This Mother Went into Cardiac Arrest While in Labor. Her Recovery Was a True Christmas Miracle.
Dr. Stephanie Martin has worked for many years to deal with maternal cardiac arrest. Tracy Hermanstorfer’s case keeps her looking for answers.
© 2010 MARIAH TAUGER
At lunchtime on Christmas Eve, 2009, Dr. Stephanie Martin was conferring with a patient in her office at Memorial Hospital in Colorado Springs. Lithe, with fine bones and long limbs, Martin, 42, looked more like a ballerina in scrubs than the head of high-risk obstetrics at a major metropolitan hospital. She was, in fact, a competitive ballroom dancer with the kind of energy and precision of movement that served her well during medical crises.
Martin was expecting a busy but not unusual day when, during the conference, an urgent message sounded over the intercom: “Code blue, East Tower, labor and delivery rooms.” In hospital terminology, code blue signals the most dire of emergencies: A patient is in cardiac arrest and needs immediate resuscitation. To a layperson, it means someone is dying; in the labor and delivery rooms, it means both a mother and a baby are in peril.
Martin ran down the hall to the labor and delivery rooms. Not on Christmas Eve, she told herself. I can’t lose anyone on Christmas Eve.
Tracy Hermanstorfer, 34, had entered the labor room with her husband, Mike, a long-haul truck driver, early that day. She was in good health and was expecting a delivery as normal as her previous two. A routine amniocentesis had revealed that their baby would be a boy, and they had already picked out a name. She and Mike, 38, were excited by the prospect of a Christmas baby.
By 12:30 that afternoon, after several hours of contractions, Tracy was growing tired. She had been given an epidural injection to ease the pain of labor and delivery, and her attending nurse was watching her closely. The baby’s heart rate was a little slow, and a fetal monitor had been attached to his head, but there were no major problems. “Rest, close your eyes,” Mike told his wife. “It looks like you’re going to have a long day.”
Racing down the hall, Martin felt the familiar rush of adrenaline in her veins. With it came a memory that continued to haunt her whenever a code-blue alert sounded. Her thoughts flew back to the Fourth of July, 1997, her first time as attending physician on a maternity ward. Only a week before, she had been just another resident on the ward. Seven days later, as the doctor in charge of emergencies, Martin encountered a normal birth involving a healthy 21-year-old woman that had gone suddenly, horribly wrong.
Amniotic fluid had escaped the placenta and entered the mother’s bloodstream, causing what looked like a massive allergic reaction. She began to bleed internally, a classic sign of an amniotic embolism. In minutes, the mother’s heart and lungs failed, and the baby’s heart rate plummeted. Despite performing an emergency C-section, Martin lost both mother and child.
The two deaths sent the young doctor into an emotional tailspin. Martin took to her bed and stayed there for days. What good am I? she wondered. No one could talk her out of her depression—not even her neonatologist husband, Jeff.
Healing had been Martin’s primary passion since she had decided as a child growing up in West Texas that she wanted to become a doctor. Now doubt had crippled her just as she had achieved her goal.
Martin’s recovery took weeks. Only her grit and determination to know more about the causes of fetal and maternal deaths gave her the strength to return to the delivery room. “I can’t give up,” she decided. “I have to find a solution.”
Every code blue in the labor and delivery unit became another challenge for her—and an invitation to do further research. Through her experiences over the 12 years that followed the July Fourth incident, Martin became an expert in the field of maternal cardiac arrest.
Tracy closed her eyes and appeared to doze. Mike felt her hand and thought it seemed too cold. He looked into her face and saw that her lips were turning blue and her skin was a translucent white. Something was wrong. “What’s going on?” he called out frantically to the attending nurses as they leaped to Tracy’s side. One began trying to revive her, while the other pulled the cord that triggers the code-blue alert. Mike recalls being hustled into the hall as people converged on the room. A minute or so later, two chaplains came to meet him.
Only a minute had passed since the alert sounded. Martin burst through the door of the labor and delivery room to find Tracy inert in her bed. All signs of life were rapidly fading. She had no blood pressure and wasn’t breathing. A nurse began administering rigorous chest compressions.
Tracy’s condition could have been caused by one of several culprits: an amniotic embolism, an allergic reaction to the epidural, a spontaneous irregular heartbeat, or the placenta separating from the uterus, causing it to fill with blood. In these situations, protocol demands that the baby be delivered before the mother is resuscitated. Martin knew that the best way to save the mother was to remove the fetus and placenta in order to take the strain off the mother’s heart, which would improve her chances of being revived.
