My exhausting twelve-hour shift at Beth was just a minute from ending one day in 2003 when I found myself in the center of a tragic reproductive mystery. The previous night had been a breeze—a few runny noses, a dog bite, and a couple of pediatric ear infections. As I glanced up at the clock one final time, the doors to my left swung open, and my replacement, Dr. Jones, strolled in, looking fresh and ready to take control. All I had left to do was sign out my two remaining patients, one of whom had an upset stomach that I was hydrating with saline and the other a heart patient with chest pains that we were monitoring closely.
In emergency medicine, the sooner you master the overnight shift, the better. But no matter how many times I worked it, I just never got used to staying up all night. This day was no exception. My brain had reached overdrive, and my red, bleary eyes gave away my exhaustion. I was just about to bid my colleagues good-bye when I heard a commotion brewing to my right. Looking past the tight circle of nurses, technicians, and residents, I managed to make out a woman slouched in a wheelchair being rushed into the department. Her head was flung backward, and her arms hung limply at her sides. She looked pregnant and appeared to be unconscious. Instincts and adrenaline kicked in. Only a few feet separated me from Dr. Jones, who was moving toward us, but in matters of life and death, seconds are crucial. I was closer, so I sped to the patient’s side.
She appeared to be in her early-to-mid-thirties and about thirty to thirty-five weeks pregnant. As the staff lifted her from the wheelchair onto a stretcher in the resuscitation room, I started my rapid-fire battery of questions.
“What happened?” I yelled in the frenzy.
My colleagues chimed in what they’d been able to piece together quickly when they ran to the door after hearing her husband’s frantic pounding on the emergency room window: She’d suddenly started having trouble breathing at home, and as her husband was rushing her to the hospital, she lost consciousness. An emergency room respiratory technician delivered oxygen through a bag valve mask, a lifesaving device used to push air into the lungs. I instructed the junior resident to take over and the senior resident to prepare for intubation, the placement of a breathing tube into the patient’s windpipe or trachea. In search of a pulse, I placed my right hand on her femoral artery, one of the major blood vessels located in the upper thigh—but I felt nothing. I heard no heartbeat through my stethoscope either. There was no chest wall movement, no breathing. I started CPR and yelled for a nurse to page the obstetricians. An E.R. technician pulled a metal footstool to the side of the stretcher, jumped atop it, and started pushing on the patient’s chest, performing compressions as if his own life depended on it. This would help circulate the blood throughout the patient’s body and deliver it to her vital organs—the heart, brain, and kidneys—as well as to the unborn child. We had to get her blood moving; it was our only hope. The wait for the obstetricians seemed to take forever, but they arrived in only about two minutes, panting from their sprint to the emergency department. They recognized the medical emergency right away. Seconds later, they were gloved, scalpels in hand.
The only chance of survival for both the child and mother was to deliver the baby immediately via C-section. Normally the surgery is performed with general anesthesia in a sterile operating room, but there was no time. It had to be done right then to allow the child a chance to breathe on its own. The obstetricians made a straight incision from the top of the patient’s abdomen down to her belly button. They cut the uterus in a similar fashion, pulled the baby from the womb, and cut the umbilical cord. It was a boy. His dusky purple skin was covered with blood and amniotic fluid. Miraculously, we managed to get a slight pulse and heartbeat, but even after we administered oxygen, the infant’s color remained dull. A nurse paged the neonatal doctor, who arrived shortly for a more thorough examination. I watched closely as the infant was placed onto warm sheets in an incubator and rolled away to the Neonatal Intensive Care Unit.
As the obstetricians did their part, tending to the baby, I did mine, caring for the mother. We tried epinephrine and atropine, squeezed a saline fluid through the central line, and kept up the chest compressions. Still, we got no response, no blood pressure, no spontaneous respirations, not even a flicker of life. There wasn’t a soul in the room who didn’t feel the weight of the situation, and no one was giving up. But unlike on television, the cardiac monitor didn’t suddenly start chirping after all the heroic medical measures. This wasn’t Hollywood. This was Newark. This was real life, and the flat line on the monitor wasn’t flinching. Sweat was now pouring from our foreheads, and all eyes remained fixed on the patient. But as the truth became evident, a few eyes began turning toward the floor. Our patient was dead. She had been dead when she’d arrived. I’d known it then but had been hopeful we could somehow trick death and snatch her back. I pronounced her dead at 7:45 A.M.
Her husband was out in the waiting room, completely unaware. I asked a nurse to escort him to the family room, a more private place for relatives to receive news about their loved ones. The windowless room with its white walls and uninspiring canvas painting felt sterile and cold, but it was at least secluded. I stripped off my bloody gloves, scrubbed my hands, and took a deep breath, preparing for the most dreaded part of my job. The nurse soon returned with news that the husband was in the family room with two small children.
