The toilet bowl baby

toilet

Simply working in a hospital is an education in itself. You see people and things that are totally outside the realm of previous experience: drug abusers, criminals chained to their hospital beds, domestic violence. And every now and then, you see something that is just totally bizarre. The case of the toilet bowl baby falls into that category.

The story began when a young woman sought care at a local clinic one frigid mid-winter evening. The clinic was busy and the woman stood in line for quite some time before even reaching the triage nurse. She told the nurse that she was suffering from abdominal pain, and, oh, by the way, she thought she was 5 months pregnant. She hadn’t had any prenatal care, but she did remember when she had conceived. The clinic was busy, the woman didn’t look too sick, and the nurse told her she would have to wait.

After waiting over an hour, her abdominal pain was worse and she got back into line to speak to the nurse again. When she reached the head of the line, she told the nurse that the pain was worse, coming and going in regular intervals. The nurse pointed to the packed waiting room and told her she just had to wait.

The pain continued to intensify. The woman got back into line. Once again she was told to wait. Now she needed to use the bathroom, and asked the nurse where it was. The nurse never even looked up, but simply pointed to the corner of the room.

Shortly thereafter, the room echoed with screams coming from the bathroom. The nurses and security guard rushed to the Ladies Room. They found the young woman sitting on the toilet, having delivered a premature baby into the toilet bowl. The staff swung into action. They clamped and cut the cord, placed the patient on a stretcher and started an IV. They left the baby in the toilet since the woman had told them she was only 5 months pregnant, far too early for a baby to survive.

The ambulance crew arrived to transport the woman to the hospital. One of the EMTs retrieved the baby from the toilet and placed it in a metal bucket. It was a tiny, but perfectly formed little girl.

They arrived at the hospital well after midnight, and an obstetrics resident went down to the emergency room to examine the patient. Dr. A. had a medical student in tow. They met the patient in an ER cubicle, examined her, and delivered the placenta uneventfully. Dr. A. briefly took the baby off to the next cubicle for a teachable moment with the medical student.

Dr. A. demonstrated the signs of death to the medical student. The baby didn’t have a heartbeat, and wasn’t breathing. The baby had mottled skin and was cold to the touch. Dead. Dr. A. also pointed out that the woman had been wrong about when she conceived. By exam, the baby appeared to at 30 weeks gestation, 7 months along. Dr. A and the medical student returned the baby to the patient’s room and went out to prepare the paperwork.

The medical student, in the way of medical students everywhere, wanted to ask the patient a few more questions. Medical students generally ask massive numbers of questions, many of them irrelevant, because they haven’t yet learned how to focus their efforts. The medical student entered the cubicle and shortly thereafter rushed out to find Dr. A.

“The baby is alive,” he yelled to Dr. A.

Dr. A. looked up from the paperwork. “The baby is not alive,” Dr. A. said, mildly. “I just showed you that the baby is dead. Remember? She had no heartbeat, no respirations. She’s dead.”

The medical student looked frantic. “She’s alive! I’m sure she’s alive! You’ve got to come back!”

Wearily Dr. A. got up to humor the medical student. They went back into the cubicle.

The nurse, in an effort to tend to more than the patient’s medical condition, had carefully swaddled the baby in an infant blanket, putting a tiny stocking cap on her head. She encouraged the fearful mother to look at her baby. The mother was amazed; the baby was so beautiful. The nurse encouraged the mother to hold her baby, having learned that viewing and holding the baby were the first steps to coping with grief. The patient seemed so pleased with the baby that the nurse excused herself to get a camera to take a picture of them together. At least the mother would have this memento.

The mother was alone in the room, still holding the baby when Dr. A. and the medical student returned.

Squeak!

Dr. A. turned to the medical student, incredulous. “Did you hear that?”

Squeak! They heard it again. And it sounded like it was coming from the baby in the bed.

Squeak! Squeak!

Dr. A., now ashen, grabbed the baby from the mother’s arms and raced toward the nurses’ station.

“The baby has come back from the dead! Quick, call neonatology! The baby has come back from the dead!”

The neonatologist rushed down. Sure enough, the baby was alive.

Of course, she had never been dead at all. What was most amazing was that the baby had been kept alive by a series of misteps.

Because she fell into the toilet and was then placed in a metal bucket, the baby was very cold. Keeping her in the metal bucket during the ambulance ride through the frigid winter night had lowered her body temperature even further. Inadvertently, the EMTs had put the baby into a hypothermic state. Her body temperature was so low that her metabolism slowed considerably. Her heart rate dropped to very low levels and she rarely breathed.

Doctors sometimes deliberately induce hypothermia in infant about to undergo complex surgery, such as heart surgery. In that state, the baby is virtually hibernating; oxygen requirements drop dramatically, and there is a much lower chance of the baby suffering oxygen deprivation and brain damage as a result.

When doctors induce hypothermia, they must reverse it very slowly in order to minimize injury. Typically, they gently warm babies over a length of time. The ER nurse, in her effort to be compassionate, had inadvertently done just that. She had wrapped the baby and placed her in her mother’s arms, where she was slowly and gently warming.

When the neonatologist examined her, the baby’s body temperature was still far below normal, but she was very much alive, with a detectable heart rate and detectable breathing. They raced her to the neonatal intensive care unit, where they slowly and gently continued the process of warming.

The mother was joyfully stunned. She had a live baby!

Dr. A. and the medical student were shaken to the core. Each of them, for a brief moment, had imagined witnessing a real miracle, a return from death. Even after they realized what had happened, they could not shake the feeling that something truly extraordinary had occured.

And the baby? The baby did great. Once she was warmed up, she had a relatively unremarkable course. She never needed a ventilator and experienced nothing more than minor pitfalls of prematurity. She was discharge from the hospital when she weighed 5 pounds, only 6 weeks after she had arrived in a metal bucket. She has continued to do well, without any lasting effects from her experience as the toilet bowl baby.

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