Elisabeth Hesse’s Blog

1-30-09: Why I’m not going into intensive care

I’ve already written my bit about why I’m not going into obstetrics,
so now I’ll hit another speciality and explain why I won’t be doing that.

The day started well enough–bright and sun-shiny (if that’s a word),
with nothing planned after rounds.  Then we started rounds, and
things went downhill from there.

Recovery ward went fairly smoothly.  The only thing that was decided
there was that one of the broken arm patients, who had his arm in a
splint and elevated to reduce the swelling, was ready for a cast, so
we decided we’d do that after we finished with rounds, thinking that
with the paucity of patients I wrote about yesterday, we would be
done soon.  Then we headed over to the OB ward, and there went our
great plan of having a quick day of rounds.  The premature baby
wasn’t looking that great at first glance, and when we looked a
little closer, we realized that he was gasping for air, and had a
pulse around 70.  That would be fine if this were an adult, but for a
tiny premature baby, it’s a pretty ominous sign.  Dr. Manar ran the
baby over to one of the exam rooms while the nurse ran to find oxygen
and Dr. Ovoi ran to find a ventilator bag with a neonatal mask, and I
tried to get the mother to stand up and walk toward the room where we
took the baby.  Before we could get the oxygen set up, the baby
stopped breathing, so Manar and I found ourselves doing baby CPR and
watching very closely.  It’s a little scary, doing chest compressions
on a baby that weighs less than 1.5 kg.  You can see all of the ribs,
and feel the sternum give way under your fingers, and everything
feels very fragile.  We finally got the baby to the point where we
felt like he was breathing on his own (albeit with the oxygen over
his face), and his pulse was back over 100.  I checked his pupils,
and they were slow to dilate, but they did.  We got another IV
started and hooked it up to the oxygen better (they have these tiny
little nasal cannulas), and the mother was still sitting out in the
hall, looking either depressed or bored, I couldn’t decide
which.  There was only one nurse in OB, and the two doctors and I
couldn’t keep hovering over the baby, so we decided to get him over
to the general ward, where there is better staff, and an outlet where
they can keep the oxygen plugged in after the electricity turns
off.  Unfortunately, the baby stopped breathing again on the way to
the general ward, and despite another round of resuscitation, we
couldn’t bring him back.  In all, we spent an hour to an hour and a
half trying to save that baby, and  we pronounced him dead at
11:10am.  I don’t know where the mother was when we finally said it was over.

After that, we still had to finish rounds (and see two more patients
with casts, both of whom were scheduled to get them off
today.  Neither had good-looking x-rays, so they have to wear their
casts for another two weeks), and it was around 1:30 by the time we
got home.  Since we didn’t get to cast the patient from recovery ward
after rounds, we went back into the operating theatre at 3 to do
that.  My job was to line the bones up while the strong men we found
(a nurse and two CHWs) held traction.  That was kinda fun, but when
I’m not sure the bones stayed where I put them when I had to let go
so we could put the plaster on.  I didn’t really want to become part
of the cast.

All things considered, with the day we had today, I’m glad that I
don’t have any assigned duties on the weekends.  I can use the day off.