Sunday, 13 April 2008

Rough day at the office

Posted by Dr. Thunder

What a horrible day today was. We have, coincidentally, 2 babies in ICU at the moment who have both suffered possible brain damage at birth. Both had their MRI scans and EEGs this morning, and the reports were with me by late afternoon.

Both babies had abnormalities on their MRI and their EEG. So, our team had to go and speak to both sets of parents in turn. It took about 3 hours in total, and was horrible.One of the problems (when I say "problem", I mean in the sense of giving information) is that both these kids could well be fine. They may well have no poblems at all. But they may suffer seizures, learning difficulties, or visual impairment at some point in the future. So, basically, it's a case of talking to the parents and telling them that, because the extent of the damage is difficult to assess accurately, we can only say that their child may run into problems. We can't give percentages, or even ball park figures. Basically, keep watching them until they go to school! I mean, how stressful is it to face into that! 6 years of being on edge all the time.

These were 2 very upset sets of parents. But, to their credit, they were very understanding about what info we could give, and what questions we simply couldn't answer.I always feel crap after these types of conversations. But it goes with the territory, I guess.

On the keep sane, i always convince myself that, in the world of neonatology at least, there's a ying and yang effect. For every bad thing that happens to me, a good thing happens. So, just as I was leaving work, the emergency buzzer went off in theatre. They were doing an emergency caesarian section. Our excellent, but very inexperienced, resident was there for paediatric input. The baby came out purple, and she very sensibly pressed the emergency buzzer, and assessed the baby.The baby wasn't breathing, and had a heart rate of only about 20. The resident tried to initiate bag+mask ventilations, but couldn't seem to get air into the baby's lungs (ie she was pushing air through the baby's mask, but his chest wall wasn't moving).

I arrived in, she explained the story as I was putting on my gloves. Baby was only 50 seconds old at this stage. I readjusted the airway, started bag+mask breaths, and thankfully the chest started to move. The heart-rate came up. Baby became pink, and started breathing himself. Happy days. It's not as difficult a task as it might sound, it's just scary! But, at the end of it we have a totally well baby, who will stay with us in NICU for a couple of days of IV antibiotics, and a chest x-ray, just in case. But no harm done. I've said it before, sometimes medicine can be the best job in the world. Sometimes it's the worst. Some days it's both!

Thanks for listening.


  1. thanks for your comment! :)

    so true. my neonatology rounds used to leave me heartbroken/amazed/both! it's always a wonderful feeling when the baby leaves the nursery! :)

    (and oops i'm sorry i want to do OB/GYN not paeds!)

  2. "Thanks for listening."


    Here's to more ying and less yang!
    (or is the other way round?)