For once I'm posting an obscure question from the coast of West Africa. Today, I just need a hug.
I was in charge, and one of our feeding program babies (not the one I posted about earlier with the high alk-phos - this is the one who was plumping up perfectly) hasn't been doing well for the past few days. He's had high fevers, a full body rash (kind of like a mild Steven's Johnson) and increasing work of breathing. Anesthesia (the ones calling the shots on his case) has been sitting on intubating him, since his CXRs have been mostly good - just some peribronchial stuff.
Anyway, when I went in today he just looked bad, you know? I called the on-call, who came down and was totally useless, so I ended up calling in another guy, one who just got off the plane last night. (I had met him at breakfast, he seemed smart, and he said he did peds!) Thankfully he came right down and took over running the show. Listened to me when I said we needed a tube, and finally got the kiddo intubated. By the time all that rigamarole was done, his tiny reserve was GONE, and he satted anywhere for 50-70% on 100%FiO2 for several hours.
In the midst of all this, while I was still trying to round on the wards and answer questions from all the new nurses working there, I got a call from the gnagway. "Hi, we have a dead baby." I ran up, and sure enough - a little 3-month old girl who was going to be admitted for surgery on her cleft lip TOMORROW was in her mama's arms, ale and starting to cool down.
I ran her downstairs and admittedly lost my cool for just a second while I plopped her on the next open ICU bed (the one next to the intubated kid) and demanded "a stethoscope - RIGHT NOW." Long story short, she was long gone, but we coded her for a couple minutes for the sake of the mama, who probably didn't understand what was going on anyway. It's the first time I've ever used a clipboard as a backboard. It's also the first time I've called a death, cleaned up the baby and handed her to the mama only to have the mama look at me like she actually expected her little one to be breathing still.
I held her while her mama tried to call her husband. They live way up north, maybe 10 hours by taxi, and she was going to have to go alone. With her dead baby strapped to her back, pretending that she was alive since she wouldn't be able to afford the jacked-up taxi fare that would be charged her if the driver realized he was trasporting a body. So I held her and I rocked back and forth, because really can we ever stop rocking them? And then I walked them out into the heat and I gave them some water and some transport money and the mama told me "Merci." I held the baby on her back while she knotted cloth across her chest and then she walked away, a tiny bundle in a pink hat on her back.
