Switchboard was asked to put the OR team on alert. As Miles deliberated over whether or not to proceed directly to a C-section, one of the ward nurses rushed into the room to show him a rhythm strip from an inpatient who was complaining of feeling light-headed. His heart rate was only 30, and his blood pressure was 75 systolic. Miles and I looked at the tracing together and concluded he was in complete heart block.

I knew exactly what he was thinking: This can’t wait. Now he had a second critically ill patient to deal with, and we were the only two doctors in the building. On the monitor behind Miles I could see our baby’s heart rate was taking an extraordinarily long time to recover from the last uterine contraction. I caught Jan’s eye. She looked scared.

“How about if you take care of Jan and the baby and I’ll go treat this guy in heart block?” I offered.

“Good idea,” he said. He turned his attention back to the fetal heart monitor. I abandoned my wife and followed the nurse back to the cardiac patient’s room.

First we started him on a dopamine drip and titrated it up until his pulse and blood pressure improved. We then attached the external pacemaker to his chest and tested it to make sure it would work properly if we needed it in a hurry. Once that was finished I got on the horn to the internist on call at the Timmins and District Hospital, which was our closest referral centre. He agreed to insert a transvenous pacer as soon as we got the patient down to their ICU. I called our ambulance attendants and asked them to start working on transfer arrangements. When I hung up the phone and turned around, Miles was standing in the doorway. The look on his face said bad news. He gave it to me straight: “The baby’s heart rate dropped down to 60 and stayed there. I’ve scrambled the OR team and we’re setting up for an emergency section.” My guts went ice cold.

I went into the operating room to spend a few minutes with Jan before the surgery. My colleagues were bustling about setting up equipment, but the only thing I could hear was the beep…beep…beep… of the fetal heart monitor. It was agonizingly slow.

Our regular anaesthetist was out of town that day, but fortunately for us a retired GP-anaesthetist in the community bravely volunteered to put Jan under. When he was ready to begin the induction, Trish the charge nurse shooed me out of the room.

“Go on now. Today you’re a dad, not a doctor. I’ll call you when we’re done.” It felt strange leaving the OR and hearing the sliding doors snap shut behind me.

This I learned later: Dr. Hill quickly cut through the layers of tissue until he got to the uterus. He opened it up, reached in and began to pull. Several seconds passed and still no head emerged. He kept working at it. Nothing.

“What’s wrong?” someone asked.

“Stuck.”

He continued struggling. Sweat beaded on his brow. Eventually he muscled the head out. It was purple. The baby’s eyes were closed. She wasn’t breathing.

“Cord’s around the neck. Damned tight,” he muttered.

He strained until he was able to pry the noose-like cord encircling her neck and wriggle it over her head. She remained limp and unresponsive.

“Another loop,” he said as he removed a second strangulating coil of umbilical cord from her neck. “And another. And another!”

The cord had been wrapped around her neck four times, choking her every time she tried to move. He hauled the rest of her flaccid body out of the uterus and cut the cord.

Miles grabbed the Ambu bag and started ventilating her. While he bagged, Catherine, a nurse who often helped with neonatal resuscitations, listened for a heartbeat. It was barely detectable. She immediately began chest compressions. They worked together feverishly. Moments later the Ambu bag shattered into half a dozen pieces. Catherine and Miles stared at each other, wide eyed. This was unprecedented. The equipment is tested regularly.

“We need another Ambu bag, stat!” Miles yelled at Trish.

“That’s the only one for newborns we have in the OR! I’ll go get one from the delivery room on unit 4!” She darted out of the room. Our child lay inert on the table. Catherine started mouth-to-mouth resuscitation. Miles took over chest compressions.

I was standing in the hallway just outside the OR when Trish burst through the sliding doors. Arms and legs flailing, she looked like the devil himself was chasing her. When she saw me she stopped running, said “Hi” nervously, and speed-walked over to the door to unit 4. She went in and shut the door quietly behind her. The instant it closed I could hear her sprinting down the hallway. I leaned against the wall and tried to breathe. I didn’t know what to do. Should I go inside and try to help? Would I be able to make any sort of meaningful contribution, or would I just get in the way?

Trish came thundering back. As soon as she came through the door she glanced at me furtively and slowed to a walk. She was carrying a neonatal Ambu bag. I wanted to scream, “For God’s sake, Trish, run!” When she disappeared through the operating room’s opaque sliding doors she started running again.

Roughly 20 minutes later Miles came out to see me. He looked grim. I steeled myself for the news that our child was dead.

“It’s a girl,” he said. “The cord was wrapped around her neck four times and she came out flat. Her one-minute Apgar was only one. We ventilated her and did chest compressions…”

…but she didn’t make it…

“…and she recovered.”

“What?” I couldn’t hear anything over the blood pounding in my ears.

“She’s okay, Donovan, at least for the time being.” He smiled.

“Oh, God. Thank you, Miles.”

“I’m going to transfer her to Timmins because I’m concerned she may develop delayed respiratory problems.”

“Okay.”

I went into the OR to meet my new daughter. She had beautiful brown eyes and a shock of curly black hair. Aside from her rapid respiratory rate she looked remarkably well, considering what she had just been through. Catherine and Trish let me hold her for a little while. I wanted to talk to Jan, but she was still deeply anaesthetized. I asked Trish to tell her I’d call at the first possible opportunity. After that I raced back to our house, sent the babysitter home and arranged to have a neighbour stay with Ellen and Kristen until Jan’s parents could fly in from Winnipeg. Once all of that was done I packed an overnight bag and began the long drive down highways 11 and 655 to Timmins.

I arrived at the Timmins and District Hospital to find our EMTs unloading the patient with heart block from the ambulance. He and my daughter had travelled together in the same rig. The attendants informed me they had already taken my daughter to the neonatal unit. When I got there a pediatrician named Dr. Inman was examining her. Her breathing seemed to be more laboured than it had been earlier, but it was hard for me to be sure – it’s difficult to maintain any semblance of objectivity when the patient in question is your own child. When he completed his evaluation he told me she was stable for the time being, but that he intended to keep a close eye on her over the next several hours. He felt that due to the asphyxia and meconium it was possible her respiratory status could worsen, and if that occurred she might require intubation. The word intubation made me wince – I had visions of barotrauma, collapsed lungs, chest tubes, chronic pulmonary disease… . He patted my shoulder.

“Try not to worry,” he said. “She looks like a fighter. I think she’ll do all right.”

I had planned to rent a room at a nearby hotel, but the pediatrics staff kindly arranged for me to use one of the hospital on-call rooms. I telephoned Jan to let her know what was happening. She described how awful it had been waking up after the C-section to find the baby and me both gone. I tried to reassure her and promised I’d call back soon. After that I went to bed. It took a long time for me to fall asleep. A few minutes later the telephone rang. It was Dr. Inman.