Link to part 1: http://www.averagemomblog.wordpress.com/2013/02/27/micahs-birth-story-part1/
“You guys are really good at not telling me what’s going on.” I mumbled. Then I felt it. I was far, far away. I wanted to tell someone that I felt strange, but couldn’t quite explain it. I still can’t explain the feeling very well.
“I can’t hear any of you. I feel like you are far away.”
I wasn’t sure they heard me and now I was freaked out. But I felt so lethargic, I couldn’t convey the panic that I felt. Actually, it was more like I KNEW I should feel panicked, but my mind could not get there.
“I can’t hear you. I can’t hear myself… I can’t hear you. I can’t hear myself…”
I would have kept repeating it, but my tongue was suddenly very heavy. ”I can’t talk either.” I mumbled. In the background I heard someone say “Get a crash cart. Someone get a crash cart!”
Suddenly I felt the overwhelming urge to close my eyes. I felt so separated from everyone else. I felt a weakness and lethargy that I had never felt before. I just wanted to close my eyes and drift away. (In my research, I found a very accurate description of what I was feeling: “drowsiness merging into unconsciousness.”) I looked up at Chris who was hovering above my head.
“Can I go to sleep? I just want to sleep.”
“No! You cannot sleep. Look at me, Caitlin, do not go to sleep right now.” I was sure sleeping was exactly what I was supposed to do right then. So I turned to the nurse on my left.
“May I go to sleep? I want to sleep.” She just gave me a weak smile.
Someone rushed in and shouted to put an oxygen mask on me. That helped immensely. Within 10 minutes of having the oxygen, I felt fine. Confused, very confused, but I could hear and speak. I did not feel the pull to surrender to that far away feeling.
The doctor came in a few moments later and explained what happened. There was a med error. The bupivacaine for my epidural had accidentally been hooked to my hand IV, where it free flowed into my bloodstream for 7-8 minutes. How this happened is murky, but we do know that several safe-falls were ignored.
1) The anesthesiologist brings the bupivacaine with him. It is sealed in a black bag. This seal was not supposed to be broken until I was completely prepped. He opened the sealed bag and removed the bupivacaine IV bag too early.
2) The bupivacaine should have never crossed to that side of the room. For safety reasons, the sealed black bag should have stayed on the right side of the room while the nurses prepped me on the left. He not only opened the sealed bag, but he placed the epidural drug on the left side of the room, directly beside an IV bag of saline.
3) All medicine administered to a patient needs to be scanned in first. They scan the bag of meds, then scan the bar code on my ID bracelet. In her rush, my nurse did not scan the bupivacaine.
After briefly explaining the error, my doctor said he would like to do a c-section. I was out of the woods it seemed, but no one really knew what the stress of labor would do to me. I wholeheartedly agreed. It was now 9pm, I was tired and done. I just wanted my baby! First they had to treat me with a “lipid rescue” which is literally an IV bag of fat. Awesome.
The c-section went smoothly, thank God! I did have to be given three times the normal dose of bupivacaine (in my spine this time!) to finally be numb. But ahhh, it was still so wonderful to hear Micah’s sweet cries and to kiss his little nose. He was beautiful and I couldn’t wait to get into our recovery room and snuggle him all night.
Unfortunately, they made me stay in the ICU over night. This was the hardest part for me. I was not told about it until I was being backed into the elevator. The ICU forbids newborn babies, for obvious reasons. I was pretty pissy when I got down there. I just laid there silently as they hooked me up to monitors and IVs. I was done. I didn’t fully understand the gravity of what had just happened. All I knew was I was here and Micah was 2 floors above me. (It did not occur to me to google what had happened until about 3 am.) They did bring Micah down for an hour or so as soon as they could. And they brought him down to nurse in the night.
