And love
Chap 61 Old life, new life
A/N: The 1st part of this chapter will be a relatively detailed description of a c-section. I am a retired Internal Medicine physician; I have never performed this procedure, but have observed several. And have undergone surgeries of various types myself over the years. I have tried to be reasonably accurate.
If detailed descriptions od medical procedures makes you squeamish, or otherwise bothers you, please skip to the next section, marked off by a series of 8888.
OBSTETRICS SURGICAL SUITE
Casey Nelson (CN) has scrubbed in to assist the nurses with Eddie's newborn infants. The c-section has just begun. The nurse anesthetist (NA) has an oxygen mask over Eddie's nose, giving her O2, and is about to inject the inducing medication into the IV. She will not do this until the surgeons (S1 & S2) are completely ready to make the incision. This is to ensure that the babies get removed from the womb and their umbilical cords cut ASAP to minimize the amount of medication that reaches the infant's blood stream. Otherwise, the 1st breath may be delayed and resuscitation may be needed. Not a disaster, but to be avoided if at all possible.
NA: Ready?
S1: Not quite.
The scrub team – 2 nurses or surgical techs who are scrubbed in (hands washed thoroughly, gowned & gloved with sterile technique) are almost finished draping Eddie, exposing only the operative field.
S2: 1 minute.
NA: Ok.
S1: Ready . . . NOW!
NA: Injecting.
As soon as the NA sees that Eddie is asleep-
NA: GO!
The surgeons rapidly make a lower abdominal incision and the rush is on. The procedure at this point appears chaotic and unorganized. It is anything but. Everyone knows exactly what to do, and they do it quickly. The 1st infant is removed from the womb, appropriately tagged and handed off to Casey or a nurse. Likewise, with the 2nd infant.
While this is ongoing by S1, S2 is working to control bleeding at both the edges of the abdominal incision & the edges of the incised womb. Having accomplished that, s/he turns to delivering the placentas or another task S1 may request.
Once the babies and placenta(s) are delivered and all bleeding points are controlled, closure begins. 1st the womb, then the abdomen is sutured and dressed. The NA weans the mother off anesthesia and she gradually wakes up in recovery.
That's how the perfect case works!
PRESENT CASE
1st baby boy is handed off to Casey who does a quick visual inspection, and a quick slap on the butt. Patrick Henry Reagan takes his 1st breath, and howls at the indignation of being removed from the warm, protective environment of his mother's womb. He is passed to a nurse who cleans him up, records his weight and length, records his APGAR score, attaches his name bracelet, wraps him in a blue blanket and places a small, blue woolen cap on his head. He is then placed in a small bassinet and whisked off to the nursery. VITALS: 6 lbs., length 19". Healthy in all respects.
2nd baby boy. Smaller, as expected. Did not take his 1st breath spontaneously, even after the butt slap. Casey does 2" of CPR, breathing begins with a weak cry. She then does the visual inspection – all normal; initial bluish coloration has cleared. The nurse does the same procedure, except the name bracelet says Baby Reagan #2. He is placed in an enclosed bassinet with O2 running, and whisked off to the NICU (Newborn ICU). An extended stay there is not expected. VITALS: 4 lbs. 15 oz, length 17".
Eddie wakes up in recovery, beside her is RN Katelyn. "How are my babies, please?" Eddie asks.
"They are doing ok; I'll have a nurse come talk with you about them soon. How is your pain level right now Eddie?" Katelyn inquires.
"Ok? That doesn't sound too good. What-
Casey appears at Eddie's bedside; she heard that exchange. 'Hi Eddie, Casey here. I'll tell you about the boys in a minute. First, about you. Your pain level?"
"5 or 6." Eddie frowns in frustration.
"Sounds like you cold use some pain medication, yes?"
"Yes, I suppose," she responds, drowsily.
Casey nods to Katelyn, who prepares some med.
"Now about your little guys."
Eddie perks up noticeably.
