Complex Case Brings Together Dynamic Team

Jeremy and Nicole Dobe knew the birth of their fourth child would not be easy, but it wasn't until March 3 as Nicole entered the PACU before surgery that Jeremy realized just how much behind-the-scenes communication, coordination and planning was involved.

“When Scarlett was born there was a constant ebb and flow of nurses. I don't know how else to explain it,” Jeremy Dobe said. “There was a huge team of so many doctors and twice as many nurses. It unfolded as a well-rehearsed performance.”

The carefully coordinated “performance” or arrival of Scarlett Dobe evolved over six weeks through scores of e-mails, pages and meetings among the medical and nursing staff in Connors, Interventional Radiology, PACU, OR, and the NICU before the curtains went up. Frequent communication led to familiarity of the case among the many caregivers in the Tower and Connors Center, earning the baby the nickname “Little Baby Scarlett.”

The Dobes came to BWH from Auburn, N.H., with Nicole admitted to Connors Center 8 with placenta accreta six weeks before the Caesarian section birth, and 12 weeks prior to full gestation. Her placenta had grown into the wall of her uterus, and there was a chance it could have grown through her uterus into other organs. To add to the complexity, Nicole's faith precludes her from accepting a blood transfusion. She would be having a complicated surgery without a traditional safety net.

“It's such an uncommon case to start with, and the limits necessary by her faith made it an incredibly complicated case,” said Leanne Espindle, RN, assistant nurse manager in the OR. Lydia Lee, MD, the Maternal and Fetal Medicine fellow, said Nicole's case prompted weeks of communication between clinician teams. “Everyone had to accept the limits of what we could do to save the young mother if it came to that,” Lee said.

Robin Schmidlein, RN, spent that day at Nicole's side beginning at 5:30 a.m. when Nicole was transferred to Connors Center 5 to begin intravenous fluids. Then it was onto Interventional Radiology where occlusion balloons were inserted into her iliac arteries under X-ray guidance. Radiology nurses Petra Clark and Nicole Pruitt joined the bedside team to monitor the patient.

Then it was on to the PACU and then the OR for the C-section and hysterectomy where OR nurses Kathy Johnson, RN, and Sandra Gilchrist, LPN, entered stage right with Lydia Lee, MD, Obstetrics, and surgeon Michael Muto, MD.

And just off center stage, Deirdre Greene, RN, of the NICU, along with a pediatrics team waited for their cue, the long-planned arrival of Little Baby Scarlett.

“You'd think Labor and Delivery and the Operating Room would have a lot in common, but then the baby comes, the OR nurses are amazed by the birth, and the OB nurses are amazed by the complex intricacies of the subsequent surgery,” Espindle said.

Schmidlein explained the whole operation as seamless, as nurses planned for and took care of all the little but essential logistics, like having the NICU's life-island and warming unit on hand. “That takes up a lot of space, needs outlets and suctions, all the tools we have on Connors Center 5, but not necessarily in the main OR,” she said.

“All told, it was a very well-coordinated effort. Everyone involved was easy to get along with and affable, and that's the way it is in cases like this. This is what we do,” said Schmidlein, who attributed the success to careful planning through effective communication.

Lee added, “All the nurses involved from the time Nicole was admitted in late December did a fantastic job in providing complete and compassionate care, showcasing our highly specialized capabilities here at BWH. Dr. Robert Barbieri and I are truly grateful for such a dedicated and professional staff.”

From Jeremy Dobe's front-row seat, the delivery of Scarlett was an amazing display of team work, communication and planning. “There were so many different nurses all doing their thing, and Robin communicated what everyone was doing to Nicole every step of the way,” he said.

Within weeks, Scarlett was off all support systems, feeding with a bottle and gaining wait. “Everyone is doing great,” Jeremy said.