It was about 5am on an otherwise uneventful shift , we have taken opportunity to grab a quick nap, the pagers tone – Code 1 – Baby born: complications.
The data terminal in the vehicle starts giving us information on the way, it’s hard to believe it’s right. “Baby born into toilet, approximate down time 30 minutes”
Surely it’s premmie, a spontaneous abortion, formed but not yet viable? As we race the few minutes to scene we discuss the foetal age before which a resuscitation is futile. The radios are full of static, we are not sure who else has been despatched. Another crew beats us to scene by a couple of minutes. The sitrep is clear – “Full term infant submerged in toilet”
His grey, lifeless body is pulled from the toilet and cleaned. The cord has sheared during the delivery, there is a lot of blood in the toilet bowl. His mother sits in the next room , she has a significant intellectual impairment, she didn’t even know she was pregnant, she is seemingly unaware of the situation unfolding around her. One officer tends to her as the rest of us rush for the ambulance while we start our resuscitation.
Our nearest Intensive Care ambulance unit is about 15minutes away, the hospital is about 3 – it would be nice to have IO access and an ETT but we’re not going to wait. He has electrical activity in his heart but it’s not pumping and he’s making no effort to breathe. We perform compressions and assist his ventilations, his lungs are full of fluid and we cannot suction enough.
The team meets us at the hospital and swings into action, IV lines are placed, suction continues, he is intubated, drugs are given, blood and fluids to combat the loss from the cord shear, compressions continue. His heart remains in pulseless electrical activity for about 40 minutes as the resus continues…
Then he has an output – his heart is pumping, but he is still not making any respiratory effort. His skin is still grey. Discussions are held – what to do? His injuries mean he faces certain extensive brain damage. Then he starts to breathe – not normal breaths but short gasps, the ‘agonal’ breaths that the dying make.
He makes no spontaneous movement, he has no reflexes, he continues to gasp slowly about 6 times a minute – the senior doctors and hospital team decide to withhold further treatment – he has suffered in his short life and they have tried their best.
They wrap him in a rug, a nurse holds him as his breathes his dying breaths, everyone is expecting he will pass soon.
10 minutes… 20 minutes… he still looks grey but not as grey
45 minutes after they have stopped resus, his breathing has changed, it’s now regular and coordinated, his colour looks normal now –like a healthy newborn.
Later he is transferred to the Special Care Nursery where he is treated as a palliative patient, to be supported until he dies, he has regular seizures and is placed on a morphine infusion, he makes no spontaneous movement, he has no suck reflex. They suspect a massive cerebral injury. And yet he keeps getting stronger – as the days and weeks progress he stops having seizures and starts feeding. Brain scans reveal significant injury and his future remains unclear but he remains alive – unquenchable.
Postscript – this young fella has continued to defy the odds and was recently discharged into the care of his family.
Disclaimer – I have written the way I remember things happening but the exact times and procedures especially at hospital are not necessarily 100% accurate.