The night was young but I was already exhausted. My feet felt like bricks as I lugged back and forth from labour ward to NICU. It was busy as it always was. My periphery was filled with people moving fast and slow. Loud crys, faint whimpers and flat babies. I guess that’s why I was there.
My tummy grumbled. I had been nil per os for 8 hours (not by choice). I decided that this would definitely be lucky number 6th admissions then I could eat something, wash my face and replenish my stores.
I was stuck with a chubby 3.8kg baby with rolls of subcutaneous fat. Every time I poked for a vein, the dreaded blue bulge of a blown vein appeared and I felt more hungry, more tired, more exhausted and more hot under the 38 degree blasting radiant warmer. The sweat dripped down my cheek and I felt my glasses slip further long my nasal bridge.
How is it possible to be so hot in here but all the babies temperatures are 35 degrees and they’re sulking in every corner, cold and hungry. One of the many mysteries I would never understand about neonates.
I had no energy left to wrestle with a heavy weight newborn. I interrupted my procedure to find some help. I cruised along looking for midwives dressed in maroon but everyone was busy.
“Dokotela! Come quickly please. Run”
I looked around and saw no one. I jogged toward the commotion still searching. All my organs were praying for a short and sweet dramatic story that ended up in a healthy baby and not a 7th admission.
I walked in to a sea of blood. Blood on the floor, blood on the midwives X2, blood on the bed, blood on the patient. I was hoping to find a small human in all this blood but my eyes could not pin point it and even more concerning, no crying.
All paediatric doctors know that a neonate, infant or child that is not crying, is in major danger.
“Cord prolapse! And the bleeding won’t stop” announced the midwife. As I got closer and started putting on a visor and a gown, I realised I couldn’t see her either. Drapes of blue covered in red became a hue of purple. “The cord is still pulsating but I can feel the placenta close to me. The head was obstructing the cord. I’ve filled the bladder, called the obstetric doctor and I’m holding the head off the cord but the pressure is too much. We need to push her to theatre now!”
Midwives are extremely quick and decisive as they have to be. In my mind they are lovers of action and i always appreciated that. She knew exactly what she was talking about. I mean almost half her elbow was stuck between a cervix and a head in a pool of blood. If she said theatre, then theatre!
We got the go ahead to push the patient to theatre. The obstetric doctor popped his head in, gasped as he saw the midwifes forearm, muttered something about being stuck between a rock and soft place and hurried along to scrub.
The team mobilized, oxygen cylinder, 3 wide bore IV lines, fluids opened on the maximum, incubator for the baby, emergency blood being warmed under the pillow of the bed. The midwife loaded herself on the stretcher, careful not to dislodge the presenting part.
“Cord is still pulsating” she announced and we moved swiftly. The stretcher gained momentum as we sped down the long dark corridor. A thought flashed before my mind but I was too hungry to think unnecessarily. I found a dirty tic tac in the bottom of my pocket that saved my life. The minty taste mixed with dust was welcomed.
We intermittently stopped to make sure the midwife was still on the bed and hadn’t been lost along the way. We could see theatre signs as we sped along. Finally, we had arrived.
The midwife suddenly gasped. “There’s no cord pulsation”. No! No pulsation meant no heart beat which meant no life which meant death. Everyone shuffled.
“Wait..guys wait… wait… wait… I can’t feel my entire hand or wrist”.
We started at each other. What did she mean? She read our minds.
“My entire arm is numb. It’s been stuck up here for so many minutes, I think my nerves are dead. We need to get her on the table now!”
We shuffled faster, the anesthetist was preparing his green balloon and fancy gases. The obstetrician started quickly auscultating for a fetal heart and found it. It’s not strong but its definitely there.
I went closer and examined the hand holding the presenting part noticing the flimsiness of her posture and a dropped shoulder. “Can you try and move your fingers? Can you feel the cord or any pressure?”
” YEY wena! I said my hands are numb, what are you not understanding? Everything from my shoulder down is gone. I was leaning against the pubic bone and my nerves are finished”.
I could see the look of helplessness in her face. Fortunately the Caesar began, the midwives upper limb was extracted with almost the same amount of skill as the baby. They sat her down in the corner of theatre, massaging her upper limb vigorously. I saw someone offer her a drink of water and proceeded to pour the rest on the dead arm. She wacked the floppy mass that was her arm a few times but did not even flinch.
I saw the baby come out in record time. A few weak whimpers, cord around the neck x 2, unsure why he wanted to bungee jump at such a young age. He attempted to cry but was so flat, exhausted from the drama. We gave him neat oxygen, some stimulation, a nice warm blanket and he pinked up in no time. APGARS 6 7 8 8. He looked pink but in moderate respiratory distress (TTN, cross fingers). The cord gas was pristine. Not today HIE, Not today.
The midwife appeared and I couldn’t help but chuckle. Her dead arm was in a home made sling with bandage, wrist hanging over. It really was lifeless. She moved her fingers ever so slightly which meant it was heading in the direction of recovery.
Labour ward belled about 3 new patients in labour and the supporting crew dispersed. It was just me, the midwife and 3 hands to make the great trek to nursery on the 4th floor. I called the nursery nurses and asked for a bed to be prepared. They ended off with “Yoooh why tonight dokotela, 7 admissions tonight but why. If his intubated, me im retiring.” and gently slammed the phone down. I smiled.
She loaded the equipment, I loaded the baby and off we went. I saw her slap her dead arm against the incubator door but felt no pain. I wish I could have fished out another tic tac from a pocket but there were none.
We finally reached the NICU. We made it. I felt a sense of relief. “Molweni guys, thanks for all the admissions. By the way there’s 4 drips out and they need antibiotics. Also Bed 4 vomited everywhere. Please check neh”.
I felt a sense of dread. I decided to tackle the ward work whilst they offload the patient.
I heard some commentary and voices growing louder.
“Hayi, it doesn’t matter if you broke your arm because the patient still needs a report and a handover from a midwife. Me when I broke my foot, I also wore a moonboot but I always wrote patients handover”
The midwife looked defeated with a hint of anger.
“My arm is numb. I can’t write with my left hand. I gave you a verbal handover. I will come back and write it when my hand is better sisi, please understand. ”
” No no no… guys, come here…come listen to this”.
I could sense trouble. The midwife looked absolutely finished, helpless and done for. She scooped up her lifeless arm and decided to go back to theatre and get another midwife to write the handover”.
I interjected and asked if it could be dictated and I write it down. The Nurses glansed at me sideways and scoffed. “Ya wena dokotela you can do that but however it’s not following the correct protocol. But continue neh. ”
We both collected our thoughts and I penned them down quickly and we parted ways hoping not to meet again that night.
I met her the next day to find her back in action, all five fingers in full force.