MIRACLE – born too Soon –  Not  born to Doom

Have we advanced in time and complexity beyond imagination? Have we grown in knowledge and understanding to the point where we can give explanations to all we see around us? Can we annul “MIRACLE” as a word with all its impact from our lives? How many of us would dare do that? Would you?

Moving through my own small world, my own small life, there are so many things that do not add up in meaning. So many things that the little logic I have gathered thus far cannot draw explanations to. Why would one fellow be born in Taiwan and the other in Djibouti and in the end we say the two are all on the same planet to face the same challenge of living? Why should one creature purpose all its living a prey to the consumption of another? Why would man, in innocence and unawareness have to make a passage through this place just to be known to have ever existed? A lot of things require so much explanation in my world. Some I accept as they are but when it is this pressing, I’m compelled to write – MIRACLE.

It was my third week as a practicing doctor – the hell of medical school was now over and man was in the earliest phase of still making strides in catching up with the tunes of the profession. One of the babies on my ward had a very high bilirubin level and needed some powerful phototherapy unit to help clear the yellow pigment away. Our part of the world thrives greatly on improvisation and the making of the best out of the very limited resources available. So a decision came up from my bosses that we had to get the most powerful phototherapy unit in the department which at the time was rather at the mother and babies unit. I had to put on the muscles to get it for this baby – about some 300 meters away. 

Getting to the MBU, something caught my attention. I stood by, had a peep, thought to myself for a while and carried on with the main reason I had surfaced on that ward. Little did I know that after a week and some days that micropreemie whose eye-catching intravenous cannula was on the lateral forehead was going to be my client to take care of. As I stood by her the earlier day, I could tell the number of times she had been lanced with none of her veins responding accordingly to the cannula my colleagues had wanted to pass – warranting one nowhere else than on the miniature skin on the forehead – are doctors sometimes wicked? Maybe for the good of their clients.

When I joined her on the ward, I said to myself, I’m here and we shall go through this together. You might be wondering what is so special about this very baby that would draw me back to the tabs to do what I have not done in months. Don’t worry… Relax and ponder through the mighty hand of the Most High as you treat yourself to the magnificence of her first few months of life.

Where do I even start from? Well, as earlier hinted, Baby Patience (mother’s name) entered our world way too soon and as the case is with premature babies, there are a host of challenges that await them in this already challenging life, not to talk about being born in our side of the world. Pre-term babies amongst the myriad of issues they can have, battle with respiratory distress because their lung maturity is not up to the task of breathing in our world, apneic attacks, because their brains aren’t grown enough and hence they forget at times to breathe, anemia, risk of infections, low threshold to jaundice, necrotizing enterocolitis, retinopathy, risk of hypoglycemia. This doesn’t get boring for the non-medic.

In less developed settings where the material set for managing premature babies is inadequate, any pregnancy terminated before 28 completed weeks is deemed non-viable and hence the product thereof, fit to be called an “abortus”. Baby Patience was delivered at 25 weeks with a birth weight of 0.6kg under mind blowing circumstances. Let me spare you that. Mother Patience was told convincingly the baby was going to die. This was around 4am on the day of delivery. Until a doctor came on duty around 10 am, Baby Patience had to struggle to get air into her dry lungs with her faint diaphragm and fragile ribs. The doctor brought some hope by immediately preparing an ambulance for referral of Baby Patience to our facility, a journey of about two and half hours. It was at the start of this journey that she received some respiratory support by administering oxygen intranasally. Somehow since then she had managed to survive there after till I found the cannula on the forehead.

Amazingly, she had been battling with some infection for which she needed some antibiotics to help in the war of which her body had become the battle field. That was when things went off. No intravenous access was attainable any longer, making administration of intravenous medications impossible. So for about 2 weeks, baby Pat had to be without antibiotics and some other medications. This was the time she rather became clinically stable and showed no signs of ongoing infections in her. Her temperature had settled, and she had been doing well off oxygen for the whole period for which she was without medication.

Then the unfortunate ensued, the puncture site on the head for which I first noticed her had gotten infected and started discharging. Baby Pat now had a sore on the head. Her temperature started spiking again and somehow, her breathing had become abnormal. At this point she needed very close monitoring. She could no longer tolerate the 12mls of breastmilk she had be taking every 2 hours because her breathing had become so fast, labored and with apneic episodes ( periods of no breathing for more than 20secs). We had to move her from the cubicles to the main hall where monitoring could be better. Fighting the new infection alone wouldn’t have been much of a bother because at this point the body had developed new vessels hence an intravenous access could be gotten and she could take IV medications but the apnea that was also ongoing.

I remember how severe it had become on day that we had to teach the mother how to stimulate Baby Pat tactilely. I would go for night duty and the mother would not sleep. She would stay awake till around 2:00 am. I just admired her faith and determination. It moved me to do the best I could for Baby Pat. Then I realized something unusual about Baby Pats mother. She had already given her “preemie” a name – MIRACLE – something no mother had done while on admission. Her apneic spells met the right period during which the department started using improvised CPAP. This helped a lot. So after about two weeks of battling with the ulcer, infection, apnea and respiratory distress, the wound had healed to an appreciable end and the temperature had settled. Just when the temperature settled, it was very difficult to get intravenous access on Miracle. She was now about 32 weeks corrected gestational age, and weaning her off the oxygen was another hurdle to battle with. Without enough monitors, it was difficult a challenge to put her oxygen off without any objective means of assessing her oxygen saturation. However, she had started KMC and her weight had increased to 1kg.

So her mother decided to buy a personal pulse oximeter as well as a glucometer. Miracle would do perfectly well with perfect oxygen saturation when she’s kept on .5L/min of intranasal oxygen. However, it took about an additional two weeks before she was finally weaned of oxygen. This was because whenever the least amount of oxygen was taken off, she started to desaturate. When she started to take strides, they came in leaps. Within a week, her weight had appreciated to 1.3kg. I couldn’t believe it when I was told one time that one of the student nurses checked and the weight was 1.2 so I took the weighing scale to her bedside and weighed her myself. It was awesome. I couldn’t hide my joy. It had been been a while since her full blood count was done. A request for one only revealed that she was anemic and needed to be transfused. This came with its own brouhaha, after several attempts to attain intravenous access had failed, an interosseous need was the way forward.

The news of her discharge brightened our days one faithful morning when her mother rushed to me  to tell me they had been discharged. The mother really relished that day. She always prayed and wished for that and said with the best of faith they weren’t going to celebrate Christmas with us on the ward. Surely it did happen.

Currently, baby MIRACLE comes for review weekly and anytime I see, her, I can’t afford but to give her a pinch at her heels to cause her to smile. At one review, she was found to be anemic again and needed transfusion which could only be done via the interosseous route.

As tough as her earliest part of life has been, God has made her a great fighter. Then I say, God is still in the MIRACLE working business. HE HAS GIVEN US VICTORY.

Glory be to God. Congrats to all my colleagues and staff who helped make this MIRACLE possible. In the nearest future, we shall see her and be proud of our profession.

OMB – 2018