Emilia stayed silent. Settling into a new life, a new home and new job would be no mean feat. But as long as Eva was happy, she’d be happy.
Just as they rounded the corner to Theatre Six, their pagers sounded in unison with an urgent call.
‘Looks like we made it in the nick of time,’ Felipe said, silencing the alarm.
They hurried into Theatre Six’s scrub room and passed their pagers to a theatre technician. Felipe reached for a theatre hat and mask and Emilia did the same.
‘Nothing like a little excitement to start your first day,’ he added, switching on the water over the sinks and vigorously washing his hands.
Emilia laughed. ‘If you say so.’
Tamping down her adrenaline with some deep breaths, she glanced into the theatre as she joined him at the sinks. Through the glass, they had a bird’s eye view of the brightly lit obstetrics’ theatre. Isabella Lopez was already gowned up and surrounded by the delivery team, and a man Emilia assumed was Sebastian Lopez, her husband.
‘So, a few weeks ago, the smallest of the Lopez triplets was prenatally diagnosed with a congenital diaphragmatic hernia, using foetal MRI scanning,’ Felipe said, bringing her up to speed on the case as they scrubbed up, side by side.
Emilia nodded, working a scrubbing brush under her nails. ‘I came in early to read the case file. I understand you performed a fetoscopic endoluminal tracheal occlusion at twenty-seven weeks. That’s impressive in a multiple pregnancy.’
He raised his eyebrows over his mask. ‘You’ll see I’m not a shy surgeon. But the parents, Isabella and Sebastian, are both emergency doctors here at the General, so they were happy to consider the procedure. They want the best possible outcome for all three babies, so together we weighed the pros and cons of the FETO. Hopefully the gamble paid off.’
‘I met Isabella Lopez when I came for my interview in January,’ Emilia said, briskly scrubbing her hands and arms.
She’d immediately clicked with the other woman, who, along with her husband, ran the emergency department at the General. And after their difficult fertility journey, she knew how much the couple wanted these three miracle babies that were about to be born. At nearly thirty-one weeks gestation, all three Lopez triplets would need to spend some time on the neonatal intensive care unit, or NICU, and the smallest baby also faced surgery to correct the defect in the diaphragm.
‘Right, let’s go meet the Lopez triplets,’ Felipe said, turning off the taps and using his back to push through the door into the operating room.
Three resuscitation tables for newborns were set up to one side of the room, each warmed and awaiting a baby. A cluster of neonatal registrars and nurses waited nearby, expressions tense.
Emilia glanced over at Isabella, trying to send her calming positive vibes from behind her mask. The birth of a child was always emotional, but when the babies were premature and one needed surgery, it might be overwhelming for the couple.
After being assisted by scrub nurses into surgical gowns and sterile gloves, Felipe and Emilia nodded to the Lopezes and joined the obstetrician performing the elective caesarean section.
The first two babies were delivered, one after another. Their umbilical cords were clamped, and they were quickly whisked away by the neonatal team. Each baby was placed on the resuscitation table’s heated mattress. The neonatal nurses gently dried the newborns with a towel and cleared their noses of mucus with a small suction tube.
‘Apgar is nine,’ the registrar caring for the first triplet said.
Emilia breathed a sigh of relief and glanced at Felipe, who nodded. The oldest Lopez baby had a low birth weight but was breathing spontaneously, had a good skin colour and normal reflexes, his condition stable enough for transfer to the NICU. The baby was wrapped up and carried over to Mamá and Papá for a quick cuddle.
At the next resuscitation table, triplet number two was being assessed by a second registrar. While slightly smaller than his brother, baby two was mewling loudly, his tiny pink face scrunched up in outrage.
‘Apgar is ten,’ the neonatal nurse said, wrapping him in a sheet and scooping him up for a few seconds of skin-to-skin contact with his parents.
Emilia smiled under her mask at Isabella and Sebastian’s joy. But there was still one more baby to deliver. As the obstetrician delivered the head of the third and smallest baby, the atmosphere in the room changed.
‘Syringe,’ Felipe asked, holding out his hand.
The tube blocking the baby’s airway, which had kept the lung expanded as the baby developed in utero, needed to be removed before the umbilical cord was cut, as it was essentially breathing for the baby via the placenta.
Emilia had only seen the FETO procedure a handful of times, so she was glad for Felipe’s greater experience in this instance. Felipe quickly deflated the balloon and removed the endotracheal tube from the baby’s mouth. The delivery of the third Lopez baby was completed and the cord clamped as usual. Except unlike his brothers, baby three was limp and silent, his skin grey with cyanosis—a lack of oxygen.
Moving quickly, Emilia and Felipe carried the baby to the third resuscitation table, which had been set up in a screened off area with dimmed lighting.
While a nurse suctioned mucous from the mouth and nose, Emilia gently dried the baby with a towel to stimulate spontaneous respiration. Urgency shunted her pulse through the roof. She reached for the neonatal resuscitator, just in case the third triplet failed to start breathing on his own.
Those couple of seconds, during which the baby made no respiratory effort, felt endless. Emilia willed him to make it, her stare flicking to Felipe’s.
‘There’s a heartbeat,’ Felipe said, removing his stethoscope, ‘but little respiratory effort. We already know from the scans that the left lung is hypoplastic.’
Emilia nodded, quickly but gently inflating the baby’s underdeveloped lungs with the resuscitator. The third Lopez baby was struggling to breathe unaided. Because of the hole in the diaphragm, abdominal organs had herniated into the chest and prevented the left lung from growing. Felipe had mitigated some of the pressure on the developing lungs with the FETO procedure, but the underdeveloped lung was still smaller than normal.
Emilia placed electrodes on the newborn’s chest, her relief mounting when the heart monitor picked up a normal trace.
Their eyes met over the tops of their masks. ‘We still have sinus rhythm,’ Emilia told him.
Felipe nodded, his thoughts likely matching hers. For the time being, the smallest Lopez baby would need to be ventilated until they could close the diaphragmatic defect and give his lungs the space to grow.
‘I’m going to intubate,’ Felipe said, reaching for a laryngoscope and endotracheal tube. ‘Then we’ll transfer him to the NICU.’
With the intubation complete, Emilia passed a nasogastric tube into the baby’s stomach to empty it of any contents and take the pressure off the baby’s tiny lungs, which were already compromised by the herniation of small bowel loops into the chest.
As the baby’s oxygen saturations climbed into the normal range, Felipe inserted an umbilical vein catheter into the cord so they could administer fluids, drugs and easily take blood samples. They worked together as if they’d been doing it for years, each of them anticipating the other’s moves and assisting where required.
Once they had the third triplet stabilised, Emilia glanced at Felipe. ‘A quick hello to Mamá and Papá and then up to NICU?’
Felipe nodded, peeling off his gloves and mask. ‘Let’s reassess him this afternoon, but he’s booked for surgery in two or three days, as long as he remains stable. The sooner we can close that hole in his diaphragm the better.’
As Isabella was still on the table being sewn up from her C-section, Felipe and Emilia carefully wheeled the mobile resuscitation table over to the parents.
‘We knew from the scans that the left lung was small,’ Felipe explained to Isabella and Sebastian, who were understandably tearful and overwhelmed, ‘so I’ve placed baby three on a ventilator, to help him breathe.’
