No air.

"Code Blue, Post Partum, 3rd floor" the page repeated overhead.
We all looked at eachother, disbelieving. We were used to the pages for the code team to the ICU, CCU, Tele floor... But our own?
Should we go? Help out? Postpartum nurses aren't much for adrenaline rushes, our patients have specific reasons for coding and the team doesn't want to touch a pregnant lady or someone who has been recently pregnant with anything less than a 10-foot pole.
Alright, we go.
I wish I hadn't.
We took the elevator, expecting the best.
Should have taken the stairs.
We bolted down the dark hall, turned the corner and found the worst, the very worst.
Wish I had expected it.
We came upon a nurse fluttering around a crib with an oxygen mask. My ears roared. I ran through a checklist in my head.
Fumbled with a stethoscope. Wish she'd stop bagging so I could listen, I can't hear a heartbeat with her bagging.
I can't hear a heartbeat.
Babies frequently need a kickstart. They need a little oxygen, a little pressure to start the gradient shift that will mark the transition out of their previously watery existence.
They finally gasp, turn pink and cry a bit and we walk away.
They all finally gasp, eventually.
All of them.
Where's that heartbeat? I pause compressions, shifting my hands. Am I doing this right? Compress to 1/3 the diameter of the chest. 90 per minute or 120? Bagging too fast. Something about counting, but I can't remember, so I keep counting. I lose it at 100 and start again.
The NICU team arrives. Good someone else to do compressions.
Someone else want to do this? Because so far I'm failing.
Fumble with a stethoscope again. There's a cartoon that I remind myself of but I can't remember which one.
Can't think, keep compressing.
"Do you want to call this?"
What?
Call it?
You've only done two doses of epi. It's only been like 5 minutes.
12 minutes? It's been 12? I've been compressing the whole time. Bagging, compressing, keeping going...
He was a little cold, I guess.
Livido, already, mottled when I got there.
No heartbeat for at least 12 minutes.
"3:56am."
Gone. Long, long gone.
Isn't there more we can do? Other drugs? I took ACLS, can we give lidocaine? Atropine? ECG? I blinked and stopped. They extubated.
I blinked and thought of his parents. Who would tell them?
Who would say "I'm sorry, there was nothing we could do."?
He was dead when I got there. Tiny soul only 28 hours old, already gone. Long gone.
I'm sure they thought they were home free. Having negotiated the treacherous pregnancy and birth process, they were relieved and waiting to go home. Waiting to take their new son home to meet his brothers and sisters, his aunts and grandparents.
But now, they'd just have an empty crib. Empty booties, shirts carefully folded away.

"Do you want to call it?"
There is nothing in the world more tragic.
But sometimes, babies die.

I wandered slowly back downstairs. Thanked the ICU nurses for coming and sat, deer-in-the-headlights. I looked up the NRP guidelines, I'd done it right, it just didn't work.
I heard the story later that the baby had been tucked in the fluffy sheets with his dad. So proud, so happy to have his new son. Fell asleep with the new babe next to him and awoke to find no breaths, no heartbeat. We educate families on bed safety - no babies in the bed because they can get wrapped up in the soft sheets. Sleeping parents have rolled onto their children, unknowing. We educate for precisely this reason. I cannot imagine that father's horror.
The autopsy showed he'd died of suffocation.

Something?

I still see them, here and there. Perfect tiny dolls with heads that were too big and hearts that were too big but voices too small.
One tried to tell me his name. Tried to tell me his story but was interrupted by his destiny.
I wish I knew what his small purpose was. Maybe I'd sleep a little easier.
I watched a birth too soon into a world that just wasn't ready for it yet.
And, to add insult to injury, 15 minutes passed and his brother came toddling behind.
I can imagine that's how it would have been - one always following the other into adventure and trouble. Dirty knees and dripping noses, they might have fought and cried together.
Loved together. Always joined in that secret knowledge that only twins have.

She, in shock, couldn't bear to face the fact. Couldn't bear to look into their little faces so soon so I took them away.
Couldn't take them to the demise room, there would be time for that later. Couldn't leave them alone but I couldn't be far away so I took them to 218 and held them close. The strong one gasped every now and then, surprising me. His chest didn't move but with each heartbeat.
For lack of anything else to do but wait, I sang them lullabies. I sang them to sleep, to death, to heaven or limbo. I sang quietly and tried to keep the notes from catching in my throat.
"Hush, little baby, don't say a word..."
I sang and waited. Checked the clock and their tiny chests over and over again. Kept them warm and tried not to move too much.
Replayed that first moment in my mind, seeing that pink translucent skin and heaving ribs, hearing that first gasping breath, too short.
All too short.
I wondered, "isn't there something we can do?"
Anything? We have to do something, what if? What if this is the one-in-a-million? I'm a gambling person, can't we intubate? Umbi-lines? Do we really have to just let go?
Misplaced hope tumbled over me like so many hard, cold rocks. I know the truth, I've seen the consequences of 'doing something'. The pokes and stabs and exams and X-rays. The infections and head bleeds and pain and pain and more pain that their little lives would hold. That their chances for living a quality life approached their chances of becoming President. Close, but not quite.
23-week twin boys just don't make it. I know this.
So I shift my hope to something new. I hope that they were comforted by my songs. That they heard their father's wracking sobs and felt some sadness and some understanding. I hope that they were relieved to be out from the squeezing pressure and stress of their shared apartment. I hope we were able to make a horrible and tragic day the best it could be for a woman losing her dreams, her heart, for the 6th time.

I hope that those little souls hang around for a while and maybe make it through her body again, this time to sing their own songs to their own children someday.