A challenge

When I entered my 24 hour shift yesterday, I knew I was in for a long one. We had three sick premature babies in neonatology, a one year-old with respiratory failure, a seven year-old arriving with septic shock needing a strong medication to keep his blood pressure up and a crashing two month-old with congenital heart disease on the general pediatric wards.

I was scurrying back and forth between the NICU, ICU and wards for the first hours. Fortunately, I got everyone stabilized except for the infant with heart disease. When we got a bed open in the ICU, we transferred him over.

The nightmare then ensued. His oxygen saturation decreased steadily to 20%. I tried many things to get them to increase, but nothing worked. Finally, I decided to place a breathing tube. I gave him medicine to induce sleep and then went into his mouth to place the tube.

“Ohhhh, no!” I should have expected this, but he did not have normal anatomy down there. I could not find vocal cords or even a hole for his trachea. I tried to look three times, but no success.

I called anesthesia STAT. When he arrived, a sense of relief came over me. As he took his first look, the stress returned when he raised his eyebrows and softly said, “huh, I’m not sure what I am looking at.” After eight attempts to place the tube he just started poking it into things hoping for the best. Finally, one long hour later, he got it and we started delivering oxygen to his lungs.

Well, not that much oxygen as the saturations never exceeded 65%. I tried to use a few types of medicines to increase blood flow to his lungs, but they didn’t work.

Finally, I called the pediatric ICU in Hawaii and asked to speak with the leading doctor. When he answered the phone, I was pleasantly surprised to hear a familiar voice. A supervisor of mine from UCSF had moved to Hawaii and was now on the other line.

We discussed the case at length and developed a great plan of attack for the patient. We had several options at our disposal.

For the next eight hours, I stood at the bedside and tried to help the infant. Unfortunately, each time I tried a new intervention, nothing changed. The frustration was nauseating.

When my shift ended, I approached the family one last time. I told them I was sorry about their child and that I wished I could have done more to help him improve.

The father responded, “Why do you keep bringing me bad news? I want to hear good news….I should have taken him to a place that knows what they are doing. I want a doctor that does not need to call someone else in Hawaii for help.”

It was a demoralizing way to end a difficult 24 hours.

After a little sleep, I will be fine and ready for the next challenge.

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