Sunday, January 2, 2011

When parents harm their children

Sorry for the sensationalistic title, but I justify myself because there is no abstract or philosophical thought that has begotten the title. It is a clear and somewhat unbelievable situation when a mother caused greivous injury to her child, albeit in ignorance, which almost led to her death.

About 10 days ago, I was called to the Emergency in the middle of the night. Now, as anyone who lives in a cold place (or who has read Jim Herriot!) knows, it is a mighty big struggle to drag oneself out of a warm bed to face the bone-chilling blast of icy wind that hits you as you open the door. The hope is always that it will be nothing surgical and a quick examination and a perfunctory word with the relatives are all that separate you from a return to the warmth of the bed (and the person sleeping peacefully in it who never complains at the regular disturbances or the freezing feet that snuggle up to hers in an attempt to get warm!).

But that was not to be. When I reached the emergency after a freezing walk up the hill, one look at the baby's tummy was enough to tell me that I could say goodbye to my sleep for the rest of the night! The tiny little thing was only 7 days old. Severely dehydrated, obviously septicaemic and with a tummy like a balloon. The story the mother told was vague. The baby had been fine, sucking well. Then suddenly 3 days previously, the baby had stopped feeding well, begun to develop abdominal distension and had gradually deteriorated with no apparent cause it seemed. As an afterthought, the mother mentioned that she had fed the baby some bananas.... I did a double-take! What!! Bananas to a neonate?!! The mother explained that it was the custom to start feeding the baby bananas from the third day and that was what she had done!! And she could not understand my consternation - after all, she had done the same to her previous 9 children and they were all fine! (Believe me, I am not making this up!!). Considering the sick condition of the baby, I let matters lie and moved on to more pressing matters.

Whenever there is a baby to be resuscitated, the first thing I do is to call our paediatrician, Dr. Susil Longtrai, who pretends not to notice my complete ignorance in such matters and kindly advises me on exactly what to do, right down to the doses of the drugs. Once we had the lines and the antibiotics in, I took the baby for an x-ray. It showed a large amount of gas under the diaphragm, which signifies a bowel perforation. Having not heard of this in such a small child, I made a quick phone call to Lurstep after posting the baby for surgery. He said, he had seen a neonate with a similar history a month before at operation, the baby had a burst stomach. Sure enough, at operation, the stomach had burst right along the greater curvature (which is the longer, outer curve of the concave stomach tube) from the esophagus nearly to the pylorus (the other end!). In the picture below taken on my cell-phone, I am holding one margin in my fingers and the other one with the forceps.
But even more interesting was the contents of the stomach, some of which had spread throughout the abdomen. It was a congealed, foul smelling mass of what was obviously bananas mixed with milk that had blocked the exit of food from the stomach, causing it to bloat up and burst like a balloon!
There was much prayer sent up for this sick little baby that night. But the value of an excellent anaesthetist, paediatrician and a good neonatal ICU were brought home to me as the baby gradually improved and is now ready to go home. This is one of the things I love about mission hospitals - patients who would have normally been sure to die keep surprising all of us. The hand of God surely rests on this place. As for the mother, she remains unconvinced about our theory that the bananas blocked the stomach and caused the blowout. She believes it must be some weakness of this particular baby that caused it!! I am sure if she does have another baby (which is quite possible!), bananas are sure to be on the menu just as they always have been!! I just hope I won't be the poor surgeon who has to deal with the stress of taking care of the baby over Christmas and New Year!!

1 comment:

  1. Oh God...7 days baby fed with bananas...I haven't heard of that custom... Thank God you were able to save that baby...

    Between read few of your posts. Happy to see you both doing Lord's work. It also reminded me of the fictitious mission hospital in the book Cutting For Stone. Probably a book which you would be able to relate too :)