A PRICELESS OFFER

It’s so amazing how saving someone's life gives you wisdom and strength at that very moment that someone's life is in danger.

I was asked to bring a 29 day old neonate with tacheo - esophageal Fistula to a hospital 5-6 hours of road-ship-road travel away from where it is coming from, to get the only solution for him to keep living, an operation that his current hospital cannot perform. Tacheo - esophageal Fistula is a congenital condition where the trachea and esophagus has an abnormal opening, so every time a baby born with this disorder drinks milk, there is a high possibility of aspiration that might lead to death within the first months of its existence. When I saw the patient, I really want to let down the offer because the patient's status is very critical that there is a high percentage that the baby will not make it while on the road. I really understand why the past nurses didn’t accept the offer.  Who would want to bet his license as a registered nurse to a baby that is almost on its last legs? The baby doesn't have the permission to breastfeed for almost 26 days already because it might cause aspiration and might lead to death, thus he is severely wasted. He is so hungry, that he wants to sip everything which gets contact with his tiny mouth, but he is also full enough to keep his fight going. How can I be hopeless when a soul who only spent 29 days in this world is battling hunger, difficulty breathing and weakness just to stay living on it. How can I turn back this challenge and opportunity to give this baby one step closer to win this life and death struggle.

And so, I said YES!

I am really asking myself if I can really do this, because I am not the most experienced and the best, but if I will not do this, no one will. I told myself, I may not be the best nurse to transfer him, but I promise to be until he is in the hospital that can perform the needed operation for his battle to not be put to waste.

I was informed at 11:15 am and we should leave at 12 noon and so I just read the chart and asked the nurses in the Pediatric ward to suction the patient for its secretion is blocking its airway, causing the patient to breath harshly and loudly.  I went home to prepare my personal things, but I am still questioning myself “Can I really do this?”.

When I arrived at the hospital, the patient is already in the ambulance.  I told the driver to stop to get an oxygen tank and an Ambu bag just in case something happened (things that should automatically be in an ambulance, but because this is the Philippines, our ambulance doesn’t have anything that could save life, but more of just a transferring vehicle). After I got these important things (at least), we already started the travel.

The patient is still lethargic, secretion is still present, causing its breath sound to growl, he is pale but his lips are dark which means he is lacking in oxygen. I checked the intravenous line for patency, just to be sure that if something happens, emergency medication will have its way to the patient’s body, and that’s the bad news. The youngest patient I was able to insert an IV line is to a 2 month old, but how can I do this for a 29 day old severely wasted patient which veins are as small as thread and dehydrated. I have no one to help me with this, so I should do it with all my might, and thank God I did on my first try without making the neonate cry or disturbing his sleep. His mother told me that whenever her baby cry, his tummy becomes distended causing pain and discomfort which keeps him awake all night. So far so good for me but can I keep up?

We already arrived at the port and the rain starts pouring, but the baby’s breath sound starts increasing in volume, I don’t have a suction machine on the ambulance to relieve his suffering but I should do something. I checked my personal emergency kit which I bring whenever I transfer a patient. It might not be complete but at least I have something ready at any situation. Damn! I don’t have any suction catheter for infants and the one I have is for adult and it can’t manage to enter his airway. I really want to panic but I can’t. I can’t let the mother worry more for his first born. She even told me that from she first time saw him until that moment; she is just trying to be strong for her baby. It is like I am caring for two patients: a baby who is fighting against his physical disorder and a mother who is crying and weak inside. I can’t let anyone go weaker or even give up the fight; I should be stronger, wiser and better for me to take care of them.

I turned on the oxygen, grabbed the suction catheter for adult, but I don’t have anything to facilitate the suction. I looked for anything that I could use and end up holding a 5 ml syringe from my emergency kit. I attached the syringe to the suction catheter and good heaven, it fitted. I hyperoxygenated the baby and inserted the suction catheter just before the patients throat and pull out the plunger of the syringe. After several tries, the baby vomited whitish secretions which made me and his mother smile. We managed to get almost 50 ml of secretions until we started to see the neonate relaxed and with silent breath sounds. 

We are already in the sea liner when it started raining which made the travel longer for the ship needs to move slower due to the strong waves hitting the vessel. I took the vital signs, listened to the breath sounds, suctioned, repositioned, and cuddled the patient every hour for the past 3 hours and everything is going well, until the rain start getting stronger. The baby began to cry nonstop, his abdomen started distending and the breath sounds is getting more strident. I started the suction but nothing is coming out. The maneuver of repositioning, cuddling and suctioning is not anymore working and his mother is already starting to worry and I am too, secretly.

The actual device I used to suction the neonate

I put the oxygen mask to the baby while thinking for a better idea, squeezing my brain to create another plan. I looked at the neonate and I saw him fighting and not giving up, trying to be stronger than her mother who is already starting to crumble. The patient is already a little bluish and his tummy is distended and very hard from air entering due to uncontrollable crying. I know, I should start doing something and so, I took an IV cannula, removed the metal needle and left with the plastic catheter which I think could already enter the patient’s throat. I attached it to the tip of the suction catheter with the help of plaster and started suctioning. And again, it worked! We were able to remove trice the amount we used to get every hour. The baby is starting to calm down and I can already see his lips turning red, which is a great sign that he is already breathing well. The rain is continuously falling but I still decided to step outside the ambulance and checked how far we are from our destination because I don’t know if the clear airway of the patient will last. It was a great relief that I can already see the port 200 meters away from the ship. I smiled, because as the breeze is confirming the success of the travel, thought of my young but strong patient making it and growing healthy touched my mind.

I went back to the ambulance to get ready for another hour of land travel and saw my sleeping patient, peaceful like angel. Smiling and breathing without any worry, like other healthy babies. His status remained the same until we reached the hospital. I was able to endorse him to the doctors and nurses properly. I stayed for 3 hours more to check on his condition and found out he’s doing fine.

At this very moment, I just sent a text message to his relatives to check for an update on his condition, hoping that this strong baby made it. That soul who stayed only for 29 days when I met him, taught me a lifelong lesson. His weak body is pushing me to stay strong until my last breath for he is doing it himself, and inspired me to keep on fighting the struggles of life. How can I give up on anything, if that weak young man is fighting since the day he was born? How can I surrender to simple problems, if someone is fighting just to breathe well?

It’s so amazing how saving someone's life gives you wisdom and strength at that very moment that someone's life is in danger, But it is more amazing that the life you are saving, is also giving you strength and teaching you lessons that sometime in your life, you might need to save yours.

There are situations that are pushing you to your limits, giving you a hint of who you can be when you start to care.