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The Suburbanite
  • 11 hours in Room 407: A new life hangs in the balance

  • Keri Gerstenslager delivered her baby 14 weeks before his due date. Doctors and nurses tried to save him, but got nowhere. Gerstenslager and her husband decided to take him off life support — and they waited for him to die.

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  • Still inside his mom’s womb, Austin Gerstenslager began a journey to his birth and medically certain death.
    A half-dozen nurses and assistants wheeled mom and unborn out of Room 407 at Aultman Hospital’s birth center. The bed glided across glossy tiled floors, en route to an emergency cesarean section. It was shortly before noon on Aug. 18, a Saturday.
    Tears slid down Keri Gerstenslager’s cheeks. She watched a blur of hallway lights above. She passed the nurse’s station on the left. Her bed took a sharp left. It zipped past elevators. Then a hard right turn. She was whisked through a set of double doors, and into an operating room.
    It was 14 weeks before her due date. Even worse, her water had broken six weeks earlier, which causes a fetus to develop even slower.
    Doctors and nurses converged on Austin after his birth. They threw everything at the tiny baby that technology and medicine could offer. Nothing seemed to help. Clearly, everyone believed, his lungs were not formed 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. In the weeks leading up to the birth, they’d studied all the possibilities. They’d memorized 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, baby Austin was removed from life support. He was taken back to Room 407. Together there, Keri Gerstenslager and her husband, Chip, held their baby. Together, they waited for him to slowly die.
    And that’s when this story actually begins.
    •••
    Chip and Keri (Kitcey) Gerstenslager already had two children, a pair of blonde-haired little girls. Kendra, 6, started kindergarten last fall at St. Michael’s. Erika, 3, loves to color. Keri had no trouble with conceiving either.
    “We just felt we were supposed to have another baby,” Keri said.
    They decided to try for No. 3.
    The addition would round out their family and further fill their five-bedroom, two-story house on Knight Avenue NW in Jackson Township, which also includes a pair of dogs. But pregnancy didn’t come as easily for the couple this time.
    Chip, 43, a management and marketing instructor at Stark State College, and Keri, 35, eventually learned she could no longer get pregnant the old-fashioned way. The Gerstenslagers agreed to try in-vitro fertilization.
    It was successful. Keri began her pregnancy with three eggs growing inside of her last February. She could have started with fewer. But from the beginning, the couple decided they’d accept all that were viable. “No bro left behind,” was their motto.
    Page 2 of 6 - In the months ahead, though, she lost two.
    At 20 weeks, her water broke.
    Keri prepared to go into labor, but it didn’t progress. Doctors put her on bed rest to save the third and final fetus. She took a leave from her job as an occupational therapist at Mercy Medical Center. She drank fluids by the gallons, to boost her amniotic fluid.
    “Why me!” she yelled at God, while cooped up in bed.
    She didn’t drink, smoke or take drugs. She’d swallowed every prenatal vitamin known to man. She’d endured daily hormonal injections from her husband. She’d gone to every prenatal medical appointment and ultrasound.
    “Why us? You’ve already taken two,” she asked.
    •••
    Keri read up on survival rates of premature babies. But those statistics were in “ideal” situations in which the mom’s water had not broken. On a calendar, Keri marked off each day she remained pregnant. Her goal: Make it to the 26th week — Aug. 18 to be exact. If she got that far, the Gerstenslagers would try everything within reason to save their baby’s life.
    They’d name him Austin.
    Chip and Keri had been married at St. Joan of Arc Catholic Church. Both were raised Catholic. Their faith in God is a constant. They’d selected the middle name of Luke, from the Bible. St. Luke is the patron saint of physicians 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 labor on Aug. 17, a Friday.
    Her contractions were four minutes apart.
    Keri’s mom, in from Michigan to help the family, stayed with the Gerstenslagers’ two daughters. Chip and Keri headed to the hospital. On the way, they visited St. Michael’s, their parish at the corner of Fulton Drive and Whipple Avenue NW. Together, they lit candles. Keri located a statue of Mary. She kneeled and prayed.
    Keri explained her situation.
    She told Mary that Austin probably wouldn’t survive. “Please, if I can’t hold him, I beg you to hold him, in my place,” Keri prayed. “Love and comfort him. Tell him how sorry I am that I couldn’t hold him ... tell him how much I love him.”
    •••
    The couple arrived at Aultman Hospital at noon on that Friday. She landed in Room 407, an antepartum suite. It’s where expectant moms go to allow their babies to grow more. An ultrasound revealed Austin’s measurements were more in line with a 23-week-old, not a 26-weeker. Certainly a lack of amniotic fluid had stunted him.
    Page 3 of 6 - “It was not looking good,” Keri recalled.
    She tried to keep that baby inside her. A fetus develops exponentially with each passing week inside a womb. By the next day, no matter how it turned out, Keri would be at their self-imposed minimum of 26 weeks, right on the nose.
    She made it — barely.
    With transducers connected to Keri’s stomach, doctors and nurses monitored Austin’s heartbeat on a machine that displays “strips” of data on a computer screen. Against a gridded background, they could watch the baby’s heartbeat.
    At about 10:30 in the morning, his rate dipped. A decelerating or non-reassuring fetal heartbeat, they call it. It’s a sign the baby is in distress. It can mean the umbilical cord is strangling him.
