It was a cold winter in Toronto when I rotated at Women’s College Hospital‘s Neonatal Intensive Care Unit (NICU). I had been a Fellow for six months by then. Not yet jaded. Still eager and willing. Many of the cases were pretty much garden variety preemies. All the more complicated ones went to SickKids across the street, where I had come from.
The days were mostly gray. That was okay. I was at work by 6:30 a.m. And I did not really get out until way past 6:30 p.m. Toronto winters are known for their short days. We made up for it in the summer, I suppose, when the sun would begin its descent from our skies by 10:00 p.m..
I was on-call on that Tuesday evening more than 20 years ago. I was relieved to see that the on-call roster showed that one of my favorite consulting staff was on-call with me. He was such a good teacher and clinician.
By the end of the day, we did hand-over rounds. After that, the other fellows and residents went home. I looked at my list of 65 babies to care for that night. I chatted with the nurses briefly and then went to the on-call room for a quick bite.
I was halfway through my salad when the nurses paged me. One of the full-terms was not doing well. She had been admitted that afternoon for poor feeding with her mother, who was a grad student from China. She was only 48 hours old. I examined the baby girl. She was about 3.85 Kg. (about 8 1/2 lb.), beautiful, with black hair and black eyes. She had the round physique of most full-term newborns after a healthy pregnancy. She opened her eyes for me but she looked unhappy and uncomfortable. She tried to cry but seemed not able to. We registered a slight fever. I could not really find much else. Something about her was just not right.
I ordered some blood and urine tests. A chest X-ray. We proceeded to scrub for a spinal tap. After that, I called the staff consultant. He listened quietly and patiently. He said he’d be coming in from home in an hour.
We did not even get the test results yet, when this baby started having a seizure. Then, her blood pressure bottomed out. She looked ashen. We were on crisis mode very quickly. I felt like I was always a step behind her deterioration the entire time.
We worked through the night with the nurses, the respiratory techs, the staff consultant. We finally got her stable enough by early morning. At least stable for a transport to SickKids. We had to sit down with her parents and extended family. They were understandably distressed. Some unpleasant things were said to us. Some pronouncements. Some threats. It was all a blur.
By the time I returned to the on-call room, my fellow residents and fellows were coming in for morning rounds. I saw my half-eaten dinner from the night before. I had no appetite. I just wanted to curl up somewhere for some quiet. But, we had rounds to go through.
After hand-over rounds, I went to pack my bag to go home. I dropped by the NICU at SickKids. I saw her lying on the resuscitation table. She was motionless. Full of tubes and monitors beeping around her. Still beautiful. You’d think she was a “healthy bouncing baby girl” on the outside.Nothing exposed the havoc that was happening inside.
I learned the next day that she had overwhelming Herpes simplex infection. Because she was full term and she was born uneventfully, she was most likely infected as she passed through her mother’s birth canal. Her mother had neglected to inform the doctors at her admission that she noticed some lesions a few days before she went into labor. The mother also had no prior history of infection. She had been married a year to her husband, who was also a grad student. Therefore, she was recently infected.
The baby died a few days later. This virus shows no mercy, especially to newborns. It was a very frustrating and unfulfilling experience. I could not forget this baby. She continues to haunt me every now and then. I often wondered if it was because she looked like she could have been my own.
My own daughter was a few months old by then. She was about the same size when she was born, with the black hair and big almond black eyes. I have relived the events in great detail in my mind and asked myself, what could I have done differently? It all went so quickly. We were told by the other neonatologists that by 48 hours, which is when she was handed over to our care, it was already too late. The virus would have been everywhere doing its damage along its path.
This post was written in response to the Weekly Writing Challenge: Characters That Haunt You.
She was not a character in a book or movie. She was real. And for the short time she was in this world, it’s unfortunate that she suffered much. I can only hope she was hugged and kissed before she got very ill. I really hoped so. I wanted so badly to take her into my arms and hug her. But I couldn’t. It was just not possible. She was too fragile.