Back to work

Today was my first day back at the hospital after a relaxing week at home in the US.  It was a busy day, with several sick patients and a few “situations” that came up throughout the course of the day, but I was glad to be back.  It’s amazing how quickly things change at the hospital – when you’re there every day it’s easy to keep up with which patients are where, to know who’s progressing, etc.  But after just one week since I’d last been there there was hardly a child in the place who had been there when I left.  I guess that’s good, that kids are getting better and going home, but it’s still a disconcerting feeling to realize everything is so different.

Tomorrow I’ll have a meeting with some other pediatrics people here about some new protocols we’re going to work on implementing.  They are all related to neonatal care, an area in which we could use some improvement for certain.  I am looking forward to being a part of the implementation process.  It can’t come too soon.

One of the bittersweet things about leaving last week was knowing that there are gaps I’m filling that wouldn’t get filled in my absence.  So, without a protocol to guide his care, the 830 gram* (1 lb 13 oz) baby I’d admitted two days prior to leaving – who would’ve likely done fine with appropriate neonatal care – died while I was gone.  But that’s an important reality check for me too.  My job here isn’t to keep on trying harder in order to personally save every patient who walks through the door – it’s to help set up systems of care which will give every kid a chance at getting the care that they need.  That’s a principle that I learned back in my QI training, but I’m really living it here now.

 

*Skip this if you’re not interested in medical details.  I Ballarded him out to around 29-31 weeks GA.  Certainly not a risk-free age, but he was stable on room air when I last saw him.  His biggest issue was nutrition.  Too young to have a suck reflex, he needed NG feeds with careful titration of IV fluids.  (Ideally with TPN, but we don’t have TPN here; most days I’m lucky to have my choice of IV fluids.)  We had NG tubes in stock (small miracle) but the mother wasn’t having any luck hand-expressing breast milk, so I’d asked the family to buy formula and begin some preliminary NG feeds.  But without appropriate tape to secure the NG, the tube wasn’t staying in place.  There was also a lack of knowledge of how to work the warmers, so a nursing assistant had unplugged and completely opened the incubator in response to the baby’s temperature being too high.  We don’t have IV pumps either, so giving 80ml/kg of IV fluid – a whopping 66ml/day – is nearly impossible to do accurately.  (That works out to 2.75 micro-gtts/min, or just under one gtt/min – that’s right, a single drop per minute.  Good luck titrating that one.)  So many things we take for granted in the US.  So many extra challenges for the patients (and healthcare providers) here.

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1 Comment

  1. Barbara

     /  March 4, 2012

    Good luck with your meeting, Sara. I hope you can make some headway in improving care for the babies. A big challenge with big rewards.

    Love,
    Aunt Barbara

    Reply

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