I dont even know what to write, or how to start writing this… One thing for sure is that DEATH is inevitable… At the end of everything, DEATH is the only victor, it will conquer us all, no matter how much we try to avoid and evade it.
(Photo courtesy: http://thinkinlikegavroche.wordpress.com/2011/11/08/a-grieving-mothers-wish-pantoum-poetry-by-toni-cross/)
A mother on her fourth pregnancy was scheduled for emergency cesarean delivery as the fetus’ heart rate and activity is reflective of ongoing distress. Baby had immediate respiratory distress requiring her mechanical ventilatory support to breath effectively and with ease. Despite the assisted breathing, baby still showed progressive respiratory distress typical of preterm babies with deficient surfactant. Within hours, surfactant was administered affording slight relief. Baby’s response wasn’t dramatic as expected; perhaps due to delay from the ideal time of administration from birth. Few days after, when favorable response was expected and weaning from mechanical ventilator was expected to be quick, another problem arose, a patent ductus arteriosus. This now prevented us from weaning off the baby from the respirator. I administered an anti-inflammatory drug in an attempt to close it. After few doses however, the artery remained patent, otherwise baby was doing well. The next day saw poor blood gas status requiring appropriate adjustment of the respirator settings. I saw baby in the middle of the night as I had another baby born at the same hospital.
On the fifth day of life, everybody was surprised by the baby’s status: she was in severe shock. The right forearm to the hands changed in color similar to the hands of Dumbledore that destroyed the ring of Marvolo Gaunt. She was bleeding from her lungs, stomach and all puncture sites would take a long time to clot. Her skin was doughy dry and pulses were thready and barely palpable. Her abdomen and lower extremities were swollen. Blood gas were abnormal and needed correction. Medications were revised, blood products were secured for transfusion, respiratory settings were increased accordingly and cardiac drug support was added. Blood gas analysis had to be done serially but to no avail, she kept on having uncompensated mixed acidosis. Ventilator settings were increasing; urine output was decreasing signifying failing kidney as well. When she was “stabilized” (and so I thought she was), I went to other hospitals to round other patients and consult those at the clinic. Having a stable update at the end of the morning shift, I proceeded to my workout (this keeps me sane), while waiting for another possible preterm baby to be delivered. Then I went back to check on her after I was done, making sure she was stable. I then decided to go home and do my waiting there for the call to deliver the preterm baby. While waiting, I received a referral about the problematic baby, saying that color became worse. She immediately requested for blood gas analysis; the result made my intestines knot several times as the figure clearly spoke of death. The pH was 6.7! (In medical parlance, a blood pH of less that 7 or more than 7.7 is NOT compatible with life). I ordered for aggressive correction and while doing so, I got called to another hospital; it was time to deliver the preterm baby. It turned out that the baby was term. Upon making sure that the newly born baby was well, I went back to the other hospital where my problematic preterm is. Yes, I brought blanket with me as I expected to keep vigil and watch over her. She remained stable and early in the morning, I repeated the blood gas analysis. It was still below 7 at 6.8. I already knew that “Death” has already claimed baby with his scythe, and I was just waiting for exact time her heart will beat last.
(Photo courtesy: http://www.medscape.com)
I saw the mother… I was helpless, I didn’t know what to tell her but I know that she already had the feeling. Mother’s have instincts, they would know when their child isn’t doing well. I just didn’t want to underscore and concretize the fear that she was feeling inside. Was that the right approach? I don’t know. I just didn’t want to sound and appear mean to her that early hour of the day. So, in my attempt not to crack the bad news, I asked her religion and if she wants baby to be blessed/baptized while there’s still a chance. So far in my mind, this was an indirect way of saying she will not make it. She agreed and arranged for the minister to pay the baby a visit. Before I left, I told her that it is up to baby’s response where this treatment will go. Then I went home at around seven o’clock to have my breakfast and for few hours rest. I was anticipating then that I will be called during lunchtime when the baby’s heartbeat has ceased. I finished my clinic consultation and rounds at other hospital when I finally got THE CALL. When I saw in my phone’s LCD that name of the caller (the hospital where the problematic preterm is), I already knew it was TIME. True enough, even without me asking, the first sentence of the caller said “We can no longer appreciate a heartbeat.” So I rushed… checked on her, and called the time of death.