8 hours on call with Arianna
(written during a brief rest on a busy call weekend)
As we move to take even better care of our patients, the pediatrics team decided to go back to full weekend calls to help with the management of difficult ones over the weekend. . .It will mean we are on 48 hours in a row, but with the help of our amazing clinical officers and nurses, it should be possible.
I came in this morning to a service of 34 babies in wards/ICU and 16 more in our NICU. Pete gave me the update when I arrived.
Bed 1 in our monitored unit is breathing way too fast. The patient is a 7 year old who had been healthy only two weeks ago, then her legs started swelling and she had trouble breathing. Last night she arrived blue, seizing, and barely able to breathe. Our team puts an ultrasound probe on her chest and sees the heart was barely moving. They started heart medicines, oxygen, but the child was bouncing with every breath. She is improved from the night, so I adjust the medicines a bit to help her heart, whisper to her when she stirs, and mutter prayers that what we are able to provide would be enough. She is in heart failure, the breathing machine can’t fix it, and we are waiting for a miracle (*which we receive, 3 days later, but that will be another post).
The next bed is a baby born with bowels outside of his body. I had intubated him 5 days earlier, but his lungs are better today and he is smiling at me on a whiff of oxygen.
The 3rd baby had been intubated the day before for seizures, fever and trouble breathing. I adjust the ventilator a bit, listen, and talk to neurosurgery about the plan for surgery and whether or not it will help her to improve. They decide to wait through the weekend. I review labs with the intern on call that had improve slightly and move to the the next bed.
The 4th child is a 5 year old admitted with fever and a giant brain abscess my previous night on call. Neurosurgery had worked through the night to drain the abscess and save his life and we had cared for him as he woke up. He is sitting on his mom’s lap, a little cross-eyed from the effects of the abscess, but doing so much better. Mom is smiling in a way you only can when you have lived in deep worry and are starting to feel hope.
Bed 5 was a child I had also intubated on my previous call when he seized and inhaled some of the porridge he was eating. He is now also doing well off the breathing machine and smiling at me sheepishly. He doesn’t know what to do with my pale skin and smooth hair, but mom smiles in recognition from the previous night. He is alive, improving, and she is happy.
The final child in our monitored unit is a 2 year old the size of a newborn we are treating for malnutrition. Food is medicine for him, so we were adding it back slowly, teaching the body how to process it again. He is sound asleep and his breathing rises and falls in perfect rhythm.
I leave these kids to round with my interns on the floor. During their intern year they work about 355/365 days learning as much as they can in a short period of time. We evaluate babies with fever and trouble breathing, ones with unexplained trouble growing, others who had been impossibly sick that are going home today and we clap and pray and review home instructions with each mom. I laugh with some moms, explain hard things to others, celebrate with moms nearing discharge and improving, and count down with others finishing antibiotics. We pray and rejoice in what God is doing with each one.
As I am getting ready to go home for lunch, I get a phone call from the obstetrician, a mom has come in incredible pain, 7 months pregnant and the ultrasound looks concerning. They are taking her to c section in the next 20 minutes. We don’t have room in nursery for a tiny one but the nurses and I rearrange the tight room. I run down the hall and push the only empty incubator from the pediatric ward to the NICU. By the time I arrive, our incredible NICU team is ready for the baby in less than 10 minutes. I chat with one of our interns about his life plans when the back up OB comes flying out of the room- something is very wrong. They hand me a tiny 2 pound girl who is a miracle, moving her limbs and taking her first breath – because instead of growing in the uterus where she belonged, she had been growing outside in the abdominal cavity. Mom is bleeding but because of the quick action of our obstetrics team, the baby is crying. We helped the baby breathe while the team worked to save the mom’s life. They do, and move her safely to recovery while we whisk the baby away to the NICU to put on oxygen and fluids and to tuck away in the incubator.
From there, I go to check on a baby in outpatient who had his uvula removed in a traditional ceremony and is now coughing. Our intern has finished his assessment and wants to make sure he can go home. He looks okay with no trouble breathing, so we write for antibiotics and watch to make sure he could breastfeed.
It is 4pm now, and I return to ICU to check if the changes we had made in the morning had helped our first patient in ICU. Her heart rate is down, her breathing has calmed, and her oxygen readings are back above 90. The rest of the babies are doing well, so I go to casualty to meet another intern who is admitting a 3 day old baby with seizures. The baby had been managed well by one of our former interns and sent to us for observation.
As I start to walk home again, aware that it was almost 5 o’clock, one of our pediatric clinical officers gets called to a twin c section. The two babies are sharing a placenta so one is much smaller than the other. I am writing this as I sit waiting for the babies. Our intern and clinical officer will receive them, and I am their back up.
The day will continue – 40 more hours before call is over, but for now, the babies are improving, and I am so grateful I get to do something I love so much every day.
It is hard, but it is so so good.