Déjà Vu

Déjà vu. That is what I experienced today. Another newborn baby desperately needed resuscitation. At three am I was rudely awakened from a deep slumber by a knocking sound on my window and what seemed like a man’s voice. Half asleep and alarmed by the strange noise, I timidly called out, “Yes?” This last week for three nights in a row there had been houses in our immediate vicinity that were known to have gotten robbed, so Todd and I were especially paranoid about having an unwanted visitor. “Yes?” I said again, this time a little more loudly. No one responded to my call, so I simply laid my head back down on my pillow, wondering if I had dreamt up the entire scene. However, five minutes later, I heard a distinct, urgent knocking on my window and voice saying, “Doctor, a c-section! The patient is waiting!” I then realized that Dr. Ang was on call and that the watchman had come to awaken us to join him for en emergency c-section. By that time, Todd had awakened to see what was going on. He and I quickly got dressed and walked over to the hospital. The night was dark, but the clouds had cleared, so the stars were unbelievably bright and beautiful.

Todd scrubbed in with Dr. Ang, and I posted myself by the “crib” (a metal tray on wheels covered with a thin sheet) as I reminisced back on my days on Newborn Nursery calls during my Pediatrics rotation. The mother was dark-skinned, petite, and very tired. The c-section was called for PROM (premature rupture of membrane), polyhydramnios (too much amniotic fluid), and fetal distress. When the baby was removed from the mother’s womb, it was limp and blue. Flashbacks of my experience with difficult babies on Pediatrics came rushing back. We bulb suctioned and deleed the baby and gave her oxygen by nasal cannula, but the baby remained limp, did not cry, did not even breathe. I felt for her pulse her umbilical cord, and it was less than sixty. We started to administer positive pressure oxygen, and I began two-finger chest compressions on her. Apgars at 1 and 5 minutes were a pathetic 1 and 1. After extensive resuscitation and some dextrose into the umbilical vein, the baby began to take a few, feeble, faltering breaths. Nonetheless, it was not enough. The anesthetist intubated the baby, and we continued to bag her. By about 30 minutes, she was finally able to sustain her heart rate greater than 100, breathe spontaneously, and her color had improved slightly. I had never prayed so hard for a baby before, and God seemed to answer our prayers as we desperately fought for life. Thank God for his deliverance!

Yesterday, I went to the Chipata Adventist Clinica again with the Eye Team. It was pouring rain (it had rained for twelve hours straight through the night), and we suspected the clinic would be slow. Nonetheless, we had a great turnout with many interesting cases – several severe corneal ulcers, a bad case of herpes zoster ophthalmicus, uveitis, glaucoma, diabetic retinopathy, foreign body, a few manual refractions, etc. I had never before seen such a severe case of herpes zoster ophthalmicus (the re-emerging chicken pox virus that affects the V1 branch of Cranial Nerve V on one side, often affecting the ipsilateral eye) – it covered her entire left forehead and eyelid area with contagious blisters, and it had only begun 5 days ago. Many of these severe cases can occur with immunocompromised states, so we encouraged her to get testing.

Herpes zoster ophthalmicus:

Corneal ulcer:

One mother came in with complaints that her one year-old son had been tearing for the last few days, right eye greater than left. We assumed it could be allergic conjunctivitis. We projected that it would be difficult to invert his lids, but we attempted it anyway. Lo and behold, a 2 mm black foreign body was embedded in his upper eyelid. We successfully removed it and at the same time learned an important lesson: ALWAYS invert the eyelids if you suspect anything fishy might be going on.