With an impending new arrival I was excited about the educational opportunities that would arise. I’d read up my fetal physiology and was eagerly awaiting the chance to write a series of posts on what normal babies do. I had planned to take pictures of meconium filled nappies and film normal neonatal reflexes. I’d made a little list of the things I really wanted to capture. But things don’t always turn out the way you expect them to.
Childbirth is such a common experience that most people don’t really consider what might go wrong. Given what has gone before we were on tenterhooks until we heard that first cry. The elective caesarean went without a hitch and mother and babe were transferred to the post-natal ward for some skin-to-skin time. Newborns really only do three things – they feed, they poop and they sleep – and her first twenty-four hours were no different in that regard.
We knew that something was wrong when she started to turn a funny colour. Cyanosis conjures up thoughts of a blue tinge but ashen grey would be a better description of the colour she turned after feeds. I’d been listening to Greg Kelly’s SMACC podcast on the drive in to hospital but it didn’t register with me as I was being dad not doctor. After it had happened a couple of times, with the midwives present, we became used to sitting her up and winding her to help a healthy rosy glow return. Until it didn’t…
I’ve attended many a Code Blue in my time but always as team member or leader. As the team arrived and started ventilating my girl I stopped being. I was outside of myself, watching everything as if on some sick reality show. I did not feel stressed or scared. It was not happening to us – it was happening to someone else – to that poor family who had already lost one daughter. That entirely dispassionate observer was replaced by another me – the doctor who writes about neonatal resuscitation.
I watched the team working together, calmly without the raised voices of a hectic trauma resus. Nurses anticipated the needs of the doctors as tubes and tapes were passed. As the registrars managed the airway, the consultant explained to us, the parents, what was going on, in clear, non-medical terms. The only distraction was the sound of our two and a half year old who wanted to get in on the action and see what was going on. This is when the medical students, who at this point had been observing quietly from the back, were given a job to do. They took our bigger girls away to distract and entertain. The whole thing must have only lasted five minutes but time stretched.
After a trip down the corridor to Special Care things slowed down and the team shrank. A more in depth history was taken and an IV placed without any fuss, the nurses going out of their way to explain what was going on and we began trying to make sense of what had happened. I tried to stop myself from coming up with a long differential but it was impossible. Over the next couple of days, as test after test came came back as negative, the list began to shrink. A normal septic screen, a normal EEG, a normal echo – what could it be? As I write this our youngest daughter is still being investigated.
I love reading Damian Roland’s What Have I Learned This Week series and so with that in mind I wanted to reflect on these events.
#HelloMyNameIs… really does help. Aside from the initial resus team we must have met ten doctors and nurses in that first hour and every one of them introduced themselves. It made them seem more human, more than just doctors, but people who cared.
Quiet is calm…is contagious. Other than the questions being asked of us there was barely a voice heard. There were quiet, calm requests for equipment but that was all.
The nose knows best… it seems. After providing some CPAP via the the Neopuff a short nasal ETT was placed in the pharynx to provide continuous pressure. Once secure it freed up some hands and made the task of maintaining the airway so much easier.
You will be remembered… I know that when we talk about giving confronting news we say that most people will not really take it all in. They do remember who you are though. As the day team handed over to the night time and the entourage came round the unit the duty consultant for the night shift introduced herself to me and I was instantly transported in time. We had met before. She didn’t remember me. I must have been one of many, many parents she had met in the last six years. But to me, she was the doctor who told me that our first daughter had died. People remember you so make sure the memories they have of you are the right ones.
Don’t give kids orange cordial… I’ve no idea what is in the fluorescent orange coloured fruit concentrate that they use to make drinks in hospital but that colour is not one that is found in nature. It is no wonder my once placid children became whirling dervishes of activity when it came time to take them home.
Words cannot express our thanks to the team at the Royal Women’s Hospital in Melbourne.