Fragile Fighter…!!!

November 12, 2008
Tiny One

Tiny One

Another busy night shift…as usual. Still having to ping off on ‘Blues & Twos’ on every job due to ‘Call Connect’  until the call taker gets more info. Its playing havoc with our ‘carbon footprint’! All of the jobs we had been sent to were not ‘life threatening’  or even serious. But we had been called and the onus of responsibility had been passed to us. Take the history, examine the patient, arrive at a possible diagnosis and then treat, transport or refer.

The occasional serious life threatening job does pop up on the radar from time to time and its then when you need to switch from ‘laid back, seen it all before’  mode into ‘switched on, do the right thing’  mode. That’s the danger with nights (and to some extent days). You get bombarded with so much that could (and should) be dealt with by either the patients themselves or their GP. Its when you are tired that you can make mistakes and things tend to bite you in the arse!

Only two hours left of this night shift and I was flagging! Another call out! I subconsciously dragged my weary boots across the garage floor towards the truck. I could hear the incessant high pitch chirping of the MDT detailing our next job. Climbing into the passenger seat I automatically shut the door, seat belt on, flick through the MDT screen and press mobile. The address was given and nothing else…standard practice!

Heading off with blues turning, the MDT gave the update seconds later. ‘Query Miscarriage’  I pressed acknowledged on the screen.  ‘Oh great! A real cheerful job to end the shift!’  I was not looking forward to this one. You need empathy in this job but at ‘dark o clock’  in the morning you need to work hard on your social skills so as not to come across as heartless or too matter of fact.

Arriving at the address we park the truck and I take in the resus bag as the minimum kit needed. A knock on the door is answered very quickly by a young man who is very panicky and implores us to do something before we even see our patient! Something tells me that this job is not going to be as described on the MDT. He shows us into the kitchen where we see his wife sat on the floor, naked and with the baby half hanging out!

Quickly getting to work and switching on, we deliver the baby…it is a dark red, purple, blue…and very, very, small. Whilst we are attaching the clamps and getting ready to cut the cord I ask mum how far on she was in the pregnancy. ’24 weeks’  comes the reply. Its a premature baby and there are no signs of life. This is going to turn out to be a downer of a job!  ‘I know its dead!’  Mum is quite calm but visibly upset.  

Just when we are convinced that there are no signs of life my mate spots something. ‘Did you see that?’  I’m cradling the baby in a dry sheet after trying to stimulate it to breath. It is so tiny, not much bigger than my outstretched hand. And then I see it. A tiny flicker in the upper arm. A tiny brachial pulse in the babies tiny arm. Using the ‘baby bag & mask’  I start to ventilate the tiny one. The smallest paediatric mask we have is covering the babies entire face.

After not more than a minute or so of ‘bagging’  the colour is improving and there is definite movement. The little one is making good respiratory efforts. We decide to make a run for it and alert the maternity via our control that we need a neonatal resus team standing by. Mum is still convinced that the baby is dead! Still bagging the baby we hurry out to the truck. My mate opens the side door and allows me to get in and position my self in the most appropriate position to carry on bagging the baby.

We have called a back up vehicle for mum and we leave for the journey across the city to maternity. Even though its early morning, dark and little traffic about we need to make progress. My left leg is jammed against the stretcher and as I cradle the tiny bundle in my left arm I am frantically trying to effectively bag the baby. Every little bump, every slight turn is magnified so it makes it even more difficult to maintain a good seal and ventilate at the same time. Jamming my leg further and squeezing my elbows in I keep up a steady rate of good, fast ventilation’s.

I’m talking to the baby, and to myself. ‘Come on baby, keep fighting’  The adrenaline is coursing through my tired veins like fire. And then….the baby cries…! Not the kind of cry you normally associate with a new born baby but a kind of mewling noise. A good sign, but the baby is still fighting for its very survival. My leg is aching, my eyes are fixed on the tiny one, ears straining to hear every cry or whimper. ‘Come on little one, dont give up!’

At last we arrive at the maternity hospital. My crew mate runs off to find the team waiting for us. As I step out of the truck still bagging the tiny one the Doctor wanders over not expecting to see how well the baby is doing. ‘Oh! Right! Erm…’  He immediately switches on. ‘Over here please, place the baby on the pad…’  I place the tiny one on the neonatal resuscitation trolley. The team get to work and carry on bagging. ‘Well done on the bagging. Must have been difficult in the back of a moving truck?’  The Doctor is very appreciative.

We complete the paperwork and take a last look at the tiny one. The baby is a fighter, I hope it pulls through. The consultant tells us there is a 40% chance of survival. Most babies that do survive a premature birth suffer some form of disability in one form or another. But some go on to have a normal, healthy life. We,ve done our bit. We leave it up to the intensive care bods to do their stuff…and to the tiny one to keep on fighting. Walking back to the truck my left leg is still shaking…!