(Image credit: http://www.myce.com/news/samsung-still-on-top)
I wonder if someone still bothers to read my personal stories that kinda pour myself out besides enacting what I really should. I already narrated some of my holiday and weekend experiences previously and this one you are about to read is not an exemption.
I went home early yesterday with the hopes of spending a worthwhile weekend with myself alone. After dinner, I had a home-service massage and while receiving such, I received no spoiler phone calls nor sms. Great start! So let’s proceed… I planned to watch a movie series on The Girl With a Dragon Tattoo that I bought during my vacation. Truly a me-time moment… Okay, so let’s sit down, switch on TV and DVD player… press play… it’s starts to run… PHONE RINGS… press mute on the remote control.
“Hello doctor, I would like to refer to you a preterm baby for joint management. He was born few hours ago and I am having difficulty to improve his oxygenation status, he is also a case of difficult intubation.” BOOM! That does it, no more DVD night, the fun is already spoiled. In cases of calls like these, I have the options: to accept or decline. But having made this abstract contract with the forces of nature and the universe to do good and promote and uphold the welfare of human beings with the best manner I could and all its accolade, I always accept when I am around. In fact, I hardly decline these distress calls and sometimes have to cancer my out of town trips whenever I handle a baby whose case is too difficult to leave.
Hearing the words “persistently desaturating” or “difficult intubation” are heavy words for people in my subspecialty that makes me wish to have the ability to teleport or apparate/disapparate. I wish I could just really do that so that I could be at these babies’ service that very instant. In general, you’d love to be there that very instant because allowing the baby to be in persistently low blood oxygen will cause damage to the brain and other organ systems. Fortunately, this baby being referred is preterm and newest school of though is telling that we don’t have to rush to increase the preterm baby’s blood oxygen to rapidly as this may cause undue side effects to the baby. Yes, oxygen is a drug and can cause oxygen radical injury, amongst other else. To combat this, the person should have sufficient amount of superoxide dysmutase. But since preterms lack the former, they are susceptible to oxygen radical injury.
I drove as fast as I could to the hospital and I got there at 12 midnight. While doing so, I was dictating to the nurse what equipment to prepare, thanks to bluetooth technology. (My phone is synchronized to the car that allows me to make/answer a call without holding a phone – a common cause of road accidents; yes, the car becomes the speaker hehehe). Upon arrival and doing my aseptic/antiseptic techniques, I intubated the baby immediately and hooked to mechanical ventilator. Despite this breathing assistance however, there was minimal improvement on the status of the baby. When I looked at the lungs of the baby, it was a case of severe respiratory distress (the entire chest area is white and there’s no way you can identify the borders of the heart).
Not the actual case but CXR picture is identical. (Image courtesy: http://www.nicu.blogfa.com/post-54.aspx)
I told the main attending to notify the father that the baby badly needs surfactant as this substance is deficient in the lungs of the baby. While securing, I prepared the baby well and did some necessary checks. Within 30 minutes, surfactant was available and I instilled it directly into the baby’s lungs immediately. Within few minutes, the baby showed dramatic improvement and thus became stable. I started decreasing the settings of the respiratory and gave my orders to the nurse so I decided to go home. I reached home at 2:00 am and was preparing already to go to bed.
A few tweets then the phone rang again. I thought the baby was deteriorating but it was the OB resident calling this time (from the same hospital). Another mother with severe hypertension and ruptured bag of waters is being scheduled for cesarean delivery and I am being asked to take care of the baby. I asked what time will the baby be delivered, the resident said, NOW. Oh my… so gathering back my things, I again rushed to the hospital. I arrived quite early though so I told the resident to ring me when anesthesia induction has started as I am just napping at the parking area.
Baby came out at 2:52 am, she was premature but more mature that the problematic one I had intubated. At least this time, the baby has no problem breathing, but is considered small for gestational age (weight, head circumference measurements are below the 10%ile, huh? whatever). This means that the mother’s hypertension has been long enough, and that the placental blood flow to the baby is so poor that lead to baby’s “malnutrition.” Hence, after attempting to make baby suckle from the mother, I had to monitor baby’s blood sugar to avoid hypoglycemic (low blood sugar) episodes. We were done already at 4:00 am but being too sleepy already, I decided to sleep in the doctor’s lounge instead of forcing myself to drive home which might make me succumb to a road accident. This in anyway also made the nurses access me for personal referral regarding the two babies we just admitted.
7:30 am, when everything was fine, I decided to go home and steal some well-deserved sleep.