    Labor and delivery nurse Jodi Johnson, who has three sons of her own, tried to reassure Keri. So did Chip. Keri’s OB/GYN, Steven Willard, entered. He told her she had to deliver now. She’d get an epidural for the emergency C-section, but there may not be time for it to work. If that was the case, Keri would get general anesthesia. She’d be asleep during the birth.
    Holding Johnson’s hand during the trip to the operating room, Keri cried.
    “I don’t want to be asleep when my baby is born; I want to hold him,” she thought over and over as the hallway lights above fluttered past.
    •••
    Austin Luke Gerstenslager was born at 12:17 p.m. His left eye was fused shut. Keri was unconscious. Chip was permitted into the room moments after. Their son was the length of a school ruler. He weighed 1 pound, nine ounces.
    “He doesn’t look that bad,” thought Roger Vazquez, the neonatologist who would treat Austin.
    The baby’s color was good.
    Chip swore he heard him cry.
    Placed into an isolette — a mobile incubator of sorts — Austin was wheeled to the newborn intensive care unit. Vazquez and a team went to work. They slid a tube down his throat. They coated his lungs with Surfactant, a needed chemical many premature babies lack. They placed him on an oscillator, a machine that breathes in and out for him. He was on pure oxygen.
    Austin did not respond well.
    The oxygen saturation level in his blood hovered near 55 percent. It should have been 90 percent by then. Vazquez wasn’t surprised. Austin’s lung tissue probably stopped developing a couple weeks after Keri’s water broke, he reasoned.
    Vazquez went to the recovery room where Keri was waking, to speak with Chip.
    “Zero chance of survival,” Vazquez said when pushed for odds.
    Even on life support, Austin’s organs would fail, he told Chip.
    Page 4 of 6 - Jodi Johnson, the nurse who cared for Keri that day, heard it all. She couldn’t help herself; she cried.
    Vazquez handed Austin to Keri. The Gerstenslagers had agreed weeks ago 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 p.m., Chip, Keri and Austin had returned to Room 407.
    •••
    That room overlooks a parking lot on Bedford Avenue SW. It’s a simple room, with a blood pressure wrap, fetal monitor, a couch, phone, dry erase board, sink and bathroom. Nurse Janet Ford demonstrated “kangaroo care,” skin-to-skin contact between mom and baby.
    Keri cradled Austin close.
    “I love you ... we love you,” she whispered.
    Chip reached out to the Rev. Don King at St. Michael. Fifteen minutes later, the priest arrived. On the spot, with a shell full of water, King performed a brief ceremony. “Austin Luke, in the name of the father, son and holy spirit, I baptize you,” he said.
    In the next few hours, Chip’s parents, brother and sister, and Keri’s mom, came into Room 407 to meet and say goodbye to Austin. Keri wouldn’t let anyone hold him. She was afraid he’d die in someone else’s arms.
    Alone again, Chip and Keri admired their baby, as he snuggled into Keri’s chest.
    “Look at his blonde 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 Gerstenlagers wondered. Were they doing the right thing?
    They summoned Dr. 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.
    Page 5 of 6 - “What the hell is going on?” Chip thought.
    •••
    Nurse Erica Bucklew began her shift in the Newborn Intensive Care Unit at 7 p.m. Austin wasn’t in the NICU when she arrived to work. He remained in Room 407, still waiting to die. Word had already spread through the unit about this baby.
    This baby who wasn’t acting like a baby on the verge of death.
    “Everyone was talking about him,” she recalled. “We all waited for updates.”
    Back in Room 407, the minutes and hours ticked away. Dr. Vazquez was 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 11 p.m.
    Giannini was as puzzled as anyone.
    Kessler introduced herself to the Gerstenslagers.
    “Do you mind if I peek?” she asked Keri.
    Austin was snuggled in so tight, 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 percent, 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 oxygen into his body.
    The clock passed midnight.
    Austin had lived into the next day. It was a milestone to Keri, though 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 12:20 a.m., about 11 hours after they’d come to 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?” he asked his wife.
    •••
    An IV line was inserted into Austin’s belly. The NICU team tried the oscillator again to help him breathe. They settled on a simple CPAP, instead. It blows a continuous stream of air into the nostrils. Austin made it through the morning, then the day.
    Page 6 of 6 - Vazquez said he’s never been so glad to be so wrong. In his 23 years at Aultman Hospital, nothing like this has ever happened. Never have they handed over a baby to die, who then continued to live. He still can’t make sense of it. He’s shared the story with other neonatologists and they couldn’t come up with a good explanation, 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 in the NICU was filled with some ups and downs, just like most of the 400 babies a year who come through the unit. And like all of them, he’ll be more prone to develop physical or mental developmental problems. But all of that is something to worry about then, not now.
    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 mom who will sit in this chair. A mom 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.”
    All 53 nurses in the NICU know Austin’s story. They can still see him in his NICU room A-2 (1002), where they watched him grow and tucked him in for the many nights. For some, his story reaffirmed their faith. For others, it awakened it.
    “By all scientific reason, he should not be here today,” said Kessler.
    “No words to describe it,” said Giannini, the nurse.
    Austin Luke Gerstenslager left the hospital on Nov. 26.
    Some nurses are certain it was a true miracle. That God must have something special in mind for Austin. Kessler, who also attends St. Michael, said Austin cemented her faith.
    Keri Gerstenslager said she’d do it the same all over again, given the facts. Her decision was for Austin’s good. She didn’t want to see him suffer.
    “I hope God understands,” she said.