‘Honey. This baby doesn’t look so good. Can you come help?’ My wife just delivered a punky baby.
I walk back into the same room and lying on the same table is a baby looking very similar to the one that died less than 36 hours ago. I put my hand on the chest and feel a heartbeat right about 40-50. Same as the last baby. I start some compressions.
‘Hey dear, has this baby ever breathed?’
‘I don’t know, I’m trying to suture up the mom. There was a lot of meconium.’
I turn to the nurse, one who seems to care a little. And the only one in the room. ‘Did this baby ever breath?’
‘I don’t know, I’ve been suctioning the nose.’
Miraculously, there’s an ambu-bag on the table. Granted, there’s no oxygen tank at the hospital, so I only have the 21% oxygen in the room air to work with. I start to bag the baby. The heartbeat comes up to about 110. Not great, but good. I stop compressions and just bag. And suction. And spank. And rub. I even rub to the point of loosening up some skin. I smack the heels. The baby doesn’t budge.
Well, I can’t exactly call the baby dead with the heart thumping away. I continue to bag.
Danae is done suturing and goes to take care of Lyol.
All I’m doing in bagging, so I send the nurse to get me an IV and some sugar. The baby is just exhausted from two days of arrested labor in a different village clinic before coming to the hospital. Typical.
The nurse pokes four or five times and can’t get anything. I’m getting impatient. I don’t feel like waiting for the lab guy to show up to check the glucose. I dribble a little dextrose into the mouth and bag away. I know it’s not one of the endotracheal meds, but I’m hoping some of it gets absorbed.
I can’t intubate because I have no handle, no blade, no tube and no ventilator. All I can do is give dextrose and so help me, I’m going to give it. I even give a little bit IM. By now I’m sure I’ve corrected any hypoglycemia.
The lab guy finally shows. Sure enough, not hypoglycemic. And not ‘high’ like the last baby.
I stop bagging, the pulse slows down. The baby makes absolutely zero effort to breathe on his own. I start bagging again. It’s now been an hour of bagging. The baby breathes. It’s a lame breath, to be sure, but it’s something.
I watch. About two breaths a minute. The pulse slows. I bag some more. After another hour, the baby is still just taking a couple agonal breaths every minute.
What’s wrong with this baby? The nurse comes in and out once in a while. Rubs more liquid on the baby, smacks the baby around some. Still no reaction.
Wait a second. ‘Hey, what are you putting on the baby?’
‘Get a thermometer.’
The thermometer starts at 34 degrees (about 91 degrees Fahrenheit). The rectal temperature doesn’t even register.
This baby’s freezing. ‘No more alcohol.’
I wrap up the baby and rub vigorously, stopping once in a while to bag again. We don’t have a Bair Hugger, we don’t have warm blankets, we don’t have warm IV fluids even if we had an IV. Even if we had pedi chest tubes I wouldn’t put them in or a urinary catheter to warm the baby. But this is Africa for crying out loud. Who gets hypothermic in Africa?!?!?!
A third hours passes. The pulse still slows when I’m not bagging, although the kid is now breathing 3-4 times a minute. We recheck the pulse. Still not registering. We get a second thermometer. Still not registering. I clean the rectal thermometer with alcohol and stick it in my mouth. Funny, I have a fever. Well, at least we know the thermometer works. The kid is really that cold?
A fourth hour. The pulse holds at 110 and the respiratory rate is now eight. Both of those number are far below normal for a newborn, but they will keep the kid alive for now.
The temperature still won’t register after two hours of trying to warm the kid with blankets and rubbing. It’s been four hours since I started with an apneic, bradycardic newborn.
I look down at my gloves. I watch as the nurse walks out of the room. I realize he had never put his gloves on.
I know that there’s only one method left to warm this child. I take off my gloves. I take the blanket off the child. I pick him up, bare-handed. Alone in a room, the mother long gone, the nurse long gone, I slide the baby up under my scrub top until his head comes out the neck. His head is snug under my chin. His mouth is out to breathe the air. His bare skin, blood, meconium and all, is pressed against my bare skin. I give him my warmth.
I embrace the newborn, now four hours old. Completely exhausted and yet unfazed, I embrace the patients, the hospital, the village, the country, the culture, the customs, the weather, the terrain, the lifestyle, the work and the calling of Him Who has brought me here.
I cannot do the work of Him Who sent me while wearing figurative gloves for six years, keeping myself sanitary. Keeping my distance. Putting up barriers. Minding my protection. Minding my safety. It’s time to put a little righteous dirt under my fingernails. It’s time to be a little less safe. Gloves serve the purpose of protecting practitioner from patient and patient from practitioner. But how often do I wear them unnecessarily just to serve as a psychological divider to separate myself from ‘them’?
Suddenly I know the answer to the voices who have haunted me for the last 36 hours. Now I know what I am doing here. This is what I’m doing here. I’m doing whatever He tells me to.