On teamwork. . .
This week on call may have been the busiest beginning to call I ever had, but it proved to me that I work with one of the most amazing teams in the world
4:00 I sign in to the Friends of Kijabe thanksgiving meeting – share all the exciting things happening in pediatrics for the year and then sign off to go get handover
4:30 I walk in to handover- The film on the screen shows a pneumothorax and I talk to the Peds Surgery fellows about how and if we should evacuate the air so the baby will stop breathing 90 times / minute. . .and not tire out.
4:35 The trauma patient in bed 3 ( 1 one year old in a minibus accident last night with multiple injuries) starts having irregular breathing and we decide to intubate to give the brain more time to rest and heal while the body heals as well. Nixon, Lolla, Wairimi get set up to intubate while Deb, Chan, and I go to finish handover in NICU.
4:40 The NICU team has just received 1400 gm twins and settled them on bubble CPAP and hands over what needs to be done and that we have no more incubators available – but one emergency cot warmer if needed.
5pm Kaya texts me from OPD about a child with temps of 104 refusing to feed, and Solomon runs to outpatient to admit them.
5:10pm The nurse midwife comes to say there are 28 week twins that have just arrived in triage, and mom is ready to deliver.
5:12pm Ima and Elizabeth work to move babies to make incubators available. I run back to ICU to see if we are ready to intubate bed 3.
5:18pm We ultrasound and realize one of the twins is in distress. The team decides to move to emergency c-section. One midwife runs for the gurney. Another runs to theatre to clear the room. I run to NICU where the team hands me CPAP and stuff to intubate the new tiny babies. Elizabeth helps me throw netting on my head so I can run into theatre. Ima rearranges all the cots
5:28pm We wheel mom into theatre and I pray with her while the nurse anesthetist starts here IV and then we consent her for general anesthesia. The OB team scrubs and runs into the room
5:45pm Mom is ready for surgery all of the theatre staff have descended on the room to get the babies out. Deb has run back to nursery 3 times to get the rest of the things we need. She says the incubator is almost ready.
5:48pm Mehret texts me and says she was able to needle the pneumothorax in ICU and remove 9 cc of air – the baby is breathing much more comfortably.
5:51 I text Madeline and ask her to make dinner, knowing it will be awhile before I get home.
5:53pm One baby comes, not crying, and we sprint to the resuscitation room
5:55pm The second baby comes, gasping.
6pm We fight for both babies, one turns pink and starts crying, one never takes his first breath. I had watched the running, the passion, the fight for these babies. I know we can tell mom we did everything possible to get them out.
6:15pm We run with the screaming twin to nursery. The nurses check a sugar, start a line, and Ima is waiting for me, and I hand her the warmed surfactant to help the premature babies lungs expand. I run to ICU to check on the two babies there.
6:20pm Bed 3 is intubated and settled. Nixon has calculated and written the infusions. The nurses are handing over to the night team. The heart rate is high, so I call Peds surgery and run to X-ray so we can figure out why.
6:30pm Ima and Deb have intubated and given surfactant. The baby’s sats are 100%, and she is screaming in protest. We place her in the warmed and humidified incubator and I run to Casualty to put in the X-ray for the ICU child. Ima and I debrief on the events of the day and then she runs home.
6:40pm Two clinical officers come to me with consults – there is baby with pneumonia and a child vomiting in our outpatient department. We bring one to Casualty and the other I go to see in Outpatient and the OPD clinical officers execute our plans
7pm The heart rate for bed three has come down; the team in nursery is getting ready to put a central line in the newest baby. . .
(I started this post 7 months ago, and then call became so busy that I didn’t finish it. It would be remarkable if I could remember how it ended, but all I know is at 7pm I had 22 hours ahead of me before I would be off call. And that the people in this story were there then and are still here in Kijabe and fighting every day for our patients. I am going to try to blog at least 25 times in the next 40 days, to make myself look around and notice all the things going on around me . . .and to share a piece of this place with you . . .)