Friday, September 17, 2010

Disturbing incident in cuidado intensivo

Every Friday at the hospital, all the med students doing their rotation there gather in the auditorium for announcements and a guest speaker.  Today it was actually a very inspirational speaker.  I don't remember his name, but he was a very experienced M.D. who also did some family counseling.  It was more of a motivational speech about how our (the med students') attitude toward work and their personal life will dictate how well we do and how much we can achieve in both those realms.  These were all ideas I've heard before, but for some reason it touched me differently, perhaps because it was in Spanish, with different metaphors and different ways of explaining things.  One line that I particularly liked was, "No es responsable por la cara que tiene, pero sí es responsable por la cara que me pone."  Translation: "You're not responsible for the face that you have, but you are responsible for the face that you give me." 

After the speaker, I went on rounds in the men's ward, then up to cuidado intensivo de recién nacidos, where I had been the whole week.  They had already started rounds with the doctora, and were huddled around a baby in the corner, discussing that case.  I joined them for a minute, then went around to look at the patients, seeing who was still there and who had gone home.  I stopped at a little baby boy, one who I had seen on my first day, the preemie that was born at 34 weeks gestation.  He was under a phototherapy light for his jaundice and had his eyes covered with a little blindfold.  As I looked closer, I thought I was hallucinating that his chest wasn't moving.  Sometimes premature babies will "forget" to breath for a few seconds, then usually start up again.  I waited, still no movement.  I couldn't tell what color the baby was because of the bright blue light he was under, but as I looked closer, it didn't look normal.  As I took all this in, it didn't register right away and it was hard for me to believe that no one else had looked at this baby earlier (they are supposed to do their physical exam right before rounds) or noticed that anything was out of the ordinary.  My heart was pounding.  Was this really happening?  Am I overlooking some obvious sign that he's really OK?  I had to tell someone, so I called a student over, he opened the incubator, listened to the baby and called the doctor over immediately.  She felt and listened to the baby, and almost right away said he was dead.  At this point it was a little hard for me to understand what she was saying because she was both talking to herself and yelling at the students, but I assumed that he had been dead a while because there were no attempts made to resuscitate him.  The doctor proceeded to lecture the students that it appeared that the baby hadn't even been looked at before rounds, when the physical exam was supposed to be done.  Afterward, we went on to the next patient and nothing further was said about it.  At that point I decided that I'm never going to have a baby or have any kind of health problems near this hospital, nor will any of my loved ones.

It occurred to me how easily something like this could happen in the cuidado intensivo here.  There are no monitors on the babies to read their heart rate or oxygen levels, so if a premature baby stops breathing, which can happen very often, there is nothing to alarm the staff about it.  The doctor and students are usually busy with rounds and paperwork, and there are only 2 nurses staffed for up to 17 babies.  Obviously the treatment the babies are getting is better than nothing at all, but it just scares me how easily a baby in trouble can be overlooked until it's too late.

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