Still inside his mum’s womb, Austin Gerstenslager began a journey to his birth and certain death.
It was shortly before noon on August 18, 2012, a Saturday. Half a dozen nurses and assistants wheeled the mother and her unborn baby out of Room 407 in the birth centre of Aultman Hospital in Canton, Ohio. The bed glided across glossy tiled floors, en route to an emergency caesarean section.
Tears slid down Keri Gerstenslager’s cheeks. It was 14 weeks before her due date. Even worse, her waters had broken six weeks earlier and had slowed the development of the foetus. Medical staff converged on Austin after his birth. They threw everything that technology and medicine could offer at the tiny baby. Nothing seemed to help. Everyone concluded that his lungs were not mature enough to keep him alive.
Dr Roger Vazquez, the neonatologist who treated Austin, said he had zero chance of survival.
The Gerstenslager family had prepared for this moment. They’d memorised survival rates of premature babies born at various intervals of gestation. They’d examined their faith. They’d thought long and hard about the fine line between selfish and selfless decisions.
So after much soul-searching by his parents, baby Austin was removed from life support. He was taken back to Room 407. Together there, Keri and her husband, Chip, held their baby and waited for him to slowly die.
And that’s when this story actually begins.
Chip, 43, and Keri Gerstenslager, 34, already had two children. Keri had had no trouble conceiving either of her blonde daughters, Kendra, six, and Erika, three.
“We just felt we were supposed to have another baby,” Keri said. They decided to try for number 3. But pregnancy didn’t happen as easily for the couple this time. They ultimately tried in vitro, and it was successful. In February 2012, Keri began her pregnancy with three embryos growing inside her.
After a few months, though, she lost two. At 20 weeks, with one baby left, her waters broke.
Keri prepared to go into labour, but it didn’t progress. Doctors put her on bed rest to save the third and final foetus. She took leave from her job as an occupational therapist at Mercy Medical Center. She drank litres of fluids to boost her amniotic fluid.
“Why me?!” she yelled at God, while cooped up in bed.
Keri read up on survival rates of premature babies. But those statistics were for ‘ideal’ situations in which the mother’s waters had not broken. On a calendar, Keri marked off each day that she remained pregnant. Her goal: make it to the 26th week – August 18, to be exact. If she got that far, the Gerstenslagers would try everything within reason to save their baby’s life.
They would name him Austin and had selected the middle name of Luke, from the Bible. St Luke is the patron saint of doctors and surgeons. “We felt he was going to need that. He was probably going to have a lot of physicians involved in his life,” Keri said.
With all but one day crossed off her calendar, Keri went into labour on August 17, a Friday. Her contractions were four minutes apart.
The couple arrived at Aultman Hospital at noon that Friday. Keri landed in Room 407, an antepartum suite for expectant mums with pregnancy complications. An ultrasound revealed that Austin’s measurements were more in line with a 23-week-old, not a 26-weeker. The lack of amniotic fluid had stunted him.
Keri tried to keep that baby inside her. A foetus develops exponentially with each week it’s inside a womb. The next day, no matter how it turned out, she would reach her self-imposed minimum of 26 weeks.
She made it – barely.
With a foetal heart-rate monitor connected to Keri’s stomach, doctors and nurses watched Austin’s heartbeat. At about 10.30 the next morning, his rate dipped. It’s called a decelerating heartbeat – a sign that the baby is in distress.
Labour and delivery nurse Jodi Johnson, who has sons of her own, tried to reassure Keri. So did Chip. Then Keri’s obstetrician, Dr Steven Willard, entered the room. He told her she had to deliver immediately.
Austin Luke Gerstenslager was born at 12.17pm. His left eye was fused shut. The length of a school ruler, he weighed just over 700 grams.
He doesn’t look that bad, thought Vazquez.
The baby’s colour was good. Chip swore he heard him cry.
Placed in an Isolette – a mobile incubator of sorts – Austin was wheeled to the neonatal intensive care unit (NICU). Then Vazquez and a medical team went to work. They slid a tube down his throat. They coated his lungs with surfactant (a chemical many premature babies lack) to prevent them from collapsing. They placed him on an oscillator, a machine that breathes for him. He was on pure oxygen.
Austin did not respond well. The oxygen saturation level in his blood hovered near 55 per cent. It should have been 90 per cent by then. Vazquez wasn’t surprised. Austin’s lung tissue had probably stopped developing a couple weeks after Keri’s waters broke, he reasoned.
Vazquez went to the recovery room where Keri was waking to speak with her and Chip.
“Zero chance of survival,” Vazquez said when pushed for odds. Even if Austin is put on life support, his organs would fail, he told Chip.
Johnson, the nurse who cared for Keri that day, heard it all. She couldn’t help herself; she began to cry.
Vazquez handed Austin to Keri. The Gerstenslagers had agreed weeks before not to turn their infant into a science experiment just to ease their guilt. They’d tried to save him, and it didn’t work. It was time to let him go. If he was going to die, he’d leave this earth cradled in his mother’s arms – at peace and in no pain.
“The most beautiful 26-week-old baby I’ve ever seen,” Johnson told Keri.
