An hour or so later we were in xray with our kidney patient when we got the dreaded "999" pages to the nursery. Anand and I ran through the halls to find Nelly blue and limp. Nelly has been our patient since her birth more than six weeks ago. She was petite and fragile, with disfiguring clefts in her upper lip/nose on both sides, and some minor anomalies of her spine and fingers and toes. But her biggest problem was her heart, a hidden and serious malformation. We have walked a tightrope with her for the last month, titrating doses of cardiac meds, almost losing her numerous times, trying to get her to cardiac surgery experts (she's the one who came back after attempted transfer because the money demanded was impossibly high and the care less personal in Nairobi). Her beautiful mother and "do everything you can" caring father were constantly at her side. Usually when she became agitated and hypoxic her mother could calm her down and we would see improvement. But not today. Her heart just gave out, basically, becoming more and more tired, less and less functional, until it stopped. Her dad stood by us for the last hour or so of her life as we tried all we could do, and understood. Her mom simply cried her eyes out when it was all over, which is exactly what I would do. I love seeing how parents can wrap their hearts around a baby like this who is so tenuous and abnormal-looking, so precious and loved.
And while we were working on Nelly, an intern who was hovering nearby finally said "you're probably wondering why I'm here" (I wasn't, but that's OK) and told us the sad condition of a one-day-old who had also just come to casualty. I knew the nurses were at their limit (we had 20 on the service at that point) but asked if we could admit just one more . . and we cleared the body of the first baby away just in time to repeat the same story, newborn, high fever, not feeding, unwrap and find a baby convulsing and desperately ill. This one though was still breathing well, and still with a stressed rapid heart rate rather than a declining one. So our day ended with another all-out push to investigate and treat, to give fluids and antibiotics, to stop convulsions and modulate temperature. When I left about six this baby was still alive, so I'm hoping she can pull through. I thanked the bustling charge nurse for taking on yet one more admission, and we agreed that if we had declared the nursery full and transferred the baby from the emergency department to another hospital, she would have been dead before arrival. Still a very hard decision to make when we can barely manage the ones we already had. Not even mentioning the baby delivered in our own hospital this morning who would have died without resuscitation, or the one from yesterday with a similar story of rescue.
The nursery is an interesting place, in many ways a sort of intermediate station or gateway between heaven and earth, a territory where little bodies and souls seem to be only partly inhabiting one sphere or the other. A place where we watch in awe as the improbable healings occur, but also choke on our prayers with grieving parents as the reality of loss sweeps over them, where we clean up and move on to the next needy person.