Failure

I was just about to go on my tea break when a male nurse came rushing into the trauma unit, clutching a big bundle of blankets. 'Somebody help me!' he yelled, 'This baby isn't breathing!' I stood up, knocking my chair over backwards, and asked him to put the baby on the bed. It looked about three months old and was still warm, but was indeed not breathing and had no pulse. It also had that murky look about the eye which in my (limited) experience usually means that the creature before me is no longer of this world.

I yelled for a bag-valve-mask, and within moments one was in my hands. This speed was impressive, but unfortunately the mask looked designed for a premature neonate, and was only about big enough to cover one of this baby's nostrils. I started chest compressions as I asked for another one. Out of the corner of my eye I could see the nursing staff first reaching to give me an adult mask (bigger than the baby's head), then trying to attach an adult bag to a baby mask, then dropping the baby mask... In my head the teaching of the basic life support course I'd been on a few months ago ran through my head: '...it is very important to give effective breaths (that make the chest rise) for infants and children during CPR.' I took a deep breath, bent over, and started mouth-to-mouth. The chest rose twice, and I started compressions again.

This is not a story with a happy ending. I was the only doctor in the room for most of the resus, and I watched in despair as the nursing staff in the unit tried to do chest compressions - stroking the sternum more than compressing it - and then squeezed oxygen into the atmosphere as they failed to get a seal around the baby's mouth when I delegated the airway in an effort to help with compressions (later I would discover we weren't even squeezing oxygen out of the bag - in the madness nobody had attached it to the oxygen cylinder). After I got the baby intubated another doctor arrived, and I watched hopelessly as he tried to set up an intra-osseous line with an ordinary needle - there were no intra-osseous sets or even spinal needles in the unit. He called it a few minutes later and then sent me off for my tea, the smell and taste of dead baby still in my mouth.

There is so much to recoil at in this story - the way the mom had brought her baby to the clinic that day because she was looking a bit feverish, and then noticed that she was no longer breathing as she stood in the queue at the tuckshop to buy herself a pie; the way I had to give mouth-to-mouth at a busy trauma unit in a very first-world city; our clumsy, haphazard and ultimately futile attempt at resuscitation; the way I had to break the news of the death to the mom and dad in a large linen storage room because the unit has no debriefing or counselling area. I don't understand why public-sector nursing staff in this country have such poor skills when it comes to things like CPR, which is something even high-school children can be taught to give effectively, and why the units never seem to have the proper equipment: it's like the health institutions don't care about their patients enough to train their staff properly and invest in decent tools. I'm also anxiously awaiting the day when I can manage an emergency situation like a resus, without looking back and wondering if it was a failure because of me and my own shortcomings.

Picture Credits

PlasTIco the Kewpie
Originally uploaded by iamsored