I was talking to a friend who had a rough week. (My wife once asked me if I had a rough night at work and I said "yes, but I know that there are those who had it rougher because I was taking care of them"). My friend had taken care of a little girl who was born with grossly underdeveloped lungs and died. There had been no amniotic fluid around the baby from about 18 weeks and the girl's lungs did not develop. My friend told me that she told the family that while their daughter was here only a brief time her life was still significant.
I have told families something similar in the past. I like to think that regardless of the length of a life, 1 minute vs 100 years, its importance can be the same. That a baby who dies shortly after birth can still be a significant and positive member of that family.
Later in the week, I was called to the delivery of a baby being born 3 months early. Mom had presented in premature, active labor that morning after an uncomplicated pregnancy. The Obstetrician tried to hold off the delivery but the mother progressed and as the baby was breech a c-section was performed. In a normal vaginal delivery the head comes out and then as the body is thinner the rest of the baby practically shoots out. When the baby is breech it is possible to deliver the body and then the cervix clamp down around the neck and the baby become stuck and suffocate, hence the reason for a c-section. But this can happen in the c-section also, not that the cervix clamps down, but that the body comes out of the incision site and the head is stuck. And that is what happened.
The baby was stuck, body out and head inside...so I had some time to think.
I had my intubation tube, laryngascope, oxygen mask and equipment all checked. The warmer was on, we had sterile towels, a bulb suction, two nurses and a respiratory therapist. We were ready for the baby, the baby still wasn't coming. I thought "What would those OB doctors do if I jumped in there and pulled the baby out myself. I decided to concentrate on my breathing. Breathing in I am refreshed. Breathing out I smile. Then I thought "What would a Zen master do in the delivery room?" The Zen master has no training in Neonatal Resuscitation. He may see life and death as two sides of one coin. Really no different except for our earthly perspective.
So back to the question "What would the Zen Master do?"
Well I thought a Zen Master might welcome the baby into the world, concentrate on their own breathing and help transition the newborn into the next phase of her life, the afterlife. And that might not be so bad if everyone else held the same beliefs. The mother and father were happy to have a minute of life on this side of the coin.
I thought of my kids. Could I accept that? I know that I would try to accept it, but the truth is I want to see them play with blocks, smile when given a Popsicle, shoot a basket and write a report on Troy. I want to experience the whole side of this coin before turning it over.
So the OB finally pulled the baby out and placed her in front of me on the warm bed. She was small, thin, purple and not moving. No breathing. No gasp. No movement at all.
I was calm. I know what to do...its almost automatic. I suction her nose, mouth and then we put the mask to the baby's face and started giving her breaths of oxygen. I wait about 20 seconds and the infant's heart rate is still less than 80 so I look into her mouth and place a thin plastic tube into the upper part of her airway and we start giving breaths through the tube. Once intubated, the heart rate rises to 150. The baby starts to move and so do we. "Let's tape the tube and go" I say. We tape the tube to the baby's upper lip, but it is a little loose as the infant is still wet. I walk backwards as we push the baby through the hallway to the intensive care unit. The baby is on a tall table that has wheels. I am near the baby's head and I have my index finger in the baby's mouth holding the tube in place as we move. As we round the last corner to the unit I can feel the baby start to suck on my finger, it makes me feel good and I get the feeling that she will be okay. She'll have a little more time on this side of the coin. I only hope that later, she will think I did the right thing. That she will know that I did it for her and not for me.
Thursday, June 12, 2008
Thursday, January 10, 2008
Do you want to believe in Miracles?
I often upset my parents by saying that if there was a testament to divine intervention than my life would be it. It upsets them because I follow this by saying that I do not believe in divine intervention and that I attribute my success to good luck. The fact that I ended up in the current position I hold and enjoying a career that I love was easily a million to one. I made multiple attempts to derail my cart and yet it always seemed to fall back on path.
For reasons that do not really concern this blog, I moved away from faith in my early twenties. Initially it had to do with trust issues and a lack of understanding of the bad that exists in this world. It is somewhat a clique to say that one sees an innocent suffer and stops believing in God. But given the mistakes that I have made, I will admit that it is hard to believe that God is intervening for me when I see those much more innocent than me suffering.
