In the spring of 1992 Michael Benson got a potentially brilliant idea about a mysterious disease known as amniotic fluid embolism. AFE comes out of nowhere to kill women and their babies in the midst of childbirth. According to the medical literature, as many as half the women it strikes are dead within an hour of the first recognized symptom. Many of the rest die the same day or are reduced to a vegetative existence.
Benson was still stewing over his second AFE paper when I first met him in July 1994. He told me his theory about the cause of AFE was easily tested, but he needed to get his second paper published in the obstetric literature so he could ask other physicians to send him blood samples. Still worried about Clark’s opinion, he didn’t think he could get the paper published—it had already been turned down by one journal as too speculative.
The nurse injected a narcotic, apparently without trying to figure out why her patient was having so much pain. Near noon a family-practice resident on obstetrics rotation came by to do a vaginal exam and unintentionally broke the amniotic sac. With my daughter flat on her back, a small amount of dark olive green, meconium-stained amniotic fluid ran out. (Meconium is the baby’s first bowel movement; its presence in the amniotic fluid can be dangerous, though it’s not uncommon.) The nurse lifted my daughter’s hips to place a clean sheet under her. Within seconds, my daughter said she felt nauseated, stopped breathing, and had a convulsion. When they felt for a pulse, there was none.
By the time I got to Michael Benson’s office four months later, I’d begun to read some of the numerous papers on amniotic fluid embolism in the medical literature. While estimates of its frequency are all over the map–from 1 out of 5,000 to 1 out of 80,000–I realized that its characterization as an extremely rare occurrence was misleading. The hospital where my daughter died has about 6,500 deliveries each year. According to information provided by the hospital, during the five-year period from 1990 to 1995 it recorded five cases of AFE, or about 1 in every 6,500 births. In America today AFE is the number one killer of women during or near the time of childbirth. It is, as one doctor put it, “every obstetrician’s nightmare.” It is also their best-kept secret.
Lushbaugh was working on a doctorate in pathology, supporting himself by doing weekend autopsies at Billings Hospital. Strapped for cash, he considered himself lucky when he was assigned a 26-year-old woman who’d died during labor at the affiliated Chicago Lying-In Hospital. Since the woman had died without delivering, he would get paid for two autopsies.
Billings required a review by the full pathology staff before an autopsy became final. This happened at weekly meetings that sometimes proved excruciating. Senior faculty members got slides of tissue from the corpse in advance, then sat in judgment while the underling who’d performed the autopsy presented his conclusions and attempted to defend them. On the Monday afternoon when Lushbaugh presented the case as obstetric shock, Paul Steiner was lying in wait.
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Steiner and Lushbaugh believed “excessively powerful” uterine contractions prepared a route for the embolism by tearing the placenta and other tissue and forcing the amniotic fluid into open maternal veins. But they also guessed that the result was more than just a mechanical obstruction of blood vessels by particles in the fluid. “Probably reflexes are initiated,” they wrote, “which produce vascular spasm in the lung [a clenching of the blood vessels] and a depressant action on the heart.”
