Into the Magic Shop by James R. Doty MD

Author:James R. Doty, MD
Language: eng
Format: epub
Publisher: Penguin Publishing Group
Published: 2016-02-01T16:00:00+00:00

SEVEN

Unacceptable

Just under the cerebrum, and in front of the cerebellum, sits the brainstem. If you imagine the cerebrum as a world-famous rock star on a concert tour, the cerebellum would be the choreographer, determining the moves the cerebrum makes, and the brainstem would be the road manager—responsible for coordinating all the information needed to make sure the tour runs smoothly and the rock star has everything he or she needs to be a rock star. The brainstem is much smaller than the cerebrum, but it is in charge of all the functions that keep the body alive, and it is the highway that is responsible for millions of messages that need to pass back and forth between the brain and the body.

The brain begins forming approximately three weeks after conception when the neural tube fuses shut and the first synapses of the central nervous system allow for fetal movement. The brainstem then develops and coordinates the necessary vital functions such as heart rate, breathing, and blood pressure—creating the potential for life outside the womb. The higher regions of the brain—the limbic system and cerebral cortex—are primitive at birth, allowing time for experience and the environment to shape them completely. This shaping and development of the higher regions of the brain through experience never ends—there is no retirement for the brain—every experience matters.

Noel came into the emergency room complaining of headaches, nausea, and vomiting. She had her husband and two children, a four-year-old girl and a six-year-old boy, in tow. The couple were in their early thirties, and Noel was eight months pregnant. Headaches and nausea can be normal symptoms of pregnancy, but in the third trimester, their sudden onset along with high blood pressure can be an indicator of preeclampsia, a dangerous condition for both mother and baby. I happened to be on call that morning, making rounds in the hospital, when the family came in. The obstetrician had been called but had yet to arrive at the hospital when Noel suddenly collapsed in the emergency room and became unresponsive.

By the time I got to her, she’d been intubated and was undergoing a CT scan of her brain. During the scan her vital signs started going crazy, and her blood pressure became incredibly unstable. Looking at the scan, I could see that what was once her brainstem had now been almost completely replaced with blood. Noel had sustained a massive brainstem hemorrhage—an intraparenchymal bleed—the kind people don’t recover from. We began resuscitation efforts right there in the CT scan suite, but I held out little hope. I saw no sign of brainstem reflexes—those involuntary movements that occur when the brainstem is functioning properly. Her pupils were fixed and dilated. She was completely unresponsive.

Noel’s body was still alive, but her brain was dead.

I ordered medications to sustain her blood pressure, and called the operating room to tell them to get ready.

“Page an OB immediately,” I yelled at the nurses. “This baby needs to be delivered now, or it will die.”

I ran alongside the gurney, heading to the operating room, praying that an obstetrician would show up.

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