a beautiful morning

It’s a beautiful morning. The air has a chill to it and there has been a fair bit of snowfall at night. It’s still snowing as I walk in the door. There are no surprises on my ward rounds. There have been no overnight admissions, a welcome rarity, and the nurses are having a slow day. I join them in the pantry to some warm tea, great home-made muffins and a few moments of engrossing shop-floor gossip. I am sure that “all is fine in this fine world.” Till I go to baby A’s room.

Baby A had not started life well. He had been born with hydrocephalus. He had endured severe birth trauma and asphyxia during the delivery, resulting in cerebral hypoxia. His brain was deprived of oxygen for long enough to have permanently damaged it. His cry was feeble, he had to be fed through a tube as he hadn’t really learnt to suckle at the breast yet and he reacted very little while being examined. He has been with us for over a month now.

His mom had known about his condition only during the last months of her pregnancy, when it had been picked up by an ultrasound scan. What was surprising was that Mom A was a nurse; yet she didn’t go for a scan till her third trimester.

Behold! The Medical VIP syndrome: When your patient is a nurse, a doctor, or indeed anyone working in healthcare, or a close family member of any of the above, expect Trouble. With a capital “T”.

They will either present with absolutely unexpected complications or react violently to a perfectly common medication. Or have an obscure syndrome that will take weeks and an eager-beaver intern to diagnose. Or end up with multi-organ failure when all they had come for was to get rid of that ingrown toenail.

Mom A was a community psychiatric nurse and really didn’t seem to understand much about her baby’s condition. The team had tried unsuccessfully to explain the extremely bad prognosis to her on previous occasions and failed. It was like talking to a wailing wall. We felt helpless in front of her tears, her pleas to make her baby better. Baby A’s head kept growing alarmingly.

The neurosurgeons would have nothing to do with him either. He had a badly infected spinal fluid, which meant that they could not operate on him until we managed to control the infection. He had been given all the antibiotics in the book, and then some. He was resistant to most of them, and the ‘safe’ ones didn’t seem to make any difference. We did umpteen spinal taps to relieve the pressure inside his head, and prayed for a sterile fluid. And the labs disappointed us every time.

Mom A is not her usual weepy self when I enter the room hoping to get in a quick exam and get out fast. Things are still running to form; head circumference has gone up by a centimetre over the weekend. Baby A is unconcerned by my probing and prodding, winces a little as I put a cold stethoscope against his chest. Mom is watching all this in silence. I am done in a few minutes and ask the usual questions about bowel movements, urine, sleep, irritability. And then the Big One: does Mom have anything to ask me?

She asks me to sit down, offers me some orange juice. Damn! This is going to be another hard long talk. I decline the juice, sit down in the uncomfortable wooden chair, and wait. She gets up and paces a bit, unsure how to start, turns around suddenly, faces me and asks, “Do you think I am responsible for my baby’s condition?”

Say what? I didn’t see that coming. Her eyes are focused, no tears there, just deep and clear. I look away, thinking of a way to answer her, and she explains. “My husband and I had a long talk yesterday; he wanted me to get the scan in my first trimester, but I thought it would harm my little one. I should have got it done earlier and then my baby would have been fine.” So that’s what it is. Guilt. It happens all the time.

The saddest part of working with seriously ill neonates, for me, is talking to the mothers. Most of these babies are born with asphyxia, cerebral hypoxia and intrauterine growth retardation. At best they’ll need surgery to correct a congenital defect. Many will have learning problems. Some will need lifelong treatment.

All the mothers will live in hope for the rest of their lives. Many will blame themselves for their babies’ conditions. It’s a difficult cross to bear.

I look out the window at the softly falling snow; compose my speech in my head. The scan would not have made him ‘normal’, it would most probably have given the parents the option of not bringing him into this world. Of course there are procedures that are done intra-utero, but not every defect can be rectified. Not every anomaly can be picked up by the antenatal scan either. And Baby A would still have suffered the birth trauma. As I turn to her to explain, I notice the tears. I hear the wretchedly silent sobs. She doesn’t want my ‘expert opinion’. She wants to share her guilt and sorrow with someone. She wants me to understand her.

I hold her hand till the tears run dry, and she smiles at me. One of the many sad smiles I will see on these mothers’ faces over the years. I walk out the room with a heavy step. The day no longer seems so beautiful.


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January 2010
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