When It's Hard To Breathe

[Here’s an explanation for that picture...]




I was in the pharmacy the other day with Olaf, a student from Princeton who was here for a week doing some research into HIV and religion, when Liz came in to say there was a Caesar going on if we wanted to watch. Naturally, we ended up throwing on scrubs and in theatre for the start of a very hectic morning.







The baby was in some considerable distress, so Karl [who is somewhat of an expert in maternity related matters] was there to resuscitate it if necessary. Everything seemed to be going fine and Karl and Liz were chatting about the upcoming World Cup, I think Karl may even have been texting someone, when they made the incision into the womb and suddenly an enormous fountain of amniotic fluid started pouring out everywhere! It literally spurted out all over the place, soaking Liz and Sister Gebe who was assisting [she even had to have a new pair of shoes brought in...eugh] – it seemed like it wasn't going to stop. Luckily for all involved it did [and the rest of the surgery was conducted in a particularly splendid puddle...]







The baby was eventually delivered, but wasn't particularly lively and had stiff lungs so was having trouble breathing on his own. Karl intubated him and he became stable so he tried removing the tube, only for him to immediately start to crash. Ben was called to give his opinion on the situation, followed by Taryn [so half of our doctors were there by this point] and it was decided that the baby needed to be transferred to an ICU where they could ventilate him. We don't have a ventilator and neither do any of the Umtata hospitals because some genius there decided to fix them all at the same time and surprise, surprise, hasn't actually done it, so the next option was East London. Karl called the hospital there and asked for them to send the helicopter to pick the newborn baby up.







The helicopter takes 40 minutes to get here [and this is the Transkei, so that can mean really anything] which meant that someone needed to ventilate the baby manually until then. It didn't make much sense for the one of the doctors to sit and do it when we had no definite timescale on the chopper’s arrival and the patients were piling up in OPD as ever, so I ended up doing it. Ben showed me the technique which always looks so easy when they do it on TV, but there's quite a delicate art to it, especially on when the set of lungs involved is so tiny. After some initial trouble getting the timing and synchronising with the boy's own breathing and feeling the correct pressure, I managed to get it right and the others left me alone with the baby and continued with their working day.







So there I sat in theatre, just me, the baby and the bleeping of the monitor. I had to make sure that the pulse rate and oxygen saturation were normal and had strict instructions to call someone if anything went wrong [people did keep checking up on me just in case though :)]. It was actually surprising therapeutic to sit and concentrate on something so simple and when I looked up at the clock to see two whole hours had gone past I was surprised! I continued on, watching the rise and fall of his tiny ribcage and hoping that the baby who was gripping my finger so tightly would survive and become strong enough to breathe on his own. I wondered what the mother must have been feeling, knowing that her baby was going to be flown away to a strange place without her, never having even seen it, let alone hold it in her arms.

Manually ventilating the baby in theatre

The ventilating became automatic and I was completely mesmerised by the vitals monitor, but then the oxygen saturation started dropping below 100% in rather rapid fashion. I started panicking and shouted to the sisters in the other room, but they couldn't hear me, so I tried dialling my phone only to hear the dreaded message telling me I had 'insufficient credit'. The pulse had dropped down to 60-70 beats [low for a newborn] and oxygen sats. were below 85% and I was starting to worry that I was going to cause the baby to die when finally Sister Gebe came in and called Ben for me.







Ben came running to check and quickly discovered the root of the problem: the monitor had fallen off of the baby's foot, so the machine wasn't getting a proper trace...so not a real medical emergency after all! [All that adrenalin rush for nothing, what an epic fail – but that's not the point.] After he had clipped it back on, everything went back to normal and I resumed my role as the ventilator for another hour or so with no further hiccups.







I heard a commotion in the corridor and then the paramedic arrived...then disappeared for about 40 minutes under the guise of 'looking for oxygen'. Pretty sure he went outside and distilled it from the air from scratch, but anyway. When he came back, the baby was put in Sister Gebe's arms and with Liz holding the oxygen cylinder and me ventilating we managed to awkwardly shuffle through OPD and out to our overgrown basketball court where to the helicopter was waiting for us. We handed him over to the paramedics and soon enough they flew off into the distance leaving everyone on the ground in high spirits knowing we'd done everything we could for the baby.







But this story does not have a happy ending. The baby died a matter of days later from some kind of congenital pneumonia [at least that's the expert opinion]. He died without a name, without ever feeling his own mother holding him in her arms. The mother never even saw the child she had carried for nine months except for the pictures that we took while I was ventilating. I held that baby's hand for three hours straight, yet the one person who should have been doing that was denied the chance to do so. Once again it hit me how raw life can be out here – a place where the reality isn't concerned with the petty problems we obsess over in the first world, a place where the reality is devastating, brutal and unforgiving. It's a cliché to go on a gap year to the third world and come back with stories of the poverty you've witnessed, but I will never forget the things I've seen here. I've always known that life in the UK is an endless privilege, and it's times like this that reaffirm that knowledge.