I have only five minutes before the driver comes to take Kenji and me to Lake Nakuru. I picked him up in Nairobi on Thursday morning after an eventful last night on call Wednesday. Gotta love the 911 page at 1am to go immediately to the operating room but no one could tell me why. I was going through the senarios in my head as I ran up the hill in pitch-black pouring rain. I looked like a drowned rat by the time I got there plus I was having a full on asthma attack from the exertion and had forgotten my inhaler at home. Turns out, the page was to resuscitate a baby with thick meconium with decreased fetal movements and reported low heart rate on the monitor but no one could tell me what the heart rate was. They had already started the c-section on mom. Ok, I thought, I know what to do with this. I received a blue, floppy baby with no respirations-- the intern dried while I checked for a pulse. There wasn't one. Hmm, worse than I thought. I started chest compressions while the RN got Epinehprine ready and the intern bagged the baby. As I pulled back the now wet blue towel to get better access for chest compressions, I saw that the back of the baby was macerated and therefore had likely been dead for at least 12-24 hours. The operating intern was shocked that the baby had been dead for some time since he thought he had heard fetal heart tones. Good reminder for interns to check mom's pulse at the same time as trying to check baby's when it is that low and you are unsure. This was this lady's first baby and now she's had a c-section. Not the end of the world but it could have been prevented.
Immediately after the code that wasn't, the peds intern looked at me and my clearly wheezing, labored breathing and went to grab the pharmacist. They then proceeded to hook me up with a 30 shilling albuterol inhaler from the pharmacy (30 shillings is equivalent to about 40 cents.) Sweet. Then she told me about the preterm newborn with likely birth asphyxsia (apgars 2/5/7) who was now seizing in the nursery. Um, yeah, would have liked to have heard about that one a little earlier but oh well. I've decided that the best way to stay sane in this place is to try and fix only what you are given at the TIME. Not what you COULD have fixed had you been called earlier. If you attempt the latter, you will literally go crazy-- trust me, I've been there.
I arrived in the nursery a few minutes later and indeed, found a seizing newborn. I remembered what I was taught in medical school:
Step 1: check your own pulse--> super high, check. I'm clearly nervous but also have had about 10 puffs of albuterol so it's not all my psyche talking.
Step 2: check the clock--> there isn't one. Forgot my watch at home. Whatever, doesn't matter anyway, who knows how long this kid has really been seizing.
Step 3: What do I want to do and what of that list is available here?--> haha, this is the tricky part.
So, after I gave a loading dose of phenobarb and sent the nurse off for an LP kit, I asked for labs and blood cultures. The aid went over to the shelf and handed me the blood culture bottle and said, "ok, here you go Docteri." Ummmm...... this means you want ME to draw blood on this preterm kiddo? Now it was my turn to give the "blank stare" response. This was quickly followed by me literally laughing. I told her to call the intern immediately. Sometimes we all need to call for help!
Uh oh, driver is here, more later after a hopefully GREAT weekend at Lake Nakuru-- bring on the flamingoes!