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Thursday, February 10, 2011

Bloody Messes of the Curative variety

Last week, I came into the special-care nursery to find a baby on our service who had been admitted the night before with severe jaundice. Bilirubin, the toxin in the blood that makes a person turn yellow-ish, can poison the brain if the levels get too high. Normal babies stay below 10, and we worry at 20. Baby F came in with a level of 40. That's about as high as it goes, and F already had signs of brain impact. He stiffened and extended his arms and arched his neck backwards, breathing was fast and labored. It seems his blood type triggered an immune response in his mother, normally minor but in this case combined with infection and poor feeding and dehydration, nearly lethal. All this happened slowly at home (he was not born at Kijabe) until the mother-in-law showed up to visit and told the parents it was time to take the baby to the hospital. The on-call team had performed one double-volume exchange transfusion soon after admission. I suppose it's like changing oil in a car, only you can't exactly drain out all the bad blood and then replace it. Instead you have to pull out small amounts at a time, and keep replacing them with small aliquots of donor blood, and if all goes well over a couple of hours you can go through the equivalent of twice the baby's blood volume.

IF ALL GOES WELL. That's a big IF. Baby F's first exchange had brought him from 40 to 32. An improvement, but atill in the severe panic range. I knew we'd have to do it again, so I didn't wait around, and made the plan first thing in the morning, hoping to be done by noon. Ha! By noon we had just received the donor blood for exchange. I still thought, foolishly, that I could make it to the latter part of an afternoon birthday party for one of our missionary colleagues, and hopefully even a planned late afternoon walk and talk with another mom. These were to be my first really social events and I was looking forward to them. However, what followed, from 12:30 to 8:30 pm, was eight hours of a bloody mess.

The line was the main problem. Newborns have the blessing of an umbilicus, and it is usually possible to put a steady, large IV line in the umbilical vein. The peds surgery team had done so the night before, a bit more difficult since the baby had been at home for a week, but done, so we were all set. But actually, we weren't. The promising umbilical catheter behaved erratically. You have to be able to pull blood out and then push other blood in, 20 cc at a time, in and out, about 25 or 30 times, until a half-litre or more of blood is exchanged. At every 5 minutes, it should take 2 to 3 hours. After the first hour we had barely done anything as we fiddled with the line, noted air bubbles, tried to change the connections, pondered a too-dark xray for placement, consulted surgery again, held up other catheters to figure out how long F's was and where it ended in his body. In short, we struggled. Eking out a few cc's of blood here, pushing in a few cc's there, always with the tenuous feeling that our access was about to close.

Baby F, with his sickly yellow skin, his stiff spastic body, his scarily pulling ribs as he tried to breathe, his oxygen tubing and IV's, his monitors beeping, did not protest. Even when at the six-plus hour mark we gave up on the line and jabbed his groin for a second IV. The difficulty of drawing from either line led to lots of small, 1 or 2 cc aliquots. Frothing blood, a dripping, slimy mess, aching back and legs, sweat in the steamy nursery, glaring lights, the blue bili-rubin lights shining in our way too, recording amounts and times, checking the baby. Who barely whimpered and never cried. Who had nothing to eat all day either, who was basically tied down to the treatment table.

I confess, here and now, I did not have a noble attitude. I knew I had to stay until the bitter end, this was my problem on my service. I'm so thankful for the partnership of a young Indian doctor who is working at Kijabe for a few months, and for the nurses who recorded the struggle and checked the vital signs. But as the day wore on into evening and night, no lunch, no dinner, no bday party, no walk, no break, I was getting more and more frustrated. Because in my heart I was thinking: this is pointless. This baby is already devastated. Are we really doing any good?

We had hoped to get the level below 25, and the next morning as I waited for the results, I was determined NOT to go through this process again. The results: 19. Better than we had hoped, probably because the whole process took so LONG there was more equilibration and effect. Next day: 13, then 8, then 5, then 3. With no further therapy. And baby F became less stiff. Without the lines and oxygen and dripping blood, he looked, well, baby-ish. Today he was breast-feeding, noisily and hungrily. He's off all his seizure medications, and not convulsing. He is starting to look like he will survive, he will leave this nursery soon. I don't think he'll emerge unscathed. His hearing is likely affected, and he may look like a cerebral palsy kind of kid. But the newborn brain is pretty amazingly adaptable. So only God knows.

Which is the point. Only God knows. And God was listening to one of the older ladies who accompanies her doctor-husband here every year, and then spends her time praying and ministering to others. She had come by our house and found me gone that first night, and when she didn't find me and heard about baby F, she decided to pray for him. And I wondered how the bilirubin levels had continued to fall so dramatically! Baby F was PRAYED for.

The cross was a bloody, curative mess too. For people like me, who, compared to Jesus, do not seem to hold much promise. Aching hours of effort, a sanginous sacrifice. No stinginess from God, no weighing of the prognosis, no withholding of the costliest and best. Let me plunge into the bloody messy world like Jesus, and let that effort bring life.

1 comment:

Anonymous said...

What a wonderful post. You have such a powerful way of bringing God's mercies into a true perspective. Thank you. i am praying for you and your dear ones and for your missions. Judy in HMB