Tuesday, October 04, 2005

A Doc's Life - Memorable Moments 6

Scenario: Largest maternity hospital in the local scene; I did a 6 month rotation through the Neonatal ICU.

I saw and did things which I would never have imagined if I hadn't gone through this posting. Among the unforgettable are congenital abnormalities some of which I would be unlikely to see again in this lifetime.

SIRENOMELIA: Or the Mermaid Syndrome. This baby was a BBA (our acronym for Born Before Arrival), still birth, born to a Malay family. It (unclear of it's gender) had just one fused limb with a single toe. The upper half of the baby looked absolutely normal.

CUTIS APLASIA: The baby was literally born without any skin. According to literature, this rare condition usually affects part of the body, most commonly the scalp. However, in the case that was admitted, the ENTIRE baby had no skin. He was covered by a thin transparent glistening membrane. You could see his muscles, superficial blood vessels etc. We kept him as comfortable as possible; setting an I/V on him was a nightmare. He survived for 3 days before passing away.

ANENCEPHALY: This was an undiagnosed case, because of lack of antenatal follow-up. The baby was a stillbirth.

ACHONDROPLASIA: This was also undiagnosed antenatally, despite adequate follow-up. Understandably, the mother was depressed. We kept the otherwise healthy baby boy in the ward longer than normal to prevent the parents from doing anything "drastic" in the immediate post-partum period, and arranged for them to see a counsellor.

One of the most heart-wrenching, gratifying, stressful, tedious tasks we had to perform was the resuscitation and intensive monitoring of premature babies, some as small as 700 grams. Blood gases, electrolytes, parenteral nutrition all had to be closely watched to keep them alive. It became a bit of a moral dilemna for me after watching the effects of surviving prematurity: CP, BPD, developmental delays, mental retardation (some more severe than others). Was it worth saving their lives? I had to accept that the moral decision was not mine to make; as doctors, we were there solely to save lives when called to do so. There was even one instance of a mid-trimester TOP who called for the NICU MO-on-duty (moi) to go to the gynae ward to resuscitate the 23 week old fetus who had been expelled & was actually crying! This little life clung on for 3 days before letting go...It was hard not to weep with the mother, who, for whatever reason, had to go through this ordeal and live with her decision.

This posting was the most stressful and at the same time the most enriching one I had gone through. Not only did I learn so much about the resilience of babies (they are not as fragile as one might think), but it would later serve me well for my adventures as a new mom (I did not become one of those panicky moms who would call the pediatricians when Baby refused to stop crying/refused to suck/poo-ed too much/poo-ed too little). And in the rare free moments, the nurses taught me how to feed/burp/bathe the babies - this definitely was good practice!


JJ said...

Hi there,

its me again to bother you :) Im just curious like doing the medical interview what kinda questions do they actually ask? and also why did you want to become a doctor?

hope its not too personal a question though, im just curious


Anonymous said...

poor mothers with deformed babies.
i cannot imagine the devastation the malay mother underwent for the BBA sirenomelia case.

aliendoc said...

JJ: It's been quite a long time since my med interview, & I believe the system has changed slightly in that potential students have to go through two interviews instead of just one. One with senior doctors, and one with more junior ones.
In my time, the usual question was "Why do you want to become a doctor?" I don't even remember what I said! I think the interviewers probably heard a lot of sh-piel about wanting to help people, it being a noble profession & so on & so forth.
As for my reasons for becoming a doctor, it was a decision made at a time when not many other options were available...'nuff said :) !

Anonymous said...

they've changed the system quite a bit. yup, 2 interviews, 1st with the faculty staff, the 2nd with medical doctors +/- medical students.

i had weird qns - "if you saw a man in a ditch as you came for this interview, what would you do? suppose we won't give you another interview if you helped this man and was late"
"have you heard of MSF? what do you think of it?"
"what do you think of HOTA?"
"if you couldn't get into medicine ,what would you do?"
etc etc

also have this essay test to write, it's not science-based. eg they asked my year to write on something we regretted (can't remember actual phrasing).

and they were thinking of introducing a personality test with some IQ bits - we did the test but it wasn't included in the final score.

it's quite complicated lah

cheers =)

Chen said...

I will always remember the moment I saw the anancephaly newborn....