Still. I can understand that pain may be necessary for a greater good. So I can see God in a world that has suffering. And I can understand that the one suffering the pain may not see or understand the good that comes of it. Take a child with fever and a stiff neck. A lumbar puncture is necessary to diagnose the condition and guide therapy. The procedure hurts and there is no way the child understands why one doctor is holding them down while another jabs a sharp object into his back. But a greater good, not understood by the child is to be gained. God may work that way.
Yet I still do not believe. To be clear: it is not that I don't believe in God, it is that I don't believe that God makes direct influences into our lives. And it is not that I don't see things that defy my explanation. I have witnessed babies breath when I thought they would not. Infants near death who suddenly are better. However, every time one family experiences a miracle, I walk over to the next bed and see where one did not occur.
And still they come.
Jaydon was born prematurely at 27 weeks. When he was one day old the nurse tried to place a tube down through his nose and into his stomach. This is an NG tube, which we routinely place in premature babies to give feedings when the baby is too immature to nipple. Well with Jaydon the tube would not pass. It coiled back up through his mouth. So I was called to the bedside and I advanced the tube as far as I could until I started to feel resistance. We took an x-ray and the tube stopped midway between the mouth and the stomach. Jaydon had a tracheal-esophageal fistula with an esophageal pouch. This means that the tube that he swallows into does not go all the way to the stomach but stops in the chest. A second tube that connects to his trachea (wind pipe) goes to his stomach. For a better picture of this condition you can visit the UCSF web site. www.pedsurg.ucsf.edu/esophageal_atresia/ The problem is that the acid in the stomach may back up into the lungs and the secretions in the mouth will collect in the pouch and spill into the lungs. So this small 1 pound 6 ounce baby needs a surgery, and not just one. Well with a minor cardiac surgery added on he had three surgeries before he was a month old.
Shortly after his third surgery we saw something a little unusual. The diaphragm on his right side started to rise higher in his chest, causing his right lung to collapse. See the diaphragm must move down to increase the space in the chest and pull air into the lungs. For Jaydon, the right diaphragm stayed up rather than moved down.
We tried four or five times to take him off the ventilator and every time he failed. He struggled to breath and I kept blaming that right diaphragm. I had to reintubate (place a tube down through his mouth and into the upper part of his trachea) him every time. He would not come off the ventilator. So we placed a camera down into his airway and everything looked normal. Next we performed fluoroscopy. This is when we take a video x-ray of the lungs. We do not do this very often in small children because of the radiation exposure. An x-ray is a single picture. To create a motion picture, it takes hundreds of pictures. With the study we can actually watch the lungs open and close and the diaphragms move. Every time Jaydon took a breath his left diaphragm went down, but his right went up. It looked like a seesaw. I watched this for about twenty seconds. The study was conclusive, the diaphragm was paralyzed and the infant was ventilator dependant.
After the study we had a family conference and the pulmonologist, surgeon and myself (all having reviewed the study) agreed that a fourth surgery was necessary to tie the diaphragm down in the hopes that this would allow Jaydon to come off the ventilator. Reluctantly Jaydon's parents agreed.
The night before his surgery the nurse caring for Jaydon found him with his endotracheal tube out. He had coughed the tube out of his airway. Normally this would have caused his oxygen levels to drop and alarms would have sounded. But Jaydon was breathing comfortably on his own without any extra support. He was breathing as normal as any healthy, premature baby. He remained off ventilatory support until he went home one month later.
I can't explain what happened. I saw, with my own eyes that the diaphragm did not work. And I witnessed this test just three days before Jaydon coughed out that tube. I took Jaydon off the ventilator many times and he never lasted more than a few hours, even with lots of additional support. Yet here he was breathing comfortably without any support at all.
So was this a miracle. As I told you before I do not believe in miracles. And the God that looks upon me may be shaking his/her head in disbelief, but I will still have to chalk this up to one of those things that happens that I simply can't explain.
However if you want, you can use it to believe. I wont hold it against you.
