I wouldn’t call myself very superstitious per say but I do believe in the general medical world do’s and dont’s. Don’t say “Quiet” on your call. If you do, touch real wood. Don’t bring too much food on call, only basics because if you do, you probably won’t eat it because you’ve invited too many admissions. Don’t wear bright colors on call, it invites trouble. I’ve learned all these rookie mistakes by being a rookie for a very very long time.
Post pandemic, I found myself at one of the largest hospitals in the country’s neonatal unit. Life was pulling me in different directions and I wasn’t so thrilled about it. I was in a strange place with no physical family support, yet again. I was amazed, suprised, scared and initially overwhelmed. At first, it was riveting. Everything felt like a movie.
I quickly learned what it’s like going to work at 7:30am, blinking, sweating, resuscitating, admitting countless neonates, opening your eyes and its already 6pm and almost time to go home. A rushed few bites of a random pie for lunch, a swig of a few sips of Coke just to keep the sugar at 3.0. Fatigue like you could not believe.
The pathology was so vast, it was unbelievable to anyone not physically there and barely believable to those present. you could see twin micro prems of 600g and 500g as well as a 5.6kg newborn at the exact same time in adjacent beds.
You could be called to 2 different Caesars and a flat baby in labour ward with an asphyxiated brain, all needing attention together. Only having 2 hands was my greatest weakness and often frustrated me.
Your mind had to be constantly sharp, you must be able to think concurrently and constantly about 6 different things. I would lie in bed at night and try absorb the day making sure not to mix days up, because things happened so fast, one really didn’t process much in real time. I would stare at the ceiling and think about each aspect of the day, trying to make sense of it all.
I couldn’t read or learn on the spot, it was far too busy. My pocket stash of food was constantly low. I remember mixing sugar into my water bottle for control.
Labour ward nursery was mostly pumping. It was a constant flow of input and output. Ward patients being mobilized, high care patients being monitored and ICU patients being intubated. The day I saw Sister Rozina was the day I felt motherly love. I watched her calm demeanor, ever so gentle in a sea of tasks to complete. You couldn’t panic even if you tried. I remember struggling with a drip for a baby with asphyxia under going controlled total body cooling to save whatever brain cells remained. An umbilical line was the last resort because I feared coagulopathy. Every time I poked and saw the dreaded bulge I sweated a bit more and my frustration grew. Any paediatric doctor knows the bulge means a blown vein. I was quickly running out of options and I asked Sister Rozina to please come stand next to me, just for moral support. She stopped her task, gave my shoulder an encouraging squeeze and the back flow gushed out the jelco. What a woman. What a nurse.
Now back to my story, unlucky 19. It was my very first ‘NICU call’ on the 19th of the month, and I was feeling great. I bounced around with ignorant childlike naivity that in retrospect, is funny. The other registrars announced that we were on call with the Professor of neonatology. At this point, I hadn’t met him yet. I guess I had met many other Profs before so I brushed it off. I wouldn’t be doing anything differently anyway.
I blinked a few times and 3pm handover arrived quickly. I walked into the handover area that I would be responsible for and things looked and sounded different. There were 9 ventilated babies and 3 ossilated babies (If you know, you know). When and where did these babies come from? The endless blood gases i would have to do…My thoughts were interrupted by Prof.
My first thought was he was definitely not like the other Profs I had met before. For starters, he wore a labcoat and blue scrubs. His forehead was only slightly wrinkled and he seemed younger than I had imagined.
He introduced himself, quickly addressed pleasantries and the handover began. I shifted nervously, hoping to get no questions but ofcourse, I got the first one. “Dr Moosa, What is the differential diagnosis for hyponatremia and how will you investigate?”. I gave a suboptimal answer as i thought about how hungry i was. He smiled with his eyes. The blank piece of paper infront of us transformed into a mind map of hyponatremia in 5 minutes. We all oo’ed and aa’ed in agreement. I wondered if all this knowledge was in his brain or he came here knowing exactly what he would ask.
We moved on to the next patient. The next registrar was questioned on pathophysiology of gas exchange in the body. Again, a mindmap of summaries, formulas and calculations flowed from his pen so naturally. I was amazed.
Prof loved maths to everyone’s (my) dismay. He could calculate doses of calcium, magnesium, phosphate, sodium and potassium while i struggled to do simple arithmetic. I blame my early years in Harding. Its difficult for a child to learn if you’re constantly afraid of being thrashed by Mr Khan (a long story for another day). I tried to keep up with my cellphone and rushed to type the calculation in, Prof had already moved on to the next. He was particular about doses as one should be when dealing with weight in grams.
“For an 800gram human, 10grams is alot”. He wasn’t wrong.
We moved on to the next patient and to our horror, realised we hadn’t gased a ventilated baby that was due for one. I waited to be skinned but Prof looked at us with eyes of disappointment and allowed one of us to get on with it. I realised the difference between this Prof and other Profs I had met. I wasn’t afraid of angering him, I was afraid of disappointing him out of respect. The balance of fear and respect is something most senior doctors struggle with.
His passion for neonatology was so clear. He truly loved the intricate details of the neonatal system and all diseases that plagued it. He was passionate about sterility and aprons and gloves. One couldn’t be caught dead without an apron doing rounds or worse, procedures.
The night progressed into hell. Besides feeling like I was working alone, everything had gone hay wire. The nurses were grumbling at me as if I had shoved meconium into the lungs of these neonates.
First, 3 endotracheal tubes dislodged at the same time. Pulses were plummeting and the process of reintubation was arduous and long. As one tube was secured, the next was out. Vulgarity was swinging in my mind but never on my tongue.
It was almost 9pm and I had one admission waiting for a ventilator, 3 tubes out then in again, no PM blood gases done, 2 drips to be resited, 2 outside phone calls waiting for attention. I hadn’t eaten since 11am and my throat was dry as a bone.
My phone rang and I wished it was Powerball calling to say I had won the R58 million rand lotto that I had never entered.
It was the intern in theatre with a flat baby, doing chest compressions. My God. Was there even a God? I wasn’t sure at this time. I ran.
When I had returned to the NICU, it was 21:55PM. I started the mindless process of collecting blood gases. Where there was an arterial line, I sighed with relief.
I was deep into the blood gas retrieval process when I looked up at found Profs face looking at me. I was shocked. “What are you doing here?!” I blurted out by mistake.
Prof laughed. I expect he often got this reaction from registrars when he surfaced unexpectedly.
“I am on call. I am checking on my domain”
I hustled to get my blood gases going, apologizing profusely. Did Prof come check on the gases because I was taking so long?!
Fellow registrars assured me this was normal for him and quite expected unless you are new and no one warned you.
Prof analysed the gases, made ventilator changes in real time and saved me the time of trying to get information across about 12 ventilated patients over the phone. He gave me plans for the new patients and left around midnight.
The rest of the night progressed poorly. More Intubations, accidental extubations, 600grammer death, suspected pnuemothoraces, fitting neonates and endless gases and septic work ups.
I kept my peripheral vision open, scouting for blue scrubs and a labcoat.
I will never forget Profs teaching, passion for arithmetic and calcium replacements, Long but fruitful academic rounds and gentleman-like qualities.
A true advocate for neonates.