“What's happening?”
“Do it, Debra. Now,” I snap.
She moves into position and puts her hands on Alexis' shoulders, holding her down firmly. I give her a nod.
“She's in labor but her baby's in the breech position,” I explain. “I'm going to have to try to move it.”
“Move it?”
I nod. “It's a procedure called an external cephalic version,” I say. “I'm basically trying to – spin – her baby around into the proper birthing position by applying pressure from outside of her belly.
The ECV isn't a procedure that has a high success rate, but it can be done – and I'm really hoping to be one of the statistical outliers here. The moment I start manipulating her baby, I can feel it moving – which apparently sends a shockwave of pain through her. Alexis cries out and starts to sit up, her face etched with agony.
“Hold her,” I snap. “Hold her down.”
Debra manages to keep her pressed down to the table and Alexis is now wide awake. Which is good. Her eyes are open wide, and her breathing is ragged. Sweat is pouring off her brow and her entire body is tense. I keep applying pressure to the right spots and feel the baby still moving. Tears are streaming down Alexis' face and she's moaning in pain.
“It's going to be okay,” I tell her, trying to project calmness. “Just stay with me. Focus on your breathing, Alexis. Stay calm and save your energy because once I have the baby turned, I'm going to need you to push.”
She nods and grits her teeth. I have to think that on some primal level, she knows that she and her baby are in trouble right now. It's not ideal, but at least she's focused. Her mind is sharp and she's here with me at the moment.
“Where are the fucking paramedics,” I growl.
“They should be here soon,” Debra says. “They're probably trying to get through traffic.”
It takes a little time, but I finally have the baby in the right position. Alexis shudders and she screams as her body tightens up. I think she's ready.
“Okay, Alexis,” I say. “It's your turn now. Can you give me a big push? I want you to count to ten as you push. When you hit ten, relax for me.”
Gripping the edges of the table so tight, I'm half-afraid she's going to snap part of it off in her hands, she cries out in pain, but she bears down and holds it for the ten counts before going limp. Her breathing is labored, and her face is slick with a sheen of sweat.
“You're doing great, Alexis,” I say, then look up at Debra, who looks paler than I've ever seen a person before. “And so are you, Debra. You're doing a great job.”
She either didn't hear me or is too focused on holding Alexis down, and doesn't respond. I look down at Alexis again though. It's not going to be long now. The baby has crowned, and a few more solid pushes should do it.
“Okay Alexis, time to push again,” I say. “Give it all you've got for a ten count. Ready? And go.”
Her scream is loud and long as she pushes. The baby is coming, so I grab hold of it, helping to gently ease it from the birth canal. Alexis relaxes, her breathing as heavy as if she's running a marathon.
“Almost there, Alexis,” I say. “You're doing great and we're almost done. Give me one more big push. That should do it. Give me one more ten-second burst.”
She raises her head, her eyes wild and something like a snarl on her face. Alexis screams again and her body tenses as she pushes. And that does it. The baby slips out into my waiting hands and I gently take it – take her.
I look up at Alexis. She's fallen back on the table, her breathing still ragged. She's exhausted and still obviously racked with pain. Using one of the wet rags, I wipe her down and give the little girl a firm smack on the bottom. Her cries are weak, and her pulse is thready, but she's alive.
I look at Debra and see her eyes shimmering with tears. She covers her mouth with her hands and looks at the baby with something like awe etched upon her features. I marvel at the tiny baby in my hands and can't help but smile. The magic of childbirth is an amazing thing.
“Alexis, you've had a baby gir –”
I bite off my words when I see that Alexis is out. She's not speaking, not moving, and is barely even breathing. The bleed from her perineal tear is getting worse and I fear she doesn't have long before she bleeds out entirely.
“Alexis,” I call to her. “Alexis, wake up.
A group of four paramedics burst into the room and rush over to us. One of them takes the baby from me and I stand back, letting them finish it up. They cut the umbilical cord and begin working on both mother and child. Alexis is unresponsive, and the baby is barely responsive.
“I – is she going to be okay?” Debra asks me, tears rolling down her cheeks.
My gut is churning as I watch the scene play out before me. I feel entirely helpless as I watch Alexis, knowing her life is hanging in the balance.
