A NIGHT AT THE PEDIATRIC ICU

11:45 pm.
1 yr 9 months.
thats the age of Fatima, a pediatric patient wheeled into the Ped ICU at 12:00 am in the night of 5.11.09.
she came, tongue bitten and swollen, a swollen lower lip, hands and legs moving frantically in all directions, pushing and struggling.
status asthmaticus, is what we were told, which led to status epilepticus. a stain of blood over her lower cheek. impules shooting across different areas of her brain. unsettling her. sparking movements beyond her control.
a bed was prepared and tubes inserted into her.
Ryles: To remove what remains in her stomach.
which could be accidently inhaled and drown her.
Endotracheal tube: To make sure that humidified air goes straight to the lungs.
An Oximeter: To measure the amount of oxygen in her blood.
2 pediatric post graduates stood. holding her down. examining her. trying hard to stabilize her. Aditya and I stood, assisting them.
"her ventiation is a problem. we'll need to call anesthesia."
the Anesthesia PG was called.
"her pulse is racing. she has a fever."
a pediatic professor was called.
"her convulsions need to be controlled."
a benzodiazepine was injected.
"her fever needs to be managed"
tepid sponging was done and a paracetamol suppository was introduced.
"she still has those involuntary movements!"
the pediatrics prof calls the Head of the Unit.
12:45 am- 1:00 am.
Enter Paeds HOD.
a gentle manner. a curious diagnostician.
"whey're there alarm bells ringing all over?"
We realize that bells are ringing every second. one for the blood pressure thats plunging(98/56) and the other for low respiratory rate. among others.
And this is only one patient we're talking about.
One head nurse. another staff nurse. they run about, loading medicines, clearing debris, sanitizing the place and pacifying the baby.
an infusion of 20 ml bolus Midazolam takes place.
the child's drugged now. moves slowly.
"yes, go ahead. she needs a clear passage".
the Anesthesiology PG swings into action. is handed over a laryngoscope and flicks it open to use its torch and curved steel limb.
Gains access.
Introduces the endotracheal tube.
Breath.
Air.
Breathe.
The sisters hold the kid down. restraining her with a few straps.
Intoduce and IV line.
Food.
Catheterize her.
Relief.
3:00 am.
the Anesthetist walks in to assess the patient.
And whats more?! EVERYTHING that you do or administer to the patient has to be RECORDED and documented. So the process drags on the hours.
AND the biochemical, microbiological and pathological status of the patient updated as soon as possible.
with the devices helpingm
2 nurses, 2 post grad students, 2 professors, 2 anesthesiologists stand around...
monitoring...
stabilizing...
diagnosing...
(caring?)
ONE patient. 8 professionals for ONE child.
slowly, each one of us left the scene. Overcome by fatigue and sleep. Eyes Shutting.Brains dimming.
the light's fading.
the ICU never sleeps of course. Some one would always be around.
=-------------------------------------------------------------------------------=
the next evening, i saw her again.
Her hand stretched out as though in flight.
Her face a whiff of radiance.
Her back arching forward to reach out to some invisible bird in the air.
"Sir! What is she on? This doesn't look like involuntary movements!"
"She's on ketamine."
*(smile)*
well, of course, when i said i hate pediatrics, i meant, i hated dealing with kids. or anything child-like.
but pediatricians. > \m/ !!