Howard's eclectic blog: Quite a day

In the morning, the resident report was cancelled and then the senior residents were also called away to a meeting. So Cindy and I made rounds with the interns and a junior resident. It seemed quite chaotic to us.

There is one baby who is quite ill. She was a bit distended on Friday and by Monday, she was very distended and much sicker looking. Her x-ray looks like she has a distal bowel obstruction. She has not been getting better. We suggested trying a saline enema yesterday since she has yet to have a bowel movement and the surgeons do not want to operate. Other options like gastrografin are not available here. We've also been told surgery here is not good. The surgeon has been coming by and we were told in the morning that the baby was going to have surgery today. Then just as we were preparing to head back to ERC, Adane called me and said the surgeon wanted us to try the enema.

At around 12, a very immature baby boy was admitted. 26 weeks, quite cold, respiratory distress. Delivered after induction because, after days of ruptured membranes, the mother developed chorioamnionitis. I think the baby was born outside the hospital, but I'm not sure. We placed him on CPAP and wrapped him in plastic to warm her. He looked pretty good actually. There were different interns then.

Anyway, we came down to the NICU to do the enema. Not very successful results. Then, when I looked over, the 26 weeker was not breathing and looked quite dead. Abebe, the senior also saw that. We started doing resuscitation, breathing and compressions. After a few minutes, his heart rate was better but he did not breathe and still looked quite blue. We realized then that the oxygen was empty. We then moved the baby across the room to the same bed as the big baby with Downs so we could oxygen. AFter a while, the little one started breathing and I turned up the CPAP pressure to 10 cm. Of course, he was then quite cold, so we had to move him back to the working warmer where he started. Once the O2 tank was changed of course. I rigged up a chin strap to see if that would help. The nasal cannula prongs are just too small though so not much of the pressure is transmitted.

We also heard the surgeons have decided to do surgery on the other one in the morning.

In the middle of all of that, Cindy became ill with likely traveler's diarrhea and disappeared to the bathroom. I missed that though I knew she was gone. And our driver, Lemma, was quite unhappy that he had to wait for us. Sister came to tell us he was ready to go and I said we would be staying until our two sick babies were more stable and we had a plan with the residents.

Here are some photos!!