Chapter 6 - The Color of Chocolate
The pediatric resuscitation bay at Children’s Memorial Hospital was an arena of controlled violence.
The moment the ambulance bay doors flew open, a team of ten doctors, nurses, and respiratory therapists swarmed the gurney. Overhead, banks of intense, heat-generating surgical lights illuminated every millimeter of Lily’s tiny form.
"Seven-day-old female, acquired methemoglobinemia from toxic benzocaine ingestion," Dr. Patel shouted over the din as she stepped into the bay, stripping off her wool cardigan and snatching a sterile gown. "GCS is down to three. Marked bradycardia, hypothermia, profound cyanosis unresponsive to one hundred percent FiO2."
"Get the warmer on! Intubation tray, size two point five uncuffed tube, straight blade!" a tall man with graying hair shouted—Dr. Mercer, the attending pediatric intensivist. "Get an umbilical venous line or an IO in the right tibia! We need central access now!"
I was pushed back against the perimeter wall, a nurse gently but firmly holding my shoulders.
"Mama, stay right here," the nurse said, her voice a calm anchor in a hurricane of terror. "Let them work. Keep your eyes on her, pray for her, but let them work."
I clamped my hands over my mouth to keep from screaming.
They had stripped Lily naked. She lay beneath the blazing heat lamps, looking impossibly small on the vast white sheet. Her skin was no longer pale or slate-colored.
It was a terrifying, dusky grayish-brown, like slate soaked in mud.
"Laryngoscope in," Dr. Mercer said, his eyes narrowed behind clear protective goggles. "Vocal cords visualized. Passing the tube... and... we are in. Bag her."
A respiratory therapist immediately attached a small, blue ventilation bag to the end of the clear plastic tube protruding from Lily’s mouth.
*Squeeze. Squeeze.*
"Bilateral breath sounds present," Dr. Mercer confirmed, his stethoscope pressed against Lily’s tiny ribs. "Secure the tube. What’s the blood gas?"
A pediatric fellow was kneeling at Lily’s foot, drawing blood from her femoral artery with a fine needle.
As the dark liquid filled the plastic barrel of the syringe, an audible gasp rippled through the nursing staff nearest the bed.
The blood wasn't bright crimson. It wasn't even the dark purple of deoxygenated venous blood.
It was the color of dark chocolate. Thick, muddy, and brown.
"Classic chocolate-brown blood," Dr. Patel said, her voice tight, standing beside Mercer. "Methemoglobin level must be over sixty percent. She’s suffocating at the cellular level. Enzymes can't reduce it fast enough."
"Where is the methylene blue?" Mercer barked toward the medication room door. "Pharmacy was notified ten minutes ago!"
"Running it in now!" a nurse shouted, bursting through the doors holding a small glass vial filled with an intense, vibrant sapphire-blue liquid.
"Dose is one to two milligrams per kilogram of one percent solution," Dr. Patel stated, watching as the nurse drew the cobalt liquid into a syringe. "Her weight is three point one kilos. Give three point one milligrams slow IV push over five minutes. If her methemoglobin doesn't drop below twenty percent in an hour, we prep for an exchange transfusion."
*Exchange transfusion.*
The words sliced through my terror. They were talking about draining the poisoned blood from my seven-day-old daughter’s body and replacing it with donor blood.
The nurse connected the syringe to the intravenous line threaded into Lily’s tiny ankle. Slowly, steadily, the plunger depressed. The brilliant blue liquid disappeared into the clear tubing, entering Lily’s bloodstream.
The monitor above the bed shrieked continuously.
*Heart rate: 74. Oxygen saturation: 79%. Blood pressure: 48 over 26.*
"Come on, Lily," I whispered, digging my fingernails into the palms of my hands until the skin broke. "Come on, my baby. Fight it. Please, God, fight it. Mommy is right here."
For three agonizing minutes, nothing happened. The slow, rhythmic mechanical thud of the ventilator bag filled the room. The chocolate-brown blood sample sat on the metal tray, an accusation in glass.
Then, Dr. Mercer leaned closer.
"Look at the capillary refill on the fingers."
Dr. Patel pressed Lily’s fingernail. When she lifted her finger, the bed of the nail flushed pink in less than two seconds.
The harsh, irregular alarm on the monitor suddenly shifted in tone.
*Beep... beep... beep-beep... beep-beep...*
"Heart rate climbing. Ninety-six... one hundred and ten... one hundred and twenty-eight," the respiratory therapist announced, his voice lifting with unmistakable relief. "Oxygen saturation reading eighty-eight... ninety-one... ninety-four percent!"
A long, ragged exhale swept through the resuscitation bay.
I watched as the terrible, slate-gray shadow that had choked the life out of my daughter’s face began to recede, like mist burning off a lake under the morning sun. The dusky hue faded from her lips, replaced by a faint, fragile bloom of pale strawberry pink.
Her tiny chest began to trigger the ventilator on its own, fighting against the plastic tube.
"She’s initiating her own breaths," Dr. Mercer said, wiping his brow with the sleeve of his scrub top. He looked across the bed at Dr. Patel. "Hannah, you made the call of a lifetime. Ten more minutes without methylene blue and this kid would have had irreversible anoxic encephalopathy, or we’d be doing chest compressions right now."
Dr. Patel closed her eyes for a brief moment, letting out a breath that sounded like a prayer. Then she opened them, looked over at me, and nodded.
"She’s back, Nora," Hannah said softly, her eyes shining with unshed tears. "She’s stable."
My legs finally gave out.
I sank down to the cold, linoleum floor of the trauma bay, burying my face in my hands, weeping so hard my whole body convulsed.
The heavy double doors of the pediatric ICU waiting room swung open behind me.
Through the glass window, I saw them.
May you like
Ryan was standing there, his face pressed against the glass, his eyes wide and red-rimmed. Standing directly behind him, clutching her designer coat around her shoulders like an empress who had been mildly inconvenienced by rain, was Judith.
***