A long day and no baby to hold at it’s end was hard. I had pressure cuffs on my legs and a blood pressure cuff on my arm that both went off every 5 minutes. But not the same 5 minutes, so it felt like something was constantly squeezing me and releasing. I had oxygen in my nose, heart monitors on my chest, a pulse monitor on my finger, a catheter and IVs in both hands. (The next morning, a nurse came to take a blood sample from me. She had to draw the blood from my knuckle.) The ICU nurses kept telling me to sleep throughout the night. It only angered me. Sleep? Switch places with me and YOU TRY TO SLEEP!
(Actually, I had no idea exactly where I was until the next morning. I just didn’t put two and two together. I texted my mom at 7am and asked her to bring me a coffee. She said sure, was I still in the ICU? Oh.. is that where I am?)
In the end, everything turned out just fine. I was okay and Micah was perfect. The nurse who made the error was so apologetic the next morning. In her 10+ years as a nurse, she had never made a med error. She cried in the ICU room the next morning and we both cried the day they sent me home (5 days later).
Just to give you an idea of how dangerous this med error was, here are some quotes from medical journals and other online resources:
“Systemic exposure to excessive quantities of bupivacaine mainly result in central nervous system (CNS) and cardiovascular effects. CNS effects may include: CNS excitation (nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision, seizures) followed by depression (drowsiness, loss of consciousness, respiratory depression and apnea). Cardiovascular effects include hypo-tension bradycardia, arrhythmias, and/or cardiac arrest – some of which may be due to hypoxemia secondary to respiratory depression.
Bupivacaine has caused several deaths when the epidural anesthetic has been administered intravenously accidentally.”
“CNS signs: Initial CNS excitation followed by a rapid CNS depression – lightheadedness, dizziness, visual and auditory disturbances (difficulty focusing and tinnitus), disorientation, drowsiness, followed by muscle twitching, convulsions, unconsciousness, respiratory depression and arrest.
Direct cardiac effects:
Myocardial depression (tetracaine, etidocaine, bupivacaine), cardiac dysrhythmias (bupivacaine), and cardiotoxicity in pregnancy. Negative inotropic effects on cardiac muscle that lead to hypotension. Bupivacaine is especially cardiotoxic.”
“A number of risks have been associated with epidural injections and infusions. One of the most significant risks involves erroneous infusions of epidural medications—particularly epidural infusions containing bupivacaine—by the IV route of administration. IV bupivacaine can quickly lead to cardiotoxicity. A Black Box warning for bupivacaine notes that the drug can cause profound disturbances in cardiac rhythm and contractility that are resistant to typical resuscitation efforts, making these mix-ups particularly deadly.“
“In this case, the woman in labor should have received normal saline IV, but a nurse accidentally selected a virtually identical bag of bupivacaine located in the same unlocked drawer as the saline. (The bupivacaine infusion did not contain fentanyl, so the bag did not require locked storage.) Since the nurse thought she was hanging a bag of normal saline, she had no reason to consider asking another nurse to double-check the solution before administering it. The patient developed seizures and cardiac arrest that could not be treated successfully.”
Basically, what SHOULD have happened (based on the dose I received) was initial symptoms of central nervous system toxicity (which I experienced) followed by seizures, followed by respiratory distress and then cardiac arrest. As is noted above, bupivacaine toxicity makes resuscitation nearly impossible. It is nothing short of miraculous that my symptoms did not progress further and that Micah and I are alive.
I don’t think it is practical or necessary to walk around with the memory constantly in my mind. I don’t need to pop out of bed every morning and sing “Today is a gift from abooove!” I try not to take myself so seriously. But it IS important for me to remember what happened and to appreciate my life. It is too easy to just move on and take it all for granted.
In the aftermath, I was reminded of a verse in the Bible that is now my favorite:
MICAH 6:8, The Message translation:
But he’s already made it plain how to live, what to do,
what God is looking for in men and women.
It’s quite simple: Do what is fair and just to your neighbor,
be compassionate and loyal in your love,
And don’t take yourself too seriously—
take God seriously.