"Patrick Henry is doing great. VITALS: 6 lbs., 19" long. Healthy in all respects. He is in the regular nursery-
"CASEY! WHAT'S THE MATTER WITH MY OTHER BABY?" Eddie is panicking.
"Easy Eddie. There is no cause for major concern-
"NO CAUSE FOR MAJOR-
"Easy, girl. Let me tell you the whole story, please." Casey takes one of Eddie's hands in both of her own, she pauses and smiles. "Let's take a deep breath, ok?" This a real test of bedside manner and patient / doctor trust!
Eddie takes a deep breath, sighs and lays back in her bed. She had tensed and partially sat up. "Ok, sorry about that. I'm ready to listen," she smiles at Casey.
"Ok. Your 2nd boy needed a little CPR. I breathed for him for 2" or so, then he took over. He was completely healthy otherwise. VITALS: 4 lbs. 15 oz, 17" long. He was taken to the NICU, mostly as a precaution. I do not anticipate that he will require a long stay there. Do you and Jamie have a name picked out for him?"
"Not yet. I have 2 suggestions, but we haven't had a chance to discuss them. When can I see my boys?"
"As soon as you are in your room, Patrick can be brought in. He can stay with you. Are you going to breast feed?"
"Yes, I need to get that started."
"Yes, you should. For baby #2, as soon as you can 'travel', you can be taken to the NICU to visit."
"Can I pump for his feedings, please?"
"Certainly; I will order the nurses to get you set up for that. I see you have had pain med; are you feeling better?"
"Yes, thanks, Katelyn." The nurse nods.
Casey checks Eddie's incision; all is ok. "I will report to Robert and Jayne that you are doing well. Any questions, my dear?"
"No, thanks so much, Casey!"
"My pleasure Eddie. I was under orders from Gregg to treat you well. 'I need her' were his exact words," they both chuckle. "You should up your fees. You've got him right where you want him!" LOL
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CATH LAB
Danny Reagan has been waiting, not so patiently, for the results of Pops cerebral angiogram. Finally, doctor Bates appears. Dr. Winters soon follows.
"Mr. Reagan, we have your grand-father's results," Bates starts. "The problem is in Henry's neck."
"Neck? But he had a TIA, a problem in his head."
"Yes, but the circulation is compromised in the carotid artery in his right neck."
"So, what exactly is the problem?"
"There is a 90% narrowing of his right carotid artery. We assume that narrowing threw off a blood clot, which temporarily cut off the circulation to a part of Henry's brain. The body's normal clot busting mechanism dissolved the clot enough that he recovered."
"But Pops is at high risk of another clot, right?" Danny surmises.
"Correct. We 'recommend surgery as soon as possible."
"How soon?"
"I have spoken with vascular surgeon, doctor Cox. By the way, he just finished operating on Jameson, your brother. He could operate on Henry tomorrow afternoon. If Henry agrees to surgery," doctor Bates voices.
"So, Pops would stay overnight and have surgery tomorrow?"
"Yes."
"Well, I will talk with him. Back in the ER?"
"We could admit him from here."
"Can I talk with him here?"
"Yes, follow us."
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SURGERY RECOVERY
Anna is Jamie's recovery nurse. "Mr. Reagan, how is your pain level?" (The age-old question)
"Ah, 4 or so, why?" He wiggles his ass, trying to find a comfortable position.
"Do you want some pain medication, sir?"
"No, I want to know about my wife and twin boys, please."
"I don't have any information about them. I'm sorry."
"Find someone who knows." He is desperate to know.
"This is the surgical recovery room. Not obstetrics."
"They are in this hospital! Use the damn phone!"
"Don't get huffy now."
"You ain't seen huffy, ma'am! Where is your supervisor?" He tries to sit up.
"Orderly!" Anna shouts.
A male staff member and an older nurse come trotting. The nurse speaks, "What's the problem, sir?"
The man puts a hand on Jamie's leg.