“What?” I blurted. “Two kids?”
As if her death were not tragic enough, she had two other children who had just lost their mother? What could I say to her husband? My head was pounding as I headed for the small room where they were waiting. I stepped inside and noticed two boys, who appeared to be about three and five years old, hugging the father’s legs. Both boys had to be the couple’s children; they were the spitting image of their mother. My presence made them uncomfortable, and they tried to hide their faces. I made eye contact with their father, Mr. Thomas, who looked up at me with an expression of fear mixed with hope that I’d never seen before. I stuck my right hand out to introduce myself.
Instead, he grabbed my shoulders and demanded, “Is she okay? Please, Doctor, tell me she’s all right.”
Before I could respond, he continued speaking, quickly, describing what had happened at the family’s home before he brought his wife to the hospital: “She said she couldn’t breathe, and I called the ambulance, but they never came. We waited and waited, but they never came. She looked like she was getting worse, so I took her to the car and drove her here as fast as I could. Tell me she’s all right! Tell me I did the right thing!”
I jumped in to assure him: “You did. You did do the right thing,” I said.
His words kept flowing. And the more I learned, the angrier I became that the city’s emergency medical system had failed this woman. She was a nurse, and she was in the final two weeks of her pregnancy, her husband said. The family lived in Newark, and he’d dialed 911 several times. Each time, a dispatcher informed him that an ambulance was on the way. Finally, he loaded his wife and children into the car, racing to the closest hospital. On the way, he could see his wife struggling to breathe, and just minutes before they made it to Beth Israel, she went limp. He kept calling her name, but she didn’t respond. He pulled up to the ambulance bay, jumped out of the car, and knocked on the window of the emergency department so hard that only the thickness of the glass had kept it from shattering.
Knowing how desperately Mr. Thomas had tried to save his wife only made the news I was about to deliver even more tragic. I’d needed to sit for this conversation, but Mr. Thomas had rushed over to me with the boys in tow.
“We did everything we possibly could,” I began, “and you have a new seven-pound baby boy. He was delivered by one of the fastest cesareans I’ve ever seen. Miraculously, we were able to get a pulse and blood pressure. He’s very sick, but he’s hanging on.”
I paused. “But your wife, she was unresponsive,” I said, continuing. “We did everything we could.”
The gravity of the situation seemed to wash over him. “What are you saying? My wife is dead?” He shook his head, looked at his sons, then to me again. “Are you sure?”
I nodded slightly. “Yes. Mr. Thomas, I’m very, very sorry.”
His expression, or lack thereof, is something I will never forget. An empty stare with depths beyond the ocean floor is the best way I can describe it. He looked at me with the saddest eyes.
“What am I to do?” he asked. “Tell me, what am I to do?”
“Mr. Thomas, you have a newborn son and two other little boys who need you now more than ever. I know it is difficult, but you have to be strong.”
My words meant little. “You can take the baby,” he told me. “Without my wife, I can’t do it. I need my wife.” He looked around the room, and back to me once more, almost frantically. “Give me my wife! What am I supposed to do?”
I had no answers. All I could muster was a meager “one day at a time.” Mr. Thomas collapsed onto the striped beige sofa. Everything about his life had just changed with unbelievable abruptness. I knew he needed a moment alone with his children to grieve. I again expressed my sorrow, then left to call the medical examiner. Since Mrs. Thomas was a young woman with no known disease, her body would be held for an autopsy. Tests would have to be performed to determine the cause of death. I had absolutely no idea what they would reveal. Nothing made sense.
When I returned to the family room, Mr. Thomas was curled in a fetal position on the sofa; the children stood next to him. He opened his eyes and begged, “Please give me my wife’s body. Let me take her home.” He rose slowly and described a ritual that had been performed for generations in his native Haiti to loosen the seriously ill from the grip of death—prayers, a chant with a hymn, water and oils sprinkled over the loved one’s body. “I’ve never tried it, but I know it will work,” he pleaded. “Please give her body to me. I have to take her now if there’s any hope.
“I cannot take care of my children without my wife,” he continued. “I need my wife! How will the new baby survive without his mother?”
His words weighed on me. My shift was over, and so I just sat with him. I explained that the medical rules would not allow me to let him take his wife’s body home but that he would be allowed to see her and say good-bye. He was clearly on the edge emotionally, but I managed to get names and contact information for additional family members. The staff kept their eyes on his children. The boys had just lost their mother and now watched in confusion as their father fell apart. Soon, other grief-stricken family members began to arrive. They were understandably in shock and repeatedly asked the same question that was on my mind: How did this happen? When I finally left the hospital, Mr. Thomas had been admitted for an overnight stay and was being sedated.