“I hope so,” I say softly. “God, I hope so.”
The medics are loading Alexis onto the gurney and I listen to their chatter, knowing just how grave the situation is. She's going to need surgery and she's going to need it fast.
“I'm coming with you,” I say.
One of the medics turn to me and shakes his head. “Sorry, I can't let –”
“I'm Doctor Duncan Clyburne and this woman is my patient,” I interject. “You're taking her to St. Francis. That's where I work. Now, stop wasting time and let's go.”
I don't have privileges at the hospital just yet, that much is a lie. That's only a matter of paperwork, though. Now that I'm back, all I have to do is file and Janet will push me through. As much as I hate to do it, I'll even go back to the One-Percent Unit, just to make sure I can see this through with Alexis and ensure that she's okay.
The paramedic's exchange glances with each other. Finally, he turns to me and nods.
“Fine, let's go,” he says.
“Thank you, Debra,” I call out. “And I'll be back to pay for whatever damages I caused.”
She looks at me – honestly, she looks a little shell-shocked, which isn't all that surprising – but says nothing. She just gives me a nod. I hustle out with the paramedics and climb into the back of the ambulance. A moment later, we're moving through traffic Each moment that passes is a moment Alexis doesn't have. We need to get to the hospital, and we need to get there now.
“You know I can't let you in there,” he says. “Not until your privileges have been restored.”
“Gary, we don't have time to stand here debating about protocol,” I insist. “I need to be in there helping.”
“Duncan, I –”
“I'm not asking, Gary.”
He looks at me for a long moment. I'm already dressed and scrubbed in. When he saw me coming through the doors, he'd ushered me back out into the scrub room, trying to block my access – something I'm not about to let happen. Alexis is my patient. I delivered her baby and now I want to help save her life.
Gary sighs. “Fine,” he says. “You can be in the room, but you cannot assist. I'm not about to get my ass sued or fired because you don't have your privileges back yet.”
It's not ideal, but it's something. Gary is a fine surgeon and I trust him completely. I just can't stand around doing nothing while Alexis' life is teetering on the brink.
We push back through the doors and step back into the operating theater. I look around at the crew and see Sabrina standing ready to assist. Even from behind her mask I can see the surprise on her face when she spots me. I'm sure there are a thousand questions firing through her mind right now, but they're going to have to wait. She needs to be focused.
I can tell by the set of her body, by how stiff and tense she is when she moves, that she's terrified and stressed out. Not that I can blame her in the least – it's her best friend on the table in front of her. It's a situation we, as doctors, all fear might happen to us. We all know that at some point, somebody we know and love may end up on our table and that it's up to us to save their lives. As if surgery isn't stressful enough in its own right.
Thankfully, it's not something that happens often, but when it does, it can be earth-shattering.
“What happened?” she asks me.
“I'll tell you after,” I say. “She needs you to be one hundred percent here with her right now, Sabrina.”
She nods. “I'm here,” she replies. “I've got it.”
“I know you do.”
I step back and do my best to keep from butting in at the table. Gary is a fantastic surgeon and I know that Alexis is in good hands. Not that it's easy for me to sit on the bench. Especially not when it's Alexis' life at stake.
For the next hour and a half, I stand behind the team working on Alexis, my tension at an all-time high. Finally, Gary turns to me and gives me a nod.
“She'll be good as new in no time,” he says.
Sabrina and I exchange a look and a nod. The sense of relief flowing between us is palpable. They finish up with Alexis and Sabrina escorts her as they wheel her out to recovery. I walk over and shake Gary's hand.
“I'm sorry I couldn't let you scrub in, Duncan,” he tells me.
“No worries. I understand,” I say. “All that matters is that she's going to be okay. Great work, Gary. Thank you.”
He shrugs. “We – or more accurately, she – should be thanking you,” he says. “If you hadn't done what you did to get that baby out of her, we likely would have lost them both. Where did you learn to do an ECV anyway? Risky stuff, that.”
I shrug. “It was all I could think to do.”
“Don't get me wrong, it was smart thinking. But high risk and really not very common. I doubt a lot of doctors out there would have even thought about it, let alone had the guts to do it. I probably wouldn't have, to be honest.”