Help at Triage, Right Now!

About 4:30 in the morning, I heard an overhead announcement, “Help at triage for a patient to Labor and Delivery, right now!” It was repeated with a true sense of urgency.

The last time I heard a similar page, I went out and caught a baby, just before it hit the tile floor in the waiting room.

This time, rather than finding a woman about to give birth, I found an anxious looking triage nurse and an even more frantic father-to-be. I was told the patient was still out in the car and the baby was coming.

Now, this would be exciting enough at the best of times, but the hospital is doing construction right now. So, there is no way for a car to pull up near the entrance to the emergency department. I grabbed the supply pack we use for precipitous deliveries and yelled at someone to get a wheelchair. I then hurried off, already some distance behind the father.

In order to get to the street, we had to run out the door to the curb, along a temporary sidewalk flanked by construction fencing, down an even longer sidewalk and then through a final walkway between more temporary barriers. As we came to the end of the passageway, which opened onto the street, I turned to make sure someone was following with a wheelchair.

When I turned back around, I was disturbed to not see the father. I quickly scanned the temporary patient drop off area. No one was in any of the cars. Where had he gone?

A holler drew my attention up the street where a minivan was parked around the corner, just out of my sight.

When I finally got to the minivan, the patient refused to get out, saying, in her Ethiopian-accented and limited English that the baby was coming out. I quickly sized up the situation. Her fundus (top part of the womb) was still high and no fluid seemed to be wetting her pants or the car seat. I told her it looked like she was OK and she had to get out of the car so we could help her.

With prodding, the patient allowed us to slowly help her out of the minivan and into the wheelchair, which was now parked in the flowerbed next to the curb. With some effort, as she would do nothing to help herself, we got her feet up on the little footrests. Then, I took control of the wheelchair and we headed back the way we came towards the emergency department.

The patient was clearly in distress. She was not holding on or doing anything to keep from being dumped on the ground as we went cross-country in the wheelchair through the flower beds, over the sidewalk, across the street, up the temporary sidewalks and around corners. I realized I needed to be a bit careful so that I didn’t dump her out of the chair onto the ground.

Fortunately, she stayed seated until we got her to the trauma room and the only open bed in the unit.

The staff got the patient up on the gurney and pulled off her stretch pants. I grabbed some sterile gloves and was just pulling them on as the baby squeezed out onto the gurney. I grabbed him and started drying him off while the respiratory therapist suctioned his nose and mouth.

For someone who rarely delivers a baby, the most anticipated thing is to hear it cry. A good strong cry means that the baby is not going to need any immediate care from me. After a couple of weak tries, this little boy was hollering just like I wanted to hear. Then, I was able to relax a bit, hand him off to a nurse and turn my attention to the mother. Soon, they were all off to Labor and Delivery.

It was not my doctoring that made the difference in this situation. I am sure that none of the other staff would have been so confident and aggressive in expediting the patient’s extraction from the car or her cross-country trip into the hospital. However, without that, the baby would almost certainly have been delivered into the mother’s stretch pants in a dark minivan or trodden flowerbed. Everything would probably have turned out all right anyway, but I was glad for the patient that she delivered on the gurney in the trauma room with us all there ready to handle any medical emergency that she or her new baby might have had.