I looked up at the black sky and saw darkness. I hadn’t seen the sun in a few weeks. When I left home, it was dark. When I arrived home, it was dark. On post call days, seeing the sun felt abnormal. It burned.

I was on call. I packed my bag and drove to work in silence. I had this funny thought on my mind recently. We are so good at preparing how to live. We know how to sacrifice 10+ years for a degree, working hard for knowledge, a car, a house etc.. and over time we lose our sense of appreciating living in the moment. Years become a blurr.


I decided to arrive 45 minutes early to type out a death summary from the week. A 700 gram baby had unfortunately passed away after 2 months of ICU stay. Everyone was gutted.

Extremely premature babies are at risk of so many serious problems. but this baby had been through so much, ventilated multiple times, 6 bouts of sepsis, countless drips, long lines, poking and prodding. I knew there was a good chance he would die every day but every day he didnt die, he lived. He kept proving everyone wrong, fighting to stay in the game. Until he couldn’t. But this story is not about him.

There’s a concept called empathetic distress. It’s not just about seeing suffering that’s painful, it’s hurting for others while feeling helplessness. I was empathetically distressed.

They say no good deed goes unpunished and I think that’s true. Coming to work early to do admin on a call day, is a good deed.

I sat down in the office next to the ICU and started typing my death summary. Engrossed in the story, I was trying to make sense of, checking blood cultures and urine cultures and dates of CRP’s. Paging through endless notes of days gone by. I saw the notes of countless doctors and nurses. He was monitored from the moment he was born, every single minute of his life was accounted for. There were thousands of words and reviews in different writing, all trying to do the same thing, keep him alive. I would have heard the distinct sound of a beeping screaming ventilator, but I was busy reading his life story.

My thoughts paused by the sound of a frantic nurse. “Dr! come quickly”, she ran back and disappeared. I followed and almost tripped over the mother sitting anxiously outside the room. Oh no.

I saw why the nurse looked panicked.

There was blood in a pool around the baby. The linen saver struggled to absorb the volume. Well, Except in the pale baby. The ventilator was screaming uncontrollably, the baby was not. Things did not look good from my angle. We simultaneously grabbed the Neopuff and suction catheter.

I cannot do a death certificate while doing a death summary. Surely the powers above would not allow that to happen to me.

We need to call for help.

“The on call registrar is in theatre with twins. The intern is in labour ward. You are the only one here for now”.

“I don’t know what happened. His oxygen saturation was 100 then 96 then 94 then 60, I tried to suction but there’s just blood”.

Pulmonary hemorrhage. An old foe. We meet yet again. My previous encounter was a month ago with twins who took turns to bleed.

I saw sweat on her nose. I felt my own building up.

The overhead monitor joined in the howling of the ventilator. We suctioned and bagged and looked up hopefully, our eyes pleading with the number in blue.

Sats 55%..57…54%…49%…..
Pulse 111..89…88…91…87….81……79

Oh no.

The more red the suction tube got, the paler the baby looked. The chest refused to rise well but i could hear faint breath sounds like bubbles under water. We did some quick suctioning, added adrenaline down the tube. The blood stopped pouring but the stubborn chest gave only a very faint rise.

Saturations 72, pulse 100. The emergency blood was was running into the vein.

The overhead warmer burned into my thoughts. Pull the tube out and dislodge clots and risk further bleeding, lose our secure airway, but the tube is likely blocked. It felt like a lifetime of thinking but it couldn’t have been more than a few seconds.

I’ve spoken before about how Prof would appear out of thin air, just when you needed him most, like genie who could smell pulmonary hemorrhage from afar. The respect I have for him, is unparalleled and not only because he has 20+ years as a neonatologist but of how he behaved in this situation. He probably doesn’t even remember this situation but to me, it’s something I will never forget.

I saw him at the door gloving up and
Putting his apron on. Calm as a cucumber while I was sweating bricks.

I tried to explain the situation quickly but he already knew exactly what was happening in a matter of a 5 second observation and a quick listen with his stethoscope. He smiled.

“Pull the tube out, you need to reintubate him. He gently passed me the tube and Laryngoscope.”

By “you”, surely he meant “him”?

I shuffled to step aside still awkwardly controlling the airway.

“No, Sabeeha Moosa. You can do this. I’m right here. I believe in you”

I almost evaporated into thin air.

I felt this weird sense of confidence. Prof was here. Prof believed in me. I could do this.

Faith.

I reflexly pulled the tube out and blood splashed everywhere. My glasses protected my eyes. I moved my eyeballs around making sure I couldn’t feel any blood and pushed on. Prof was suctioning.

The sats picked up to 81% the heart rate hovered at 112.

Hope.

The tube was crusted with blood obviously blocked.

I looked into the mouth and saw a pool of blood at the cords. The cords widened for the gush of more blood.
The emergency blood went in through the vein and out through the cords.

I focused on the airway. Waiting for the 1 second gap to try and get the tube into the cords.
Now, no. Now, no.
Now, yes.

We added more nice things to the tube like adrenaline.

Prof listened and we adjusted the tube and pressures. The sats hovered at 84%.

I heard the sound of the oscillator.
The sats were now 91%. Success.

We washed up and I started making the famous retrospective notes which basically always means something bad went down. Prof adjusted the oscillator and stood with his arms folded.

Beeping.

I looked up and suddenly I saw prof pumping the chest. I shuffled for the adrenaline. The Pulse was 20. The sats were a whole 0. More blood poured out the tube into the oscillator circuit. The baby looked grey. Things did not look good. We resuscitated until the very end.

Short story shorter, the baby died. We debriefed and saw the morning team walk in completely unaware, fresh as a daisy, caffeinated and wide eye’d.

My scrubs were drenched in sweat, my glasses slipped off my nose and my mouth was dry. Profs apron was drenched in blood, with a sprinkle on his forehead.

The day had to begin.

The show must go on.

Throughout the call, I kept thinking about the situation. All it really takes is just 1 person who is more experienced, more knowledgeable, and more skilled to believe in you. We’re so focused on trying to be better by identifying what we do wrong. It may seem like an endless vacuum of negativity. But hearing just one positive thing gives you the courage and strength to actually be better. And that’s an incredible and powerful notion to wield.