Shanksteps #173

I sit against the operating room wall holding a small baby in my lap. He is wrapped in a dirty blue towel that has amniotic fluid and meconium all over it. He had come out of the cesearean section that I just performed with a big cry and apparently breathing well at the beginning. I was doing a surgery on a woman with a small pelvis that had been in labor for three days before making it to the hospital in the evening. I had done the same girls previous surgery a couple years ago. She says that her girl is still living. She wanted to have her tubes tied after this surgery. Her husband agreed. As we finished up the surgery, Yaouke was suctioning the baby, Dr. Solomon and I were closing the uterus, and abdomen. Yaouke said the baby wasn’t breathing well. At the end I checked the baby. If a black baby can be blue this one was, or at least his lips were! I put oxygen on him. He had small grunting sounds. I sat there against the operating room wall will the nurses cleaned the room. As I sit there I cradle this new life in my arms. I try to wipe meconium off my finger by wiping it on a “clean” area of the towel. I place the oxygen monitor on the baby’s finger. The whole hand fits inside, but eventually I get a reading. When the baby wiggles around and the oxygen comes off his nose, his saturation drops to 77% (normal >92). He desperately needs the oxygen. The next thought that runs through my mind is how long should I sit here holding the baby. As we have been back here it is easy to fall back into my previous roll and concerns. Again, how long will I sit here taking care of this baby. It’s a little different this time because I only have to have enough energy for two more weeks, not a year. So I sit there longer. After about an hour there seems to be no change and everyone is done with their cleaning and other tasks and ready to head home, 10PM.

I take the baby to the nurses sleeping room, office. I set up the oxygen concentrator, monitor, and voltage converter to keep all running. The nurse finds a padded foot of the bed to move into place on the floor. I place the baby on it and tape the monitor to his foot that is moving constantly. It seems to pick up his vessels and oxygen concentration. Tape the oxygen cannula to his face and cover him with all the cloth the family was able to come up with. A couple small pieces. I watch the pile on the floor move a few minutes and everything seems to be working.

I check on the 17 year old girl that had a bad motorcycle accident. She arrived unconscious and on palpating her head I felt she had a depressed skull fracture. I had rushed her to surgery yesterday afternoon. I explored her scalp. There was a large hemotoma (blood collection), but no apparent skull fracture. I closed up my incision. I talk to the family who is sleeping on the mats beside her bed. They say she has not moved or done anything since surgery. I uncover her from the large blanket that is on her and she feels hot. She’s about the age of Sarah, and I worry about her, knowing I can do nothing more. We get a glass thermometer and check her temperature, its equivalent to 104.5 deg F. Is she having malaria, or a central (brain) fever? Well I can treat malaria and not the other, so I treat malaria, and give her IV asparin to help bring down her fever. IV asparin is the only med here to give for fevers.

I check on the small pile of fabric in the nurses room. It’s still moving with the baby boy inside. The oxygen numbers seem OK, so I head out to the ER, on the way home. There I am stopped by a nurse who just brought a pale baby to the the ER from the pediatric ward for oxygen. A hematocrit (blood count) has been ordered since 2PM but not done. I ask them to call the lab tech and get it. Then to verify the blood of the mother who is present to give it to her baby. They are instructed to call me if there is no match as I am O+ and can give to most people. I head home.

…

I am thanking God! HE protected the child through the night and the kid had breast fed a couple times before I saw him. Mom is complaining of pain, but then again why not, I forgot to write our strongest pain medicine, Ibuprophen! The mom is laying in her bed on her back. She is covered by panye (colorful cloth) from the waist down, the top bear with the baby attached to her right breast. She is smiling because her baby is alive. This one moment makes my hours last night worth ALL of it!