New beginnings don't come often but when they do, make sure to make the most of it.
So here I am at Shri Chamarajendra Hospital, Hassan for the next 10 months. I'm posted in Paediatrics for now and today I finish my tenure at the NICU.
The NICU is all about details. Its about specifics, minute details, extensive workup, meticulous follow up and identifying danger signs. Is it all about oxytocin high inducing cuddly little ones? I'm afraid its anything but that. There's more of sick and malnourished neonates, febrile irritable babies, babies in respiratory distress as they gasp and grunt for every breath, yellowish jaundiced little one and sometimes a convulsing neonate who needs immediate management.
Since my first day here it has been an overwhelming experience as you watch the birth of a baby, give immediate newborn care and hand it over to the attenders even as they are sometimes overcome with emotions. Sometimes you see sick babies and admit them for further treatment and investigation and watch the troubled expression on their parents faces. Babies may often make a quick recovery necessitating their shift to the mother side and eventually a discharge but this is closely monitored to prevent any lapses.
While in the NICU, stats are everything. The birth weight, yesterday's weight and today's weight are important for growth monitoring and also for antibiotics dose calculation. We need to look for urine output, grbs and the days of life of the baby and in the hospital to decide the course of treatment and relevant investigations.
The consultants need the numbers. A fall in platelet or rise in WBC or CRP+ve implies a change from 1st line to 2nd line antibiotics or upwards. The feed for the baby is NGF or OGF and slowly DBF is introduced when the baby improves. Fluids for the baby are either 10% dextrose in the initial days and then to isolyte P based on the weight.
Part of NICU duty is baby receiving which means when the OBG intern calls you saying there is a case shifted you run to put on your OT dress, grab a tray and gloves and receive the incoming little one. Sometimes you are informed late and you run to the OT only to hear the little one giving its first cry, you trip and fall right at the OT entrance even as everyone inside gave a surprised expression and went about their work. The sheer number of cases is staggering. There are days with consecutive caesarean sections with skewed sex ratios like 7 males and 1 female in a matter of few hours. Sometimes we rush to the labour ward (with the sister, of course) when there is weak cry or meconium aspiration. It might seem dramatic but there are times when I have rushed out of the labour ward with a baby bundled in my arms to be resuscitated in the NICU. Once the baby is inside, the trolley is rolled in and emergency intubation is done if the baby is in distress.
As this is the district hospital we get a lot of cases referred from the Government hospitals in Sakaleshpura, Belur, Holenarsipura, Alur and Chanraypatna.
The NICU is a closeted space from the rest of the hospital and it attracts a huge amount of daily visitors implying the need for strict sterile precautions.
The consultants look at the investigation reports and charts and decide the course of treatment in the morning and also have a counseling session with the parents where they tell them the present status, course of treatment and prognosis.
Later in the day there is another rounds after the reports from the morning investigations are brought back.
Sometimes we refer the babies to a higher centre (Indira Gandhi Children's Hospital) when we realize that the child may improve under different conditions. Baby of Pooja had elevated urea and creatinine continuously and we had to shift it out. We explained the same to attenders and told them about the free ambulance facility. The attenders asked me if one or both kidneys were damaged because if both were damaged they wouldn't be able to afford treatment. We tried our best to tell them about the free facilities and after some running around for an RMO sign and the ambulance, B/o Pooja was off to Bangalore. Similary B/o Gayathri came with abdominal distension from Arsikere and one look at the X Ray showed that something was not right. The surgery consult said that it was likely a case of Congenital Hypertrophic Pyloric Stenosis which would require paediatric surgical intervention. B/o Pavithra had elevated Bilirubin (20+) levels in spite of phototherapy so on one rainy evening we referred her to Indira Gandhi again.
During the course of my NICU posting, I've seen life and the beginning of life in close quarters. I've also seen the darker side, with death rearing its ugly head often in the NICU. Explaining the condition of a critical baby is always a hard time and there are times when you push back tears of your own.
Baby of Mamatha was a tiny preterm LBW baby who fought for a while until it was too laborious to breathe anymore. While sometimes the parents understand that their child hangs precariously between life and death, at other times, it is a tough moment for them to see that after 7/8 months of nursing dreams of a newborn, the little one did not make it.
Baby of Mala was also a brave little one who was lucky enough to receive surfactant (rare in supply and requires an indent), caffeine and when his Hb% decreased one evening, I even decided to arrange for 1 unit of B +ve blood that night even though his saturation was not maintaining. When the blood finally arrived, he had already desaturated and had no cardia thus leaving one unit of blood to go without use. This was also the first time I practised intubation thanks to the hyper Veena sister.
Baby of Asharani was the first of the 28week twins who lived for a day on the ventilator unlike his brother who didn't make it out alive. Baby of Pavithra is also the first twin who breathes mechanically at 27weeks. In such cases it's important to find out the underlying cause especially since in this case the mother had APH and a similar preterm pregnancy.
Perhaps its the 'perk' of being in the NICU but it is indeed a tough moment when the parents place so much faith in you and ask you to do everything you can to save their child's life. Sometimes you go back with a smile when you send a discharged patient after a long stay. Sometimes you can only tell them that you are doing everything possible in this hospital's facilities.
There were days when I didn't answer questions I ought to know, there are moments when I feel how can I have this responsibility upon me; do I know what I should know?
