NEONATOLOGY

‘You have only one week here. You should learn fast and you need to learn a lot, ‘ said the senior doctor while taking an oxygen tube out of a neonate baby the size of a doll. ‘ Now… here’s how you can tell the difference between a preterm child and a normal baby..’ He rattled off, all the while continuing his work. Ten minutes later I was doing my morning follow-up in my assigned area of the ward.

A neonate is any baby less than 21 days old. Any neonate that is sick from the Obstretics ward above end up here in this overcrowded ward. There were around 20 beds in the main ward. Each bed had THREE small babies on it. Their mothers or any related females sat nearby on the ground. I had to be careful not to set my file on the bed without checking, else what I thought was a bundle of cloth might have a baby inside. Oxygen tubes ran in random directions all over the ward so I had to make sure I didn’t make any sudden turns or moves.

In my internship I had to complete one month in Pediatrics Medicine. Out of that, one week consists of working in Neonatology. The place was overcrowded to say the least. Besides the main ward, there were some 20 more beds in the outside room. A separate room with UV lights for babies with jaundice. Another separate room for severely underweight babies. Anywhere from 1200 grams to 750 grams; tiny, tiny babies. A friend of mine claimed he came across a baby who was 650 grams. The entire ward had only one incubator. Just ONE. Needless to say it was occupied all the time.

My first evening duty in the ward I had to give CPR to a baby. I had to be so careful wrapping my hands around the babies tiny torso and using my two thumbs to press its chest. Three presses and the Senior doctor squeezed with an AMBU to give the baby some air. After a while the doctor instructed me to stop. It seemed hopeless. I pressed on. The baby seemed so tiny that if I pressed hard I felt like I would break its ribs. I couldn’t bring myself to stop , not because I wanted some heroics but it felt surreal. The baby didn’t look or feel like a human. It felt so doll like. I stopped to check for a heart beat one last time. And I could hear one!
‘What do you know! You got a heartbeat! “ The doctor moved in quickly checking the babies vitals injecting steroids, adjusting the babies fluids.

I felt elation. I’ve just saved a life. I went home happy.

Still… it was an overcrowded neonate ward. What did I expect? What I saved in the evening, fate took away during my next night duty. Three babies died while I was giving CPR , late in the night. At least I beat the average. Usually four die per night. Thinking back I didn’t feel any sadness. I could see some mothers crying. I could see fathers angry and upset. I saw a mother fall to the ground and beat her chest and cry out loud. I saw this all as if I was in another place. As if I was observing from afar.

I remember months ago when I was in Pediatric Surgery and I called the CA on duty to inform him that a child was dying. He didn’t bother to come. He came after the child died and wrote the death certificate. There was no emotion, no sadness. I remember thinking what kind of monster acts like that. Later I learned that the child was expected to die that day. He had multiple organ failure , his whole body was undergoing sepsis. There was nothing anybody could do. Was I becoming like the CA? Am I heartless? Is this what happens to people in our profession?
But I felt happy when I saved the kid. Why can’t I feel sad?

From 4 am in the night I was sitting in between two babies on the little bed that’s considered to be the ICU. Babies that needed special attention. These two were going into convulsions. I had to give them Phenobarbitone to keep their convulsions in check. The convulsions that neonates undergo are different from older babies. It could be a repetitive movement. A boxing movement. A cycling movement of the hands. Lips smacking repeatedly. Or the hands held still in one position if it is tonic convulsion. The eyes will be looking upwards and sideways in a fixed gaze. Its hard to tell a neonates normal movements from a convulsion. I couldn’t wait around though. Convulsions without treatment might result in permanent brain damage. I kept giving them the appropriate doses of injection every half an hour . I stayed there till morning. Still alive. Looked normal. A baby nearby started going into respiratory distress. I added an oxygen tube and a headphone. Still no improvement. He was gasping for air. The senior doctor told the father that the baby needed a special machine that gave artificial respiration. The baby was not able to breath on its own. They didn’t have such facilities in a government hospital. They had to take the baby to a private clinic. Nearby, the childs mother was crying. Blood came out of the baby’s nose. My duty was up. I left home tired after the morning doctor came.

I learned a lot during my week there. All the drugs, the proper dosages. To check for babies with neonatal sepsis both early onset and late onset. Neonatal Asphyxia , Post-term babies, Meconium aspiration. Convulsions, jaundice. I learned a lot and I learned fast.

I completed my week and I thanked my teachers.

Days later I was in the main Pediatrics ward. Children from 23 days up to 14 years were admitted here. During admission day I had night duty. Usually people from far away villages came during this time. They come from their farms on long journeys and usually arrive at this hospital at midnight. The government hospital. The only place they can afford. These poor people.

A family arrived. They had brought their daughter. She was 9 years old and she had dark skin and short straight hair. She was beautiful. She was in obvious pain. They showed her legs and hands. Large red splotches . They lifted her dress and showed her stomach. Even larger areas. She had a severe cases of Steven Johnson syndrome. These people had tried their traditional medicine for months and it didn’t work. So finally they came to the hospital. She was in so much pain she couldn’t sit or lie down because her wounds hurt.

Finally I could cry.