24

in one 24 hour shift...
we did a stat suction currettage on a 17 year old girl who was "bleeding from a very heavy period." she was getting transfused 4 units of blood intraoperatively. we got in there and found a botched probable 23 week gestation status post dilation and evacuation procedure (where you do an abortion, but the baby is so big that you have to dilate the cervix and use 'skull crushers'). she was bleeding like crazy, because there were still... parts... in there. i was sick and dizzy. when you do a suction d&c after someone miscarries, it's usually within the first trimester and baby parts aren't identifiable. this time there was cartilage. i confronted the girl after the surgery, all alone. i asked her if she had an abortion. no i did not.

in the same shift...
a young girl came in by ambulance. she was 23 weeks, 4 days gestation. 24 weeks is the grey-zone cutoff for viability. her water broke at home. she wanted to push. baby was still alive, cervix was dilated to 5cm with a shoulder poking out. we counseled her that her baby had a 10% chance of survival, but a 100% chance of some neurologic delay. the only way to deliver the baby safely enough was via c-section, because due to it's position the head could get entrapped in her cervix. she agreed. we prepped her for surgery stat, and as we got the baby out 6 members of the NICU team began resuscitation. it was a girl. i looked around the o.r. there were probably at least 20 people in there, all that she might live... which she did, after 45 minutes of unsuccessful resuscitation, then died quietly in her mother's arms.