Later that night I returned to the hospital for my next shift and received a tragic update: The baby had died, too. The poor child had never stood a chance. He’d spent his short time alive experiencing multiple complications, including seizures and periods of unresponsiveness. Those few minutes without oxygen had caused irreversible damage to his organs. I wanted to attend Mrs. Thomas’s funeral. Even though she most likely had died before she’d reached the emergency room, I felt connected to her.
She was a fellow medical professional who had chosen to live in the city over the suburbs, a rare choice among young professionals working in Newark at the time. In the decades after the 1967 riots, census records show, Newark had lost 100,000 residents, mostly middle-income, both white and black. It was a devastating drain of talent and resources. By the time I returned home in 1999, though, the city seemed to be inching back toward a long-promised revitalization.
Politicians had finally figured out that packing poor families on top of one another in huge, poorly maintained high-rise complexes only increased crime. So the 1960s-style public housing projects that had helped to give Newark the moniker “Brick City” were being imploded and replaced by garden townhouses. But what would this revitalization mean if the city couldn’t provide basic services to protect residents like Mrs. Thomas, who’d decided that life in the city was worth the trouble?
Unfortunately, the medical examiner’s report shed no new light on her death. It said only that she’d died of cardiac arrest. I already knew that; I was the one who’d written it on her chart. What I wanted to know was why: Why had her heart stopped? Why had a previously healthy young mother suddenly stopped breathing? I researched the possibilities and suspected a blood clot, or what’s called an “amniotic fluid embolism,” a rare condition in which amniotic fluid or fetal hair, cells, or other debris somehow get caught up in the circulation of the mother’s blood flow from her heart to her lungs, causing both organs to shut down abruptly.
There’s no telling how many minutes really had passed from the time Mr. Thomas first called 911 to the moment he decided they could no longer wait for help. In a crisis, passing seconds can seem like an eternity. And when a patient goes into cardiac arrest, every moment is crucial. The time it takes for help to arrive can mean the difference between life and death. A patient can die, or suffer permanent brain damage, if not treated within four to six minutes of the heart stopping.
And too often, emergency help doesn’t arrive quickly enough. An investigation published in 2005 by USA Today found that emergency medical systems in fifty of the country’s largest cities are slow and inconsistent and save only a small fraction of the victims who would be saved with the help of improved response times. A myriad of problems—infighting and turf wars between fire departments and ambulance services, inconsistent ways of measuring performance and response times, the lack of leadership around the issue—contribute to the delays, the investigation found. Cities that have addressed these issues head-on and improved the true time from the initial call for help to the delivery of medical services save many more lives.
I will never know for sure whether any of these potential problems contributed to Mrs. Thomas’s death. But I am haunted by the thought that a young mother who spent her days helping to save lives had no one there to save hers in the moments that mattered most. In the end, I decided against attending her funeral. I worried that my presence might only pile on to the family’s grief, reminding them of that fateful day in the emergency room when their lives changed suddenly and forever.
I never expected to learn what happened next in the family’s life. But about a year later, I was working an emergency room shift at another hospital when I entered the room of a patient who had sprained his shoulder lifting a heavy object. As soon as I walked in, I recognized the man accompanying my patient. It was clear from his expression that he recognized me, too. It was Mr. Thomas. I had never forgotten his face, or his raw grief. All of a sudden, we were back to that awful night. I wasn’t sure what he would say. But his face softened into a smile, and before I could utter a word, he spoke.
“Thank you, Doctor,” he said, extending his hand. “Thank you for all you did.”
I asked about the children. They were well, he said. He looked well, too. I smiled and gripped his hand tightly, greatly relieved, and grateful for this rare moment of closure.
• Chest pains
• Weakness
• Shortness of breath or inability to breathe normally
• Heart palpitations
• Vomiting
• Sudden collapse or unresponsiveness
• Loss of consciousness
• No pulse
What to Do If You Encounter Someone Who Has Collapsed or Is Unresponsive
• Call 911 (or your area’s emergency response system)
• Conduct CPR. If the person isn’t breathing, press hard and fast on his/her chest (a hundred compressions per minute). If you’ve been trained in CPR, deliver rescue breaths after every thirty compressions. If you haven’t, continue chest compressions, allowing the chest to rise completely between each. Keep doing this until emergency help arrives or a portable defibrillator becomes available.
• Use a portable defibrillator (if available). If you have not been trained how to use it, inform the 911 or emergency operator, who may be able to walk you through the process. Deliver one shock (if advised by the device) and begin CPR with chest compressions for about two minutes. Using the defibrillator, check the person’s heart rhythm. If necessary, the defibrillator will administer a shock. Repeat until the patient regains consciousness or EMS personnel arrive.