By 1.30 pm, Chip, Keri, and Austin had returned to Room 407.
Keri held Austin close. “I love you … we love you,” she whispered to him. Chip contacted the Reverend Don King at their parish. Fifteen minutes later, the priest arrived. With a shell full of water, King performed a brief ceremony. “Austin Luke, in the name of the Father, Son, and Holy Spirit, I baptise you,” he said.
In the next few hours, Chip’s parents, brother and sister, and Keri’s mother came into Room 407 to meet and say goodbye to Austin. Keri wouldn’t let anyone hold him. She was afraid he would die in someone else’s arms.
Alone again, Chip and Keri admired their baby as he snuggled into Keri’s chest.
“Look at his blond eyebrows,” Keri cooed.
“His hair, his fingernails.”
The end, they believed, was coming soon. And that was OK.
The only sound in the room was an occasional beep from Keri’s IV line. NICU nurse Melissa Giannini popped in every so often to check Austin’s heartbeat. When it was time for him to die, his heart rate would begin to slow.
After four hours, Austin was still breathing. His heart thumped at a healthy 120 beats per minute. He moved his head when Keri’s IV beeped. He wrapped his fingers and toes around the fingers of his parents. The Gerstenslagers wondered whether they were doing the right thing.
They summoned Vazquez. “Sometimes it just takes a while,” he explained. Austin had a strong heart, he told them. If they second-guessed their decision, even five years down the road, Vazquez told the
Gerstenslagers they could call him.
Chip thought about making funeral arrangements. They’d have Austin cremated. Giannini placed a stethoscope on Austin’s chest. He tried to swat it away. Four hours became five, then six. Still 120 beats per minute.
What the hell is going on? Chip thought.
Nurse Erica Bucklew began her shift in the NICU at 7pm. Austin and his parents remained in Room 407, still waiting for the end. Word about this baby had spread throughout the unit. This baby who wasn’t acting like a baby on the verge of death.
“Everyone was talking about him,” Bucklew recalled. “We all waited for updates.”
Back in Room 407, the minutes and hours ticked away. Vazquez was at home reading. Nurse practitioner Fran Kessler had taken over the NICU for the night. Giannini kept checking on Austin. He was going strong.
“Would you come with me next time, to meet him and his parents?” Giannini asked Kessler.
It was about 11pm. Kessler introduced herself to the Gerstenslagers.
“Do you mind if I peek?” she asked Keri.
Austin was snuggled in so tight that Kessler could barely see him. She lifted the blanket. Austin sucked on a pacifier. She checked his heartbeat. She could barely hear it because he was sucking on that pacifier so hard.
“He’s beautiful,” Kessler told Chip and Keri. “His heart is strong … he’s moving air. He even has a little bit of an attitude about him. Do you mind if we run a few tests? I’m not trying to change your mind. We just want to see where we are.”
Austin’s blood oxygen saturation registered 88 per cent, normal. A blood gas reading showed an acceptable level of carbon dioxide in his blood. His blood was not acidotic, which meant he was getting sufficient oxygen into his body.
The clock passed midnight. Austin had lived into the next day. It was a milestone for Keri, although she couldn’t explain why.
Kessler, who’d phoned Vazquez before running the extra tests, phoned him again. He digested what she was telling him. Why is this not going according to plan? he wondered.
Kessler put Chip on the phone. “Chip, the game has changed,” Vazquez told him. Chip Gerstenslager said he will remember that sentence for the rest of his life.
It was 12.20am, about 11 hours since they’d entered Room 407 to allow their baby to die. Giannini, the nurse, put Austin back into the Isolette and away she went with him to the NICU. They were going to try to save him.
Keri and Chip looked at each other. “What just happened?” Chip asked his wife.
An IV line was inserted into Austin’s umbilical-cord vessels. The NICU team tried the oscillator again to help him breathe. They settled on a CPAP, which blows a continuous stream of air into the nostrils. Austin made it through the morning and then the day.
Vazquez said he’d never been so glad to be so wrong. In his 18 years at Aultman Hospital, the doctor said, nothing like this had ever happened. He still can’t make sense of it. He has shared the story with other neonatologists, and they couldn’t come up with a good explanation for Austin’s survival either.
“By all rights, he should not have had developed lung tissue,” Vazquez said. “Most babies do what you expect, and they tend to get worse before they get better. This baby, not only was he breathing on his own for 12 hours, he was able to make sugar for himself. He did better without the technology than he did with it.”
In all, Austin spent 100 days in the hospital. His time was filled with some ups and downs, just like most of the 400 babies who come through the NICU annually. Like all of them, he’ll be prone to physical or mental developmental problems. But his family will worry about them then.
On the night before his release from the unit, Keri wrote this on her Facebook page: “As I sit holding my son in this NICU room for the last night, I worry about the next mum who will sit in this chair. A mum who this very moment probably has no idea that she will be sitting in a chair like this … I pray for her, that her outcome will be as good as ours.”
CantonRep.com (March 11, 2013) © 2013 by GateHouse Ohio Newspapers, Canton, Ohio