From the plush confines of Subbaiah to the government hostels here, its been quite a journey. Real exhaustion is when you sleep for 12 hours straight after your duty ends. Its when you eat what's in the mess without a squeak because you're too hungry to complain and your co-intern is waiting to be relieved.
Its been about 10 days here and nearly 10 months to go.
Adios Amigos.
So here I am at Shri Chamarajendra Hospital, Hassan for the next 10 months. I'm posted in Paediatrics for now and today I finish my tenure at the NICU.
The NICU is all about details. Its about specifics, minute details, extensive workup, meticulous follow up and identifying danger signs. Is it all about oxytocin high inducing cuddly little ones? I'm afraid its anything but that. There's more of sick and malnourished neonates, febrile irritable babies, babies in respiratory distress as they gasp and grunt for every breath, yellowish jaundiced little one and sometimes a convulsing neonate who needs immediate management.
While in the NICU, stats are everything. The birth weight, yesterday's weight and today's weight are important for growth monitoring and also for antibiotics dose calculation. We need to look for urine output, grbs and the days of life of the baby and in the hospital to decide the course of treatment and relevant investigations.
The consultants need the numbers. A fall in platelet or rise in WBC or CRP+ve implies a change from 1st line to 2nd line antibiotics or upwards. The feed for the baby is NGF or OGF and slowly DBF is introduced when the baby improves. Fluids for the baby are either 10% dextrose in the initial days and then to isolyte P based on the weight.
Part of NICU duty is baby receiving which means when the OBG intern calls you saying there is a case shifted you run to put on your OT dress, grab a tray and gloves and receive the incoming little one. Sometimes you are informed late and you run to the OT only to hear the little one giving its first cry, you trip and fall right at the OT entrance even as everyone inside gave a surprised expression and went about their work. The sheer number of cases is staggering. There are days with consecutive caesarean sections with skewed sex ratios like 7 males and 1 female in a matter of few hours. Sometimes we rush to the labour ward (with the sister, of course) when there is weak cry or meconium aspiration. It might seem dramatic but there are times when I have rushed out of the labour ward with a baby bundled in my arms to be resuscitated in the NICU. Once the baby is inside, the trolley is rolled in and emergency intubation is done if the baby is in distress.
As this is the district hospital we get a lot of cases referred from the Government hospitals in Sakaleshpura, Belur, Holenarsipura, Alur and Chanraypatna.
The NICU is a closeted space from the rest of the hospital and it attracts a huge amount of daily visitors implying the need for strict sterile precautions.
The consultants look at the investigation reports and charts and decide the course of treatment in the morning and also have a counseling session with the parents where they tell them the present status, course of treatment and prognosis.
Later in the day there is another rounds after the reports from the morning investigations are brought back.
Sometimes we refer the babies to a higher centre (Indira Gandhi Children's Hospital) when we realize that the child may improve under different conditions. Baby of Pooja had elevated urea and creatinine continuously and we had to shift it out. We explained the same to attenders and told them about the free ambulance facility. The attenders asked me if one or both kidneys were damaged because if both were damaged they wouldn't be able to afford treatment. We tried our best to tell them about the free facilities and after some running around for an RMO sign and the ambulance, B/o Pooja was off to Bangalore. Similary B/o Gayathri came with abdominal distension from Arsikere and one look at the X Ray showed that something was not right. The surgery consult said that it was likely a case of Congenital Hypertrophic Pyloric Stenosis which would require paediatric surgical intervention. B/o Pavithra had elevated Bilirubin (20+) levels in spite of phototherapy so on one rainy evening we referred her to Indira Gandhi again.
During the course of my NICU posting, I've seen life and the beginning of life in close quarters. I've also seen the darker side, with death rearing its ugly head often in the NICU. Explaining the condition of a critical baby is always a hard time and there are times when you push back tears of your own.
Baby of Mamatha was a tiny preterm LBW baby who fought for a while until it was too laborious to breathe anymore. While sometimes the parents understand that their child hangs precariously between life and death, at other times, it is a tough moment for them to see that after 7/8 months of nursing dreams of a newborn, the little one did not make it.
Baby of Mala was also a brave little one who was lucky enough to receive surfactant (rare in supply and requires an indent), caffeine and when his Hb% decreased one evening, I even decided to arrange for 1 unit of B +ve blood that night even though his saturation was not maintaining. When the blood finally arrived, he had already desaturated and had no cardia thus leaving one unit of blood to go without use. This was also the first time I practised intubation thanks to the hyper Veena sister.
Baby of Asharani was the first of the 28week twins who lived for a day on the ventilator unlike his brother who didn't make it out alive. Baby of Pavithra is also the first twin who breathes mechanically at 27weeks. In such cases it's important to find out the underlying cause especially since in this case the mother had APH and a similar preterm pregnancy.
Perhaps its the 'perk' of being in the NICU but it is indeed a tough moment when the parents place so much faith in you and ask you to do everything you can to save their child's life. Sometimes you go back with a smile when you send a discharged patient after a long stay. Sometimes you can only tell them that you are doing everything possible in this hospital's facilities.
There were days when I didn't answer questions I ought to know, there are moments when I feel how can I have this responsibility upon me; do I know what I should know?
From the plush confines of Subbaiah to the government hostels here, its been quite a journey. Real exhaustion is when you sleep for 12 hours straight after your duty ends. Its when you eat what's in the mess without a squeak because you're too hungry to complain and your co-intern is waiting to be relieved.
Its been about 10 days here and nearly 10 months to go.
Adios Amigos.
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