifetime. When there is no time for anesthesia and the skin incision is under local before the patient is completely asleep, a minute from skin to baby is eternity.

When you cut to save a life that hasn't yet begun, you gamble. Most of the time, we win; but sometimes the house has the odds.