ExOfficio 22 Mar 2015
It started slowly. Just a few droplets at first. Within minutes those droplets were merging into streams which became rivers...of my sweat. I had been manually ventilating a newborn baby boy for 30 minutes and it was hot. I hadn't paused to pull on my OR clogs so I was barefoot and small puddles of my sweat were starting to form on the concrete floor. At least I was wearing my ExOfficio underwear. It's good for wicking sweat.
Flashback 35 minutes earlier: I had been watching a movie in bed with Kim. Its useless to try to go to sleep "early" when it is 90degrees in your house. Instead we just lay in pools of our own sweat waiting for the right mix of fatigue and hot air from our fans to mercifully lull us into something more resembling a nap than a nights rest. As I slipped into a semiconscious stupor, footsteps approached from outside and a voice called for me. There was a baby not breathing. Can I come?
After a quick stop to grab the key from Olen's house, I dashed to the OR. As I approached the door I heard the familiar sound of mouth to mouth resuscitation. A nurse was trying to ventilate a baby as she waited for me.
Flash forward again: I've been breathing for this kid for 30minutes and I'm pouring sweat. We are inside a cinder block OR that has been heated all 110degree day long and it feels like we are in a tandoori oven (man I miss Indian food). I usually try neonatal resuscitation for about 30 minutes...after that the success rate is pretty close to zero here in Chad. There were now 2 nurses plus a "pharmacist" watching me resuscitate this baby. I started explaining the science of resuscitation, acidosis, oxygen saturation, Carbon dioxide, etc. I felt like a Professor again.
When we reached the "quitting" point, I stopped ventilations and talked them through this boy's dying process. Yes he had a pulse but he hadn't initiated more than a rare gasp for ~45 min of his short life. His color changed from pink to dark and dusky blue as his oxygen saturation dipped to 43%. I walked out of the OR to wash my equipment. I returned a minute later to see him breathing a bit more...and his oxygen levels were marginally climbing. Instead of dying, this boy took a real breath. His pulse did not slow and then stop as I had described and seen so many times before. This kid was refusing to die. I grabbed the ambu bag and gave him oxygen again. Good color, good pulse, good oxygen levels. UNBELIEVABLE.
After an hour he wouldn't cry but he was alive. His eyes were open and he was breathing consistently. I sat with him for another 20minutes as the nurses continued stimulate and clean him up. I tied his umbilical cord and eventually we sent him back to maternity to reunite with his mother! Wow.
So here are the final scores for today:
My day started with a Cesariene section. Happy mom, happy baby. A+
By mid day we had done a sad laparotomy for a 6yr old girl with ultimately a non-resectable cancer. I stayed with her until she was fully awake and carried her to the pediatric ward. She is laying on a bed made of concrete with no mattress and no mosquito net. D-
I completed Pediatric rounds by late afternoon. 21 inpatient kiddos but discharged a few who are doing much better. A+
My night is wrapping up with a small and possibly short lived victory. A baby fought for life and refused to die. A++
I'm going to take another shower now and try to find that elusive sleep. Maybe I will pull on those ExOfficio underwear again too.
Flashback 35 minutes earlier: I had been watching a movie in bed with Kim. Its useless to try to go to sleep "early" when it is 90degrees in your house. Instead we just lay in pools of our own sweat waiting for the right mix of fatigue and hot air from our fans to mercifully lull us into something more resembling a nap than a nights rest. As I slipped into a semiconscious stupor, footsteps approached from outside and a voice called for me. There was a baby not breathing. Can I come?
After a quick stop to grab the key from Olen's house, I dashed to the OR. As I approached the door I heard the familiar sound of mouth to mouth resuscitation. A nurse was trying to ventilate a baby as she waited for me.
Flash forward again: I've been breathing for this kid for 30minutes and I'm pouring sweat. We are inside a cinder block OR that has been heated all 110degree day long and it feels like we are in a tandoori oven (man I miss Indian food). I usually try neonatal resuscitation for about 30 minutes...after that the success rate is pretty close to zero here in Chad. There were now 2 nurses plus a "pharmacist" watching me resuscitate this baby. I started explaining the science of resuscitation, acidosis, oxygen saturation, Carbon dioxide, etc. I felt like a Professor again.
When we reached the "quitting" point, I stopped ventilations and talked them through this boy's dying process. Yes he had a pulse but he hadn't initiated more than a rare gasp for ~45 min of his short life. His color changed from pink to dark and dusky blue as his oxygen saturation dipped to 43%. I walked out of the OR to wash my equipment. I returned a minute later to see him breathing a bit more...and his oxygen levels were marginally climbing. Instead of dying, this boy took a real breath. His pulse did not slow and then stop as I had described and seen so many times before. This kid was refusing to die. I grabbed the ambu bag and gave him oxygen again. Good color, good pulse, good oxygen levels. UNBELIEVABLE.
After an hour he wouldn't cry but he was alive. His eyes were open and he was breathing consistently. I sat with him for another 20minutes as the nurses continued stimulate and clean him up. I tied his umbilical cord and eventually we sent him back to maternity to reunite with his mother! Wow.
So here are the final scores for today:
My day started with a Cesariene section. Happy mom, happy baby. A+
By mid day we had done a sad laparotomy for a 6yr old girl with ultimately a non-resectable cancer. I stayed with her until she was fully awake and carried her to the pediatric ward. She is laying on a bed made of concrete with no mattress and no mosquito net. D-
I completed Pediatric rounds by late afternoon. 21 inpatient kiddos but discharged a few who are doing much better. A+
My night is wrapping up with a small and possibly short lived victory. A baby fought for life and refused to die. A++
I'm going to take another shower now and try to find that elusive sleep. Maybe I will pull on those ExOfficio underwear again too.
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