I liked the two of them right away. Mike was good-natured and cheerful. He called me “Doc,” and bragged that he once helped deliver a baby in a cab. Mike and Kerry’s first child was delivered by c-section because “the baby was sunny side up.” The couple wanted to try for a vaginal delivery this time.
Kerry mentioned that they adhered to a religion that did not allow blood transfusions. Receiving the blood of nonbelievers would deem them “unclean,” and they would be cut off from their community and an afterlife in heaven. I counseled them on the risk of postpartum hemorrhage and described a list of standard blood products, confirming that she would not accept any of it, even at the point of death. We discussed death directly to ensure they understood that the medical staff only recommended blood transfusions in extreme circumstances. The two of them remained unwavering in their refusal. I went straight to the computer to check Kerry’s bloodwork results. Luckily, her blood level was on the upper end of normal for a pregnant woman. Kerry was a low-risk patient. She and Mike had the odds on their side, regardless of their spiritual beliefs, and that made me feel less anxious.
Kerry mentioned that they adhered to a religion that did not allow blood transfusions. Receiving the blood of nonbelievers would deem them “unclean,” and they would be cut off from their community and an afterlife in heaven. I counseled them on the risk of postpartum hemorrhage and described a list of standard blood products, confirming that she would not accept any of it, even at the point of death. We discussed death directly to ensure they understood that the medical staff only recommended blood transfusions in extreme circumstances. The two of them remained unwavering in their refusal. I went straight to the computer to check Kerry’s bloodwork results. Luckily, her blood level was on the upper end of normal for a pregnant woman. Kerry was a low-risk patient. She and Mike had the odds on their side, regardless of their spiritual beliefs, and that made me feel less anxious.
I whispered a quick thanks to my God, who does not object to blood transfusions. I, too, am a person of faith. My belief in both medicine and God are humble attempts to grasp Truth, contain fear of loss, and manage uncertainty. Both shape my intuition and guide my judgments.
Hours later, Kerry’s labor stalled and a c-section was now required. Mike whistled while putting on his paper scrubs to go to the OR with his wife. When the baby came out crying, Mike tried to reach over the sterile drapes to give me a high-five. The charge nurse had to put him back in his seat.
My attending and I proceeded with the routine surgery. Kerry’s uterus, however, was not contracting as it should, which caused excessive bleeding. I called for vessel-constricting medications, and started to manually massage the uterine muscle. My brain rapidly cycled through the algorithm of medical options. We attempted the usual surgical maneuvers. The uterus continued to pour out blood, like a faucet on full blast. Her blood had stopped clotting and was now dripping to the floor. Mike looked confused as he was ushered out of the room.
I took off my surgical gown to talk to Kerry. Leaning in towards her face, I explained that we would need to put in a tube soon to help her breathe. We were removing her uterus. She nodded weakly. I asked her again about blood transfusion. “Mike,” she murmured, and lost consciousness. My attending was working quickly with two other senior surgeons to control the bleeding. The nurse had placed a blanket on the floor so no one would slip. “Get the husband to consent to blood transfusion,” my attending barked at me.
I walked outside. Mike was talking on his cell phone. He hung up when he saw me. “I called the pastor. He’s starting the prayer chain. How is she?” “She needs blood,” I said simply. He looked tormented. I updated him on her life-threateningly low blood level, which may not be enough to deliver oxygen to her brain. She was on a breathing machine. The surgeons were doing a hysterectomy. She had received fluids to keep up her blood pressure, but her vital signs were unstable. Mike looked at my bloody scrub pants. “That’s hers?” I secretly pleaded with my God that he would change his mind.
Mike started to sob and gasp: “Oh my God, I can’t lose her. What am I going to do without her. And the babies. Oh my God.”
“Patient records are confidential. No one will ever know,” I reasoned.
“No one will ever know,” Mike repeated, “God sees everything.” He was searching his faith for an answer.
“God forgives.” The words were tangible and weighty. I still remember the feel of them in my mouth. There was no taste of doubt.
At this moment, a nurse with bloody shoe covers rushed out to get supplies.
“Ok,” Mike said and buried his head in his lap to hide his tears. “Will we have to tell her?”
“She should know,” I replied, keeping ‘if she makes it’ to myself. This is the reality of medicine. You can do everything right and the patient still dies. You can do everything wrong and the patient lives.
I ran down to the blood bank. Carrying back a paper bag filled with packets of red blood cells, plasma, and platelets, I sprinted up the stairs, praying that God would give me strength to make it up the 8 flights. Hospital elevators always seemed too slow in moments like this. I burst into the OR and handed the anesthesiologist the paper bag. The transfusion tubing had already been set up. The surgery was almost done, but Kerry was still in grave condition. No one knew if she would suffer permanent brain damage from the long oxygen deprivation.
Kerry spent the night in the ICU. I sat with Mike to keep him company until his church family arrived. They embraced him without suspicion. Then they all laid hands on Kerry and prayed. The pastor thanked the medical team for our hard work.
Kerry was awake and breathing on her own the next day. When I told her about the blood transfusion, she just nodded and squeezed Mike’s hand.
Two days later, Kerry was back on the regular postpartum floor. She looked pale and drained, but was cuddling with her baby. Mike had his arm protectively around them. Church ladies were there again with flowers, sandwiches, diapers, and happy chatter. An opened Bible sat on the side table. I looked from the door and decided not to go in. Mike was the only one who noticed me. He subtly smiled, and winked.
I don’t know what saved Kerry’s life, if it was the skilled surgeons, the timely blood transfusions, the fervent prayer, or God’s sovereign will. That, I suppose, is the essence of faith. I sometimes wonder if what happened was the best outcome for them, if they have been able to hold on to the promise of heaven.
