The glass is half full (31/3/12)
Princess Victoria died on Wednesday. One of the many potential complications of prematurity attacked - necrotising enterocolitis (NEC). Within 48 hours she just couldn’t fight it anymore. Despite our antibiotics trying to fight the rot in her gut, and the surgeons doing what they could, her tiny 900 gram body was just overwhelmed by the infection and we lost her. I couldn’t help but cry after the covering pediatrician told me, as my hopes were so high. And my heart is heavy for her mother Catherine, despite the the fact that both of us knew all along that this was always a possibility.
Baby Mercy was born suddenly at 35 weeks, and her lungs didn’t quite get the news in time, so she had a lot of trouble breathing at birth. But this week, we had the expensive surfactant, her parents could afford it, and the ICU had room for her to stay on a ventilator for 5 days while her lungs figured out how to breathe for her. Yesterday we took out her breathing tube, and all night long she merrily breathed on her own, keeping her oxygen level at 100%. Today, after a week on the edge of a precipice, we were able to move her back down to the nursery, well on her way to going home.
Between the two of them, I think the glass is half full.
Jennifer is away for 2 weeks in Uganda and South Sudan with the family, leaving me with a visiting pediatrician to cover the pediatric ward and a community pediatrician to help out for 2 days on the nursery. On Saturday, I had to round on 3 children on ventilators in intensive care and 36 other babies and children after a post-call night of helping the family medicine doctor manage the overnight emergencies and then manage them for the whole weekend. This morning I had to do rounds alone again.
But the visiting pediatrician was here for 2 weeks when we needed her – Stacey, a joyful, friendly, exceptionally competent kindred spirit who was willing to jump in with both feet and handled it admirably. Mary, our community pediatrician, was able to efficiently and decisively handle the crises in the nursery, including sweet Princess Victoria’s death. Without them, I would have been unable to cope. And today, miraculously, only one little girl was on a ventilator in ICU and the hospital director saw her for me, and there were only 20 other babies and children to see, meaning I was done by 10am and am now free to have a weekend.
The glass is half full.
Edmund was admitted to hospital for surgery to remove a brain tumour. Half way through the operation, he had an inexplicable cardiac arrest. He was resuscitated and taken to ICU, but it wasn’t until the next day that we were able to fully assess that his brain had not survived the hit it took on the operating table. Every bed in ICU was full and Hans, the adult ICU doctor, told me there was an adult in the emergency department who had a swollen airway and could only breathe because he had a breathing tube placed – and for him to survive, he’d need one of the ICU beds. Together, we walked around all 5 ICU beds to decide which patient needed to give up their space. And it became apparent Edmund couldn’t breathe on his own, and was unlikely to get any better. I had to call the neurosurgeon to ask him if he could talk to the boy’s family and tell him that there was nothing more we could do. And then I pulled out his breathing tube. He lasted a few hours.
Faith and Esther were born 2 weeks ago, nearly 9 weeks before their due date. They both needed the surfactant medication for their immature lungs – 2 vials each, at 17,000KES ($200) apiece. Our hospital pharmacy had only 1 vial. Jennifer had decided to give them half a vial apiece and to look for more. The pharmacist called around the country, and Dad physically went to hospitals in Nairobi to find some. In the meantime, while both of them received pressurised oxygen via their noses, Faith developed a pneumothorax (air trapped outside the lung, making it impossible for that lung to breathe) and nearly died. She was revived and taken up to ICU on a ventilator. Esther, her sister, started to breathe harder and harder and need more oxygen – a sign that more of the precious drug was needed, and soon.
Dad returned from Nairobi empty handed. The pharmacy, however, hit gold – I think it must have been actual gold, because a single vial of a different brand of surfactant, was 69,000KES ($700). Jennifer, in a Solomonian task, had to decide what to do. Together we decided to pay for the vial from the Needy Patient’s Fund, and give it to the child who wasn’t in ICU, as her chances of survival were better, and then we prayed.
2 weeks later, after Faith spent 3 days on the ventilator, and Esther took her place for 3 days after Faith recovered, both girls are back in the nursery. Esther needs no oxygen. Faith is recovering from pneumonia, a kidney infection and a separate blood infection, but is almost off of oxygen herself. The girls are starting to take breast milk by mouth, and their mother’s smile every day I see her is just precious.
The glass is half full.
Even though I walk through the darkest valley,
I will fear no evil, for you are with me;
your rod and your staff, they comfort me.
You prepare a table before me in the presence of my enemies.
You anoint my head with oil; my cup overflows.
Surely your goodness and love will follow me all the days of my life,
and I will dwell in the house of the Lord forever.
Psalm 23: 4-6
It has been a pretty rough week. There have been other deaths, and other babies are still hovering on the brink. But there are babies who have lived, who have beaten the odds, are home with their families. The cup is half full. If I am honest, and I work through the tears, and then take a deep breath and a good look around, my cup actually overflows.