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A Day That Was…

24 Feb

FRIDAY NIGHT

The eve before the Grand Street Dance Parade of the 18th Panagbenga Festival. I had a good dinner and night cap with friends. In anticipation of the heavy traffic that will ensue during and after the parade, I went to visit my premature baby by 1 am. This will also make me feel and sleep confidently as I have checked his status just prior to going home. And so I thought.

SATURDAY

Being sure that baby’s condition was stable and perfect before I left, I slept comfortably immediately upon reaching home. At dawn, the resident on duty was calling me, referring to me the baby presenting with abnormal color and oxygen saturation. I instructed her to do a blood gas analysis and was waiting for the result. I didn’t notice, I fell back asleep.

At 6 am, the phone rang again, telling me that baby’s color has become dusky and the oxygen saturation registered in the monitor kept fluctuating. I was asking for the blood gas analysis report but she said they weren’t able to do it because the test method was not available in the laboratory. I told her to ask the respiratory therapists to do it instead but she said they’re having difficulty or don’t want to attempt because the baby was too small. (in fact, my thumb is even fatter than the baby’s forearm, so I really understood why they can’t find a good vessel to puncture. I then told the resident that I will be the one to obtain the blood sample upon coming to the hospital).

As I was getting myself fixed, the phone rang again, resident telling me that they have started doing cardiopulmonary resuscitation as they could not anymore appreciate the baby’s heartbeat. I PANICKED! Immediately I ordered them what they should do, although they have initiated doing it already, properly.

In my fear that I might lose the baby, I forgot that I just survived a cardiac arrest, that I should never be stressed. In my haste, I had to forego breakfast, I forgot to bring along my medications. I had to drive with my hazard lights blinking and honking my horn just to be able to drive fast and reach the baby before it would be too late. I was indeed like a hell driver. Midway to the hospital, my phone was ringing. I was fearful of what the caller will say as I saw in the monitor that it was the resident who referred the baby. Good thing at that time, the traffic halted, so I had few seconds to grab my phone and press the speaker. She was calm unlike earlier when she sounded panicky, telling me now that they were able to revive the baby after only 2 doses of epinephrine. However, the cardiac tones are not that yet strong and the oxygen saturation is still fluctuating. That made me feel a little lighter, calmer and “come down to earth.”

I arrived at the hospital with the baby alive but still in unstable condition. Found out that baby has severe metabolic acidosis and the pH was too low that it can coagulate all cellular enzymes of the baby. I tried to reverse it and in doing so, frequently checking baby’s blood gas after each corrective measure I have done. I was able to sneak in having lunch at the hospital canteen but went back immediately to the NICU and still found out that the baby’s blood gas status was not acceptable. In 2 hours, I was able to raise the pH to higher level, safer than the initial blood gas analysis I got where the pH read an alarming “LOW.” (It should be in figures. LOW means that the level was really too low that the machine can’t read any value, that survival is nil if it remained uncorrected. On the other hand, I cannot reverse also the abnormal blood gas as rapid attempt to do so might trigger intracranial or germinal matrix hemorrhage, a bleeding into his brain parenchyma, which is more fatal).

Then, all of a sudden, while waiting for baby’s condition to stabilize, the power went off. All of the gadgets attached to him alarmed. Good thing the ventilator he was using has an hour of reserved power thus it continued to breath air for the baby. The mother who was at her room got nervous as well that she immediately ran to the NICU. (Well, she need not worry as everyone were alert and attended to him immediately.)

At about 3:30 pm, the blood gas was now normalized, baby resumed his old self of being active. I received a referral for care of a baby about to be delivered. Mother was on her second pregnancy, and arrived at 4-5 cm cervical dilatation. It then made me estimate that the mother will deliver in about 6 hours following the normal labor curve (though this is 2nd pregnancy, thus it can be shorter.) I then left my premature for a while, did my rounds at the wards. I also visited my other patients at the other hospitals. After which I went back to my baby and get another blood gas. The oxygen saturation was again dipping and after corrective measure, it went back to normal. I got an SMS that the mother was already 6-7 cm dilated so I thought there was ample time for me to go home, freshen up and probably work out for an hour before she delivers. I went then to my car. It was less than 30 mins from the SMS when the resident notified me that the mother was now 9cm to fully dilated. Instead of going home then, I just waited at the car for the call for delivery. I sent my reply and said I will just wait at the car. Upon sending the message, the resident replied and said that the mother is now about to deliver. I then immediately went back to the nursery then to the delivery room. In between the mother’s bearing down, I went to the NICU and peeked, ensuring that the premature was doing fine; he did cooperate. The baby, gladly, was term and robust. He was well. He also had his first breastfeeding at the delivery room few minutes after coming out.

I then decided to go home to freshen up then come back for dinner. But as I drove, the traffic was unbelievably still. And surprisingly, it is the traffic going out of the city proper that’s not moving, instead of the inbound traffic. So weird. I couldn’t see policemen manning the street just because it was already past 5 pm! So instead of my original plan, I dialed my phone and called a fastfood and ordered food delivery to my apartment instead. I turned back, detoured to a longer route than my usual. It was initially continuous flow but as I was near the exit to my apartment, the traffic was as bad as the one I left. It barely moved. Just imagine a 2 kilometer stretch that I took for 30 minutes. I was reassured my food will be delivered in 45 minutes. But I was already done with shower and my food has not arrived yet. Considering the traffic all around the city, I understood why the food arrived late. After devouring, I then decided to take a nap instead of going out and celebrate with my friends. Was I tired? No. I was DRAINED and EXHAUSTED. But then, with a brand new coronary arteries, I wasn’t at risk for a new heart attack. Not yet. Not this soon.

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Posted by on February 24, 2013 in Uncategorized

 

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