Midnight Call for Help   1 comment

April 30, 2009
12:45 AM
Moi Hostel

Wednesday evening had been spent relaxing at a local club called Caesar’s which was packed to the walls with people watching the Manchester United vs. Arsenal champion’s league soccer match.  It was a fairly uninteresting game and we were all ready for sleep when the taxi dropped us off at the hostel at about 12:30 AM.  The rest of the group continued on to IU House.  I was about to climb into bed when my phone rang.  It was Manika.  “Something’s wrong in the NICU Chris.  I don’t have any details but the hospital sent word to the guards that they need help right away.  Can you go and call if you need help?”  “Of course.” 

I threw on my shoes and white coat and bolted out the door of the hostel, crossed the street and passed the hospital guards.  As I reached the NICU, nothing immediately presented itself as wrong.  There was a nurse calmly searching through drawers in one of the rooms.  “Did you call for help?” I asked.  “Yes doctari, I want to start CPAP on a baby but I can’t find all of the parts.”  CPAP or continuous positive airway pressure is essentially a canister of water attached to an air hose that helps keep oxygen flowing into the lungs.  As we searched for the parts, I asked what baby this was for and she indicated it was a new admission in the incubator room.

The tiny room was stifling, filled with mothers tending to their babies, some breastfeeding.  A single warming bed was left unattended at the back of the room.  As I stepped forward, I saw the tiny lifeless grey body lying uncovered on the gel mattress.  Its hands and feet were blue.  There was no movement.  A sudden gasp for air showed signs of life, but was an agonal breath which is a sign of the brainstem trying to save itself, not of functional breathing.  The oxygen saturation which is supposed to be no lower than 90% was 31%.  This baby was on death’s door.  As I assessed the situation, I quickly called Manika to tell her I would need help and we agreed that I would start delivering oxygen by ambu-bag and order labs while she found her way to the NICU. 

As I began to breathe for the baby, the nursing mothers filed out of the room, none of them particularly interested in what I was doing.  I ordered the nurse to get labs started and find the on-call registrar (resident).  The nurse left the room.  It was 1:00 in the morning, I was alone in the NICU, sweat pouring from my forehead, pumping air into a dying baby.  Was I helping?  Was the air getting in?  Was I forgetting anything?  A million questions ran through my mind.  The pulse oximeter chimed and showed that the oxygen level was rising above 50.  The baby twitched.  65.  Color began to come back to the skin.  80.  Was there a cry?  90.  The tiny black eyes open, not seeing, but alive.  It was working.

Manika burst into the room and I updated her with the little I knew about the baby.  In her hands were tools for intubating the infant.  I recalled stories about how infants at this hospital are almost never intubated because there are no ventilators available to breath for them once the tube is inserted.  We agreed to try and start CPAP as a last resort.  The nurse brought in the device from an infant who no longer needed it and I began to set it up for our patient.  The setup took less than a minute and the oxygen had already dropped to 50% telling us how fragile this infant was.  We watched as the pressure began to fill the tiny lungs and the pulse oximeter assured us that the CPAP was working.  We bundled the baby and sat on the nearby bench to watch for signs of distress.  Thankfully, there were none.  The baby was stable.

As we both sighed with relief, we noticed that nearly every monitor in the large NICU room across the hall was alarming.  Manika held down the fort with our patient and I went to investigate.  It was 2:30 AM.  Three children on CPAP were not properly set up and were not getting the oxygen they needed.  Several babies had EKG leads that had fallen off.  The warming beds were alarming because the temperature sensors were not attached and the bed couldn’t gauge the temperature of the patient.  There was no nurse in sight.  I moved quickly from bed to bed correcting the problems and silencing the alarms one by one.  Manika joined me.  Our patient was stable and sleeping.  We finished tending to the more than 20 infants in the room.  Still no nurses.  An hour passed.  No sign of the people responsible for the wellbeing of these children.  Children with the greatest need of attention in the entire hospital.  Children in intensive care. 

Finally, a door at the end of the hall opened and the nurses re-entered the unit.  “Excuse me, but where have you been for the last hour?”.  I was responded to with blank stares then, “It has not been an hour.  We have been here the whole time.  We had to prepare formula for some of the babies.”  I wanted to yell, to tell them how unacceptable their behavior was, how lives were in their hands and they were hiding in a back room.  “Is that your phone ringing?” Manika asked.  She saw my anger growing and rightly defused the situation.  Chastising the nurses was not going to change anything tonight.  “One of you needs to watch these babies the rest of the night.”  I was done, I had to leave them alone.  The resident had returned and assured us she would check on our patient throughout the night.  A hospital pickup truck picked up Manika and I and dropped me at the hostel.  It was after 4:00 AM

Thursday Morning, April 30 
8:30 AM

I reported to the NICU for rounds.  “Dactari,” said one of the night nurses, “your baby is doing so fine this morning.  We knew she would make it.”  I walked quickly to the incubator room passing several smiling nurses.  There she was, still on her CPAP, pink instead of grey.  She had made it through the night.  I don’t know what future she has.  Her weight is at a point where few infants survive in Kenya.  We have no way of knowing how long she went without breathing properly.  There may be underlying conditions that caused her to crash in the first place.  Regardless, she has the chance now to try and survive another day.  Against all odds.

Friday Morning, April 31
4:00AM

The fight was lost during the night.  She never had a name.

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Posted May 3, 2009 by chrislux in Travel

One response to “Midnight Call for Help

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  1. Chris,I\’m so sorry. I can\’t imagine what that experience must be like. Nonetheless, your commitment to saving her life gave her a chance and, sometimes, a chance is all that can be given.Jeremy

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