2. Miley
B eep, beep, beep, beep.
This beeping doesn’t increase my blood pressure. In fact, this beeping is the slow steady rhythm of someone doing well on the operating table. This beeping is what anesthesia lullabies are made of.
One word, and the OB resident on call, Lexi, rushed to help me. Together, we wheeled Annabel to the OR. There was no time to wait for transport. She did, however, find the time to teach me that the correct terminology is not “perfed,” but “ruptured.” In the moment, however, she knew I meant the fallopian tube had broken due to the ectopic pregnancy. I can’t believe it happened right in front of me, but my mind immediately went to my textbook knowledge about her diagnosis. A ruptured fallopian tube can cause bleeding, hypovolemic shock, and could ultimately lead to death–it’s why I jumped on the phone right away.
While pushing Annabel to preop, we both called in our attendings, who then rushed to us as well. The urgency of the situation was not lost on any of us.
Lexi scrubbed in faster than I’ve ever seen anyone do. I’ve watched many surgeons go through the process to wash their hands approximately ten times, scrub each finger individually, then each nail, then under each nail, then repeat, before even entering the OR. Then they dress in a sterile gown, spinning in a circle to tie it. They also don gloves, and sometimes special glasses. I don’t envy them, but Lexi looked like she managed all of that in 9.2 seconds flat.
While Lexi and her attending scrubbed in, my attending and I sedated and stabilized Annabel.
We started pressors and opened up her IV fluids to get her blood pressure back up. I can feel my scrub top sticking to my back because of how sweaty I am from hurriedly transporting Annabel, and the panic. Let’s not forget the panic. As we learned in medical school, anesthesia is 90% peacefulness, punctuated by 10% panic.
But, in truth, I’m just thankful I was at her bedside at the right time. I don’t even want to imagine what could have happened otherwise. She was in a private room, and it could have been minutes before someone realized something was wrong. Even though her husband was there, he may not have noticed the early signs and it could have taken him time to realize and find help. Minutes could have been catastrophic in this case.
I shake my head as I’m brought back to the present as I hear Lexi talking to her attending.
“You did a great job bringing her to the OR so quickly,” Lexi’s attending, Dr. Levin, says to her.
“You have to thank Miley over there. She was with the patient, consenting her for anesthesia, when she recognized that she ruptured,” Lexi says, giving me credit.
My mask hides the blush creeping up my cheeks at her compliment.
“You guys are doing the hard work over there,” I say from the comfort of my chair. Compliments always make me uncomfortable, and deflecting is my coping mechanism of choice.
“Miley, we’ll be closing in five minutes.” Lexi’s voice comes over the other side of the blue drape.
“Thanks Lex,” I say, grateful for the warning. It gives me time to adjust the medications so the patient is not in a deep sleep when we’re done and will be able to wake up from anesthesia more quickly.
Dr. Levin takes this opportunity, while they’re closing up, to do some teaching.
“What are some risk factors for a ruptured ectopic?” she asks Lexi.
Lexi is brilliant, so she answers confidently. “A previous ectopic pregnancy, a history of pelvic inflammatory disease, IVF treatments, an IUD in place at the time of conception, and endometriosis.”
“Anything else?” Dr. Levin asks, as she pulls out one laparoscope from Annabel’s abdomen.
“A history of infertility, previous surgery on the fallopian tubes, or other pelvic surgeries,” Lexi continues, letting the carbon dioxide out that surgeons use to inflate the abdomen for the procedure.
“And last question, what is the most common site of ruptured ectopic pregnancy in the fallopian tube?” Dr. Levin pushes, as she starts the reverse process of undressing, taking off her gloves first. Lexi is putting in the final few sutures. The laparotomy incisions are small, but still require a stitch or two.
This is beyond my knowledge. Although I’ve always enjoyed OB and I would have considered it as a career path, it hits a little too close to home. I don’t think I could remain emotionally disengaged from every patient I see.
As Lexi places one last stitch, she says, “The ampullary portion of the tube is where 80% of ectopics occur, Dr. Levin.”
“Excellent work today, Lexi, and you too, Miley. If you decide anesthesia is not for you, come join us.” She laughs, pulling off her gown, knowing full well it’s nearly impossible to change residencies this far into the game.
Now it’s time to wake up Annabel.