Three babies and a boy

I’m not sure if I mentioned this in a previous post, but the triplets were born early by emergency c-section due to cord prolapse. I’ve been taking care of them all week before sick ward rounds and it has to be the best possible start to any day. They are doing exceedingly well. The mother is a tiny beautiful African woman, full of energy and excitement. All three are boys and mom is a full time breastfeeder. The mother’s mother is there with her at the bedside and forcing her to eat all the time so that she produces enough milk. Every time I walk over to the bed, the grandmother grabs the babies and places them in birth order so that I can keep straight who is who. Today grandma had stepped out and I was three for three. I discharged them this afternoon, it was bittersweet- I will miss my morning visits with healthy babies and small triple miracles. This mother is more than aware that this is a rare blessing and she is nothing if not grateful. Three whole lives ahead of them.

I’ve been on call every day and night for the last 4 days and it has been brutal. Last night we had 3 admissions early before 8- a little boy needing rabies prophylaxis, a 4mos female with fevers, hypoxia, and respiratory distress born to an untreated HIV+ mother, and a little 1 year old boy completely unresponsive.

The 1 year old little boy was brought in by mother and grandma, completely limp in the mother’s arms. The story is that he had been having diarrhea and fevers for 5 days and first went to a traditional healer before going to an outside hospital/clinic. By the time he got there he was so dehydrated that they were unable to place an IV so they attempted to resuscitate him with an NG tube. Later that evening he had a full generalized seizure and has been completely unresponsive since that time. So here is this tiny malnourished child, laying on the bed like a skeleton, with his tiny heart beating a million times a minute. His lips were cracked and his abdomen was scaphoid. His eyes were rolled back into his head. He had raw flesh exposed over his right arm and hand where he had been burned 2 weeks ago, his fingernails were long and caked in dirt. And so we tried with everything we had to get IV access in this child. Shaved his head, called in reinforcements, frantically texted my PICU attending Cecilia, you-tubed how to put in an external jugular line. Can you use a regular 18 gauge needle to place an interosseous line? I still don’t know. All I kept thinking was if I don’t get a line into this child, he will die. In the end, I A-stuck him for labs and the surgical team was able to do an emergency cutdown.

And so we started fluids. He was barely responsive to sternal rubs and barely withdrew to pain. He had ants crawling all over his body and flies taking breaks on his little shaved head. Couldn’t tell how hypotensive he was because we didn’t have a small enough BP cuff, but his cap refill was almost non-existent. Should I be doing something else? He was nothing but dead weight when I lifted him up from his oversized hospital bed. The other children stared, large-eyed and curious, their mothers looked away, eyes down and horrified. Antibiotics, anti-malarials, fever control, fluids, fluids, fluids. His liver function tests were through the roof, his spinal tap was clean. Made a couple overseas consults, put my arms around mom’s shoulders, sat at the bedside for a couple hours, walked back to my house and stared at the ceiling.

This afternoon I was standing at his bedside, adjusting his oxygen, and he moved his legs and coughed. Best sound I’ve ever heard. I imagine it is a similar feeling to when a mother first hears her newborn cry.

Maybe tomorrow he will cough more and move his arms. Maybe he will open his eyes. Maybe he will cry. Of course there is always the chance that he won’t make it til tomorrow, but I am holding on to that tiny little cough like it is a triplet birth in Africa.