neonatal resuscitation

Before I get to the strictly medical portion of this blog entry, a few things:

1) I mused about finding a picture of the hospital surroundings. And yesterday on my way to lunch, I decided to take one. Here it is. It's pretty green these days, but the general chill of the late afternoons (and the percentage of time on call) has discouraged me from taking a walk off the compound. Maybe this weekend...

2) Little Kimutai, for whom I had asked prayers, unfortunately died late Saturday night after a failed resuscitation. And today I lost a little baby in the nursery who had been pretty seriously ill ever since she was admitted about two weeks ago. Her mother, Mercy, actually wanted to hold her while she died, and it was one of those times when I didn't even try to hide my tears... as often as I've seen it happen, it just never gets easier.

3) Last night, my med student friend Laura invited me to have "tea" with her. As she is from England, it turned out that this was code for a light supper. She proposed having "eggs and soldiers" for our meal, so I got to learn what that was, too. (It is toast cut in strips - per her internet research, optimal width 22 mm - and dipped in soft boiled eggs.) Of course, since I'm a little leery of eggs that are wet enough to dip anything in, I hardboiled mine and made them into an egg-and-tomato sandwich instead. But still with toast. Yum!

4) Tonight there was a Kipagenge (yummy outdoor potluck for the whole compound). Sadly, I didn't know about it until about half an hour beforehand, and so I had already eaten a large lunch, too. (Yes, "too".) Also, it was cold outside. No kidding. Adam White (one of the MKs) had some parka-type outerwear on, and though I teased him about looking as though it were below freezing, he was probably a lot warmer than me by the end.

5) I'm not on call tonight!! Even though I slept a reasonable amount this weekend, it's still very (wonderfully) different lying down in bed, turning out the light, and being certain that your phone isn't going to ring in five minutes.

6) I started to develop a sore-throat-type feeling earlier today. Please pray it doesn't blossom into anything.

Okay, I think I'm finally going to get around to discussing the heading... back in the States, neonatal "resuscitations" hardly merit the term. I distinctly remember the apprehension I had prior to my first night of solo Mac House call as a PGY-2 and being told confidently by the chiefs,"Don't worry - just dry the baby off." And really, most of the time, that's all it is... there. Here, it's a different story. I think I've been summoned to at least one or two resuscitations each day. When I arrive, I always feel a sense of trepidation asking the OB nurse why I'm there. What will it be this time? Or what combination of things? A huge percentage of the babies I'm called to resuscitate have meconium-stained fluid, and many also have fetal distress, because many of their mothers have been in second stage labor (pushing) for many hours at home before they come to the hospital. Not to mention that I've had two cord prolapses in the last three days! (Only one of them had mec on top of that.)

So "resuscitation" takes on real meaning in the Tenwek PACU (where the C/S babies are brought), and I get more practice intubating and bagging babies in one week here than I do in a year's worth of Mac House moonlighting. I've made the process into a routine over the past week: 1) Set up equipment. 2) Locate spirit swabs and wipe last baby's dried goop off equipment. 3) Find out from nurse what all the problems are before she rushes off to the theater. 4) Pray continuously for baby until nurse arrives with bundle in towel and places it in front of me. Praise God, the routine has worked out reasonably well so far, and even the first cord prolapse baby, who required about five minutes of PPV before his respirations were truly adequate, is doing well. And even when I have to jump out of bed at 3:00 am, pull on my fleece and walk briskly up to the hospital, it's still a joy to see a baby go from blue and and frighteningly floppy to pink and screaming and crying. It's just one of God's miracles that never gets old...