In this harrowing essay for Slate, ER doctor Grace Glassman recounts the birth of her third child, a daughter, and the risks involved with pregnancy at age 45. In a piece that is a master class in pacing, Glassman remembers her uncontrollable bleeding post C-section and going into hemorrhagic shock that required life-saving emergency surgery. In reflecting on her experience as a medical doctor, she suggests that only one thing stood between life and death: pure luck.
The anesthesiologist returned. “I don’t get your pressures. They don’t reflect how you look.”
In her defense, I did feel well, even though my blood pressure was abysmal.
“We could put in an arterial line and then we’d know for sure,” she said. She was referring to a small wire with a sensor that gets placed in an artery, a more accurate gauge of blood pressure than a cuff. “But it hurts. I don’t think we’ll do that.”
I disagreed. Just put in the damn line, I thought. She was slight, with brown hair in an unfussy bob. She wore dark tortoiseshell glasses. She moved slowly, catlike, and seemed not too concerned. I worried that she wasn’t more worried. It was the emergency doc in me, always defaulting to the worst possible outcome, I told myself. I reminded myself that this was not my show.
She decided instead to transfuse more units of blood and start pressors, medicines that boost blood pressure. Blood pressure can drop for many reasons—a hemorrhage, an infection, a reaction to medication, a compromised heart. Pressors divert blood to the vital organs, such as the heart and the brain, at the expense of body parts that can be sacrificed, like the arms and legs.
Pressors are the mark of a critically ill patient.
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