Two teams began to assemble. Martin would head the surgical group that would operate on Tracy and attempt to resuscitate her. The second team would stand ready to receive and revive the child. When a mother stops breathing, there is a five-minute window before the baby begins to suffer brain damage. The fetal monitor already indicated that the baby’s heartbeat was fading. Medical personnel intubated Tracy, forcing air into her lungs with a manual pump in an effort to provide oxygen and help the heart start beating again.
The 12-year-old nightmare of a mother bleeding her young life away flashed in Martin’s mind. Then she cleared it away. She would perform a C-section right there in the labor room. The staff rolled in a table of surgical instruments. Martin put on gloves, and a nurse slipped a mask over her face. Then Martin poured a bottle of surgical soap over Tracy’s abdomen. She picked up a scalpel and made the first cut—a six-inch horizontal incision low on the abdomen to open a pathway. The incision did not draw blood, because Tracy’s heart was no longer pumping. Then came the second incision—a horizontal cut that opened the uterus. Inside was the translucent tissue of the amniotic sac that contained the baby. The doctor pulled it apart. Her hand located the fetal monitor attached to the baby’s head. She quickly lifted out the limp baby, cut the umbilical cord, and disengaged the fetal monitor.
Martin immediately saw that the baby’s vital functions were severely depressed. The infant boy was pale and unmoving. Martin handed the child to the neonatologist, who took the baby to the warming table. There the child’s nose and mouth would be suctioned, his body dried and rubbed, and he’d be given artificial respiration. The baby had been delivered in less than five minutes.
Martin’s attention returned to the mother, who had by now turned blue. Martin began an examination of the surgical site. She placed a finger on Tracy’s aorta, the large artery that courses over the abdomen, and was astonished. She felt a tiny heartbeat, as faint as the fluttering of an eyelid, pulsing against her fingertip. “Let’s get her to the operating room. Now!” Martin said. If Tracy required more surgery, the team would need a fully equipped OR for it.
Mike was waiting in the hallway outside. As the gurney bearing Tracy passed by, Martin told him, “Give her a kiss.” Mike bent and gently pressed his lips to his wife’s forehead. He feared he might be kissing her goodbye.
In the OR, Martin found her patient’s heartbeat to be strong and regular. Tracy was put on an automatic breathing machine to assist her. Martin removed the placenta. Before closing up the incisions, she reexamined the organs, using her physician’s eye and instinct to try to figure out what had caused the cardiac arrest and what had led the heart to start up again, but she found no obvious clues.
© 2010 MARIAH TAUGER
When Martin was finished, she accompanied the unconscious but living, breathing mother into the intensive care unit to oversee preparations for her recovery. Suddenly, Tracy woke up, opened her eyes, pulled out the breathing tube, and began to talk. “My baby’s name is Coltyn,” she told the stranger in scrubs who had saved her life.
Mike Hermanstorfer was still waiting. He had watched doctors and nurses running to the labor room from all parts of the hospital. He had seen his wife wheeled away. He had no idea of the condition of his son. Time seemed to stretch out forever.
Then a nurse beckoned Mike into the room, and his son was put into his arms. To the stunned father, the baby at first seemed lifeless, though he was simply exhausted after his ordeal. Then he stirred in his father’s embrace. To Mike, these tiny movements were nothing short of miraculous. “He came alive in my arms,” is how he puts it. Shortly after, father and son were reunited with Tracy in the ICU.
At home that night, Stephanie Martin recounted the astounding events of the day to her husband. She had never encountered such a case, she told him. Tracy’s cardiac arrest didn’t spring from typical causes. Even more inexplicable was the sudden and seemingly spontaneous revival of Tracy’s heart. Only then did Martin give way to emotion. She did not have to bring a family bad news at Christmas.
A year later, the Hermanstorfer case still intrigues Martin. How and why had Tracy recovered so quickly from her ordeal? Doctor Martin keeps looking for answers. She is writing a paper about the case and continues to study maternal cardiac arrest so she can teach other doctors how to respond in such crises.
When Tracy Hermanstorfer reflects on her near-death experience, she says it teaches her to forget the petty concerns of the day and enjoy her three children. Mike simply calls it a miracle, one that happened on Christmas Eve, when a child was born, a mother was saved, and a gifted, caring physician was reconfirmed in her calling.
© 2010 JACOB PRITCHARD/WONDERFUL MACHINE