One of the worst experiences of my medical life.
This happened about a month ago – but I couldn't bring myself to put it down on paper due to the hurt and tears it caused me. It is a good representation of the difficulties we face here.
A mum bought in her child to me…. 6 days old….born with no problems.. however day 4 of birth the babies skin started peeling off. Literally the whole epidermis was peeling leaving red raw areas exposed. There were also areas of superficial infection on the raw areas, and it looked a bit greenish. The baby had slightly decreased feeding but was otherwise alert and vigourous. When I saw the baby I thought the baby looked in pain, so decided to treat it with pain relief, some very strong IV antibiotics to get rid of the infection, regular feeding, and treat it like a burn; wrapping to keep warm, dressing, and IV fluids because it was losing fluid through the loss of its skin.
The next day I came in – more of the skin had come off including the babies hands and finger nails which looked like loose gloves. The baby was making a constant whimpering sound which seemed like the baby was in extreme pain. Oh even as I think of the sound it makes my heart cry.
I charted the baby a tiny whiff of morphine so the nurses could do some dressing changes…. After about half an hour the nurse ran to my room to say I urgently needed to come. I arrived the baby was blue …. Blue…. Not breathing, heart rate about 20. So I called for help and started CPR (thank god for my Advanced Paed Life Support training!). It was the scariest thing I have ever done – anyway after a period of time of mouth to mouth and some oxygen the baby came back. Anyway the baby was placed on oxygen and I sat with her all day. She continued to have these blue spells where her heart rate dropped and she needed CPR all day. She had overwhelming sepsis from the secondary skin infection that meant she needed support to maintain her physiology.
I looked at the other doctor who was with me and my eyes welled up – surely she is not going to die because we ran out of oxygen! He got into action and started bagging her (which means a mask and a bag attached – so essentially we were pumping in air which has less oxygen in it). The pressure of the bagging of air maintained her heart rate and we continued like this, one by one, for about an hour. Until finally she started breathing by herself.
Rightio – this is about 5 hours later and she was finally stable enough to be sent by ambulance to the Regional Hospital where they had oxygen. Called the ambulance….”oh sorry doc the ambulance, it’s travelled for servicing”…… called ambulance number two….”sorry doc it is not running today…” WHAT!
When finally we found an ambulance that was running from the Regional Hospital, and it arrived quickly...but without oxygen and sirens! "doc the sirens have spoiled"... sigh... ok I will take it in my stride. I sat in the back with the 6 day old baby and watched her constantly, while the ambulance was beeping it's horn trying to get bicycles, goats, pigs, cars out of it's way.
Nearly at the hospital... baby stopped breathing, turned grey and I couldn't even hear a heart rate with my stethascope.... argh ....started CPR and continued it until we arrived at the maternity area of the hospital. Now, when I got there the baby was still not breathing so I ran with this limp doll in my arms - up the corridor, around the corner, up another corridor .....(where the hell am I!!!!!) until I finally reached maternity. I kept with the cardiac compressions and mouth to mouth when I found a bed and kept yelling "HELP!".
The midwives found me and directed me to an area where the ladies give birth, and I started bagmasking the baby until she pinked up.
NOW..... we are here at the Regional Hospital, it's 6pm and the baby is still alive and on oxygen... whew!
BUT....... where is the doctor? Apparently it's protocol to arrive at outpatients department and see them there. Oh well I thought, I will go down to the OPD and discuss the emergency situation with the doctor on call. Walked all the way there (approx 500m) and found the consulting room. I introduced myself, and explained the situation, and that he needed to come immediately to assess this baby. Anyway, he said NO, he said he was not going to attend to the baby and that he wanted to finish off the 'well' patients who were waiting. WHAT??? I then asked him his name, and if he was a medical assistant (which he was), told him he was making a grave mistake because this baby is going to die, and walked out. As soon as that door slammed behind me....I balled! I couldn't believe it that the one person consulting would not attend to this baby....AND it turns out he was the only doctor in this useless hospital! (all the cuban doctors that work here had gone away on a conference!).
I was then stunned.... what do I do??? I walked to the paediatric department where I knew a nurse who was working and stood there crying.... in front of all the nurses.... what do I do??? The nurses just stared in disbelief... a white doctor crying for a local baby...
Luckily though the nurses where empathetic enough to call in one of the doctors who was on call and at home, which is totally not allowed, it is meant to be the Medical Assistant who calls them in. He kindly agreed to come in, so I waited for him to arrive. Whilst waiting the nurses were wonderful enough to move the baby to ICU (a bear room with oxygen...that's pretty much it), the baby had one more episode of cardiac arrest which we managed with bagging, but became stable on the oxygen until the doctor arrived.
About 8pm, exhausted I went home, and cried and cried......cried with frustration of the lack of caring of the MA.... cried for this baby who would have died if I hadn't been a boshie whitey..... cried because we ran out of oxygen..... cried because doing CPR on this baby felt as if I was holding a limp grey doll in my hands....
Next day I heard the baby had started taking NG feeds of expressed breast milk and was stable, I felt relief but also a degree of numbness.
.....sadly the baby died two days later. All I know is the feedback from the midwives, apparently it was a technical difficulty in ICU.....something to do with the oxygen.....sigh
