Dr. Galen's Little Black Bag: Stories. R.A. Comunale M.D. M.D.

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СКАЧАТЬ adults. Put a tourniquet around the arm, watch carefully as a vein pops up in the elbow crease and, voila! You get your blood sample.

      Babies are different. They are like very old people, whose veins in their arms and forearms are deeply buried and inaccessible. Instead, babies have nice, juicy scalp veins on either side of their heads.

      Chuck was very good at taking tests and reasoning from point A to point B. If you needed blood from an arm, you put a tourniquet around the arm above the vein.

      And if the patient is an infant? Chuck’s reasoning was very logical: for a scalp vein, well, you place a tourniquet around—you guessed it—the baby’s neck!

      I stopped him just in time.

      Chuck was advised to switch to a Ph.D. program, and he did well at it. Years later I heard that he taught comparative anatomy at a university and was made the faculty adviser for students who sought to enter the healthcare field.

      Sometimes I saw miracles.

      “Galen, she needs an exchange transfusion.”

      The pediatric chief resident possessed the Wisdom of Solomon. Stuart Zelany was an older man, an engineer who had finally found meaning in life by returning to school, obtaining his M.D. then specializing in what he loved best: children. He, like Agnelli, was a doctor’s role model, a resident who made you want to stay late and observe even when you weren’t on call.

      “Here’s the scoop, guys,” his deep voice rumbled.

      He was, to us kids, the Old Man—he was over forty!

      “This baby has ABO incompatibility, and its red blood cells are being chewed up by maternal antibody reaction.”

      It was one of those genetic, toss-of-the-dice situations. The blood type of the mother and her baby did not match. Enough of the non-matching cells had managed to cross over into the baby’s circulation before birth, so a destructive process had begun that caused the baby’s red blood cells to break apart.

      Little Tyra, who was not quite one day old, wouldn’t survive another twenty-four hours, unless…

      Zelany, mesmerizing us with his calm, steady voice, pointed out the increasing jaundice (yellow skin) and swelling in little Tyra’s face and abdomen. He had us obtain special blood samples for blood typing and cross-matching. Then he demonstrated the technique of putting a catheter—a plastic tube—in the large vein in her belly button.

      Slowly he removed some of the baby’s damaged blood into a large, special syringe and then, oh-so-carefully, gave Tyra the new blood. For each small amount of bad blood removed, an equal amount of good blood replaced it. The biggest danger was trying to remove and replace too quickly. That would overload the baby’s heart and cause it to fail.

      To this day I can see Zelany’s ham-hock-sized hands gently holding that little baby and crooning over and over, “It’s okay, little one. It’s going to be okay.”

      It took several hours. We stood, watched, helped when we could, and even prayed silently. We exhaled only when Zelany smiled and said “done.”

      Tyra became a grandmother forty years later.

      Amazingly soon third year was coming to a close with our last rotation in obstetrics and gynecology.

      June immediately demonstrated her uncanny ability with the young, pregnant women in the prenatal clinic. There was a light in her eyes whenever she had the opportunity to assist a resident or attending physician in the birth of a baby or the surgical correction of a woman’s pelvic problem. It was obvious to the rest of us that The Model had found her calling.

      Dave had no such interest.

      “City Boy, I’ve helped birthing in too many horses and cows to want to do it all my life.”

      Bill’s skill and empathy made him stand out, but, he, too, did not have the fever for OB/GYN work, and Peggy and Connie preferred general medicine and pediatrics.

      Me? I also found great satisfaction in catching babies. June and I were the only students whom the residents allowed to perform simple deliveries on our own. It almost became a contest to see who could deliver the most vaginal (normal) births.

      I would like to say that I let June win, but she beat me fair and square.

      I probably would have followed June into an OB/GYN residency except for one incident.

      “Mr. Galen, would you like to assist me?”

      It was a singular honor. Dr. Tully, the department chairman, was dealing with what he called an unusual situation, and all the other residents were involved in other cases. June also had a full schedule.

      By then I was an old hand at suiting up and performing the pre-op, surgical-scrub ritual of cleaning one’s hands and forearms before being assisted by the scrub nurse into sterile gown, latex gloves, and face mask.

      I entered the OR and was startled to see that the patient lying on the table was a child. According to her chart, Saranda was only eleven years old. But she had been raped by her older brother, and Mother Nature had played the cruelest trick by allowing this girl to physically mature earlier than normal.

      This child was going to have a baby.

      I looked at the department chairman, a distinguished OB/GYN, and he saw my look.

      “Saranda has a problem, Galen. Her pelvis is too small to deliver naturally. We’re going to have to do a C-section.”

      Caesarian section: a procedure involving opening the abdomen, lifting the uterus up, and opening it to extract the baby, which couldn’t escape any other way without hurting itself or its mother.

      As the young girl was being anesthetized, Tully whispered to me through his mask.

      “There’s a problem with the baby, Mr. Galen.”

      I held the retractors and helped mobilize the uterus. The surgeon’s scalpel quickly made an opening.

      There was an audible gasp from the entire operating team, as we stared at what came out.

      Nature is not nice. It doesn’t care what we want or expect. I saw a misshapen creature with very small head. Everything was wrong.

      “Mr. Galen, God help us, it’s a fetal monster.”

      No, this was not some horror or science-fiction movie. When the genetic dice are tossed, sometimes they come up craps.

      The term fetal monster is used to describe a malformed, genetic mistake. It can take many forms and appearances. The one kind thing about such a situation is that the baby is either born dead or does not live more than a few moments.

      Such was the case with Saranda’s baby.

      I decided then and there that obstetrics was not my field. Maybe June would have felt the same. I’ll never know—and I never told her.

      I can still hear Saranda’s groggy voice as she awoke out of the anesthesia.

      “Can I hold my baby?”

      We СКАЧАТЬ