For reasons that do not really concern this blog, I moved away from faith in my early twenties. Initially it had to do with trust issues and a lack of understanding of the bad that exists in this world. It is somewhat a clique to say that one sees an innocent suffer and stops believing in God. But given the mistakes that I have made, I will admit that it is hard to believe that God is intervening for me when I see those much more innocent than me suffering.
Still. I can understand that pain may be necessary for a greater good. So I can see God in a world that has suffering. And I can understand that the one suffering the pain may not see or understand the good that comes of it. Take a child with fever and a stiff neck. A lumbar puncture is necessary to diagnose the condition and guide therapy. The procedure hurts and there is no way the child understands why one doctor is holding them down while another jabs a sharp object into his back. But a greater good, not understood by the child is to be gained. God may work that way.
Yet I still do not believe. To be clear: it is not that I don't believe in God, it is that I don't believe that God makes direct influences into our lives. And it is not that I don't see things that defy my explanation. I have witnessed babies breath when I thought they would not. Infants near death who suddenly are better. However, every time one family experiences a miracle, I walk over to the next bed and see where one did not occur.
And still they come.
Jaydon was born prematurely at 27 weeks. When he was one day old the nurse tried to place a tube down through his nose and into his stomach. This is an NG tube, which we routinely place in premature babies to give feedings when the baby is too immature to nipple. Well with Jaydon the tube would not pass. It coiled back up through his mouth. So I was called to the bedside and I advanced the tube as far as I could until I started to feel resistance. We took an x-ray and the tube stopped midway between the mouth and the stomach. Jaydon had a tracheal-esophageal fistula with an esophageal pouch. This means that the tube that he swallows into does not go all the way to the stomach but stops in the chest. A second tube that connects to his trachea (wind pipe) goes to his stomach. For a better picture of this condition you can visit the UCSF web site. www.pedsurg.ucsf.edu/esophageal_atresia/ The problem is that the acid in the stomach may back up into the lungs and the secretions in the mouth will collect in the pouch and spill into the lungs. So this small 1 pound 6 ounce baby needs a surgery, and not just one. Well with a minor cardiac surgery added on he had three surgeries before he was a month old.
Shortly after his third surgery we saw something a little unusual. The diaphragm on his right side started to rise higher in his chest, causing his right lung to collapse. See the diaphragm must move down to increase the space in the chest and pull air into the lungs. For Jaydon, the right diaphragm stayed up rather than moved down.
We tried four or five times to take him off the ventilator and every time he failed. He struggled to breath and I kept blaming that right diaphragm. I had to reintubate (place a tube down through his mouth and into the upper part of his trachea) him every time. He would not come off the ventilator. So we placed a camera down into his airway and everything looked normal. Next we performed fluoroscopy. This is when we take a video x-ray of the lungs. We do not do this very often in small children because of the radiation exposure. An x-ray is a single picture. To create a motion picture, it takes hundreds of pictures. With the study we can actually watch the lungs open and close and the diaphragms move. Every time Jaydon took a breath his left diaphragm went down, but his right went up. It looked like a seesaw. I watched this for about twenty seconds. The study was conclusive, the diaphragm was paralyzed and the infant was ventilator dependant.
After the study we had a family conference and the pulmonologist, surgeon and myself (all having reviewed the study) agreed that a fourth surgery was necessary to tie the diaphragm down in the hopes that this would allow Jaydon to come off the ventilator. Reluctantly Jaydon's parents agreed.
The night before his surgery the nurse caring for Jaydon found him with his endotracheal tube out. He had coughed the tube out of his airway. Normally this would have caused his oxygen levels to drop and alarms would have sounded. But Jaydon was breathing comfortably on his own without any extra support. He was breathing as normal as any healthy, premature baby. He remained off ventilatory support until he went home one month later.
I can't explain what happened. I saw, with my own eyes that the diaphragm did not work. And I witnessed this test just three days before Jaydon coughed out that tube. I took Jaydon off the ventilator many times and he never lasted more than a few hours, even with lots of additional support. Yet here he was breathing comfortably without any support at all.
So was this a miracle. As I told you before I do not believe in miracles. And the God that looks upon me may be shaking his/her head in disbelief, but I will still have to chalk this up to one of those things that happens that I simply can't explain.
However if you want, you can use it to believe. I wont hold it against you.
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