Dashed Dreams

Two months ago, I had a series of dreams. In these dreams, newborn twins or triplets were admitted to GLA, and all of the babies needed CPAP. I knew that it would be a challenge for our NICU, if a set of multiples did arrive. I decided that I would not be caught out. I made CPAP hats, and got the circuits ready, and I made plans and contingencies for caring for these babies. I was prepared

So when, at 8am on Monday morning, news reached me that a set of tiny twin girls were downstairs, I was ready. The girls weighed in at 2lb 1.7oz and 2lb 0.3oz. They had been born 9 hours before, five miles away at the Baptist Mission Hospital in the mountain village of Fermathe. They were icy cold and they were not breathing well

The rest of the day went by in a blur, as we warmed the babies, and struggled to get them stable. I remember I started working on Sandia, the smallest twin, first. She was showing more signs of respiratory distress. I got her on CPAP, and directed Mme Bernard to start her sister on oxygen.

I remember that we could not keep Edna's CPAP working. Two oxygen concentrators were down. Two incubators malfunctioned. I was glad for my contingencies! I remember being caught between the urgency of Edna's breathing problems, and her twin sister's low blood sugar. I remember getting an umbilical line into Sandia, then Edna.

Starting them on intravenous fluids, giving vitamin K to prevent blood clotting problems and brain bleeds, antibiotics, medications to stimulate them to breathe.... It was difficult to get the girls warm. When their temperatures did rise, the consequences of prolonged cold stress caught up with them. Oxygen levels falling, heart rates fluctuating, me running between the girls at shift change over, both of them apnoeic...


As the days passed, we lurched from one crisis to another. Sandia's temperature would not stay in the normal range, and whenever her CPAP became disconnected, her airway would collapse. She needed a high flow of oxygen through her CPAP and once or twice a day, we would have to hyperventilate her with an ambu bag, to blow of excess carbon dioxide build-up.


Edna's immature digestive system could not process sugar. Her blood sugars were dangerously high and her tiny body was forced to burn fat for energy. There were two problems here: Edna had very little fat to burn, so as the days wore on, she became emaciated. And as the days wore on acids that were produced from the break-down of body fat, accumulated in her blood. She needed regular doses of sodium bicarbonate through her umbilical line, to neutralize the acids.

I worked double shifts with the girls, starting at 5:30 in the morning. The extreme heat in the NICU, and being on my feet all day made my feet and ankles swell, I was dehydrated, having muscle cramps, and my whole body hurt. I was exhausted: I was woken in the night more than once to help get a struggling baby out of crisis. By Thursday, Sandia and Edna were stable, kicking their legs and waving their arms in their incubators.

Sandia had became anemic and needed a blood transfusion, but she improved significantly when she received it. Edna was on room air CPAP. There were reasons to be hopeful, Soon, the girls would be well enough to tolerate milk feeds. They would stop burning body fat for energy. I was running on adrenaline and I was elated. We were winning, I was sure. Finally, we were winning!

I wish that I could tell you today, that everything we did, paid off, that all the knowledge we gained from working with babies like Jonathon and Sophie Dora had saved two twin girls lives.

Instead, I have to tell you, that Sandia died at 11 am on Friday morning, from a collapsed lung, or an airway, obstruction, we don't know.

As we were working on Sandia, her sister, Edna, began having breathing problems. Less than an hour after her sister died. Edna stopped breathing all together. Blood tests showed extremely high acid levels in her blood. Dixie and I worked until late into the night. Edna legs were stiff, and she wasn't moving the right side of her body. Her pupils were dilated and we were afraid that she had had a brain bleed. We made a call to a neonatal nurse practitioner in Pennsylvania. Eventually, after 6 hours of ambu-bagging, and lots of drugs, Sandia responded to treatment. She opened her eyes, she began moving, and eventually she was breathing on her own.

The next morning, her exhausted body gave up the fight. I held her on my chest. There was a flicker of recognition across her face as Edna relaxed to the rhythm of my heart beat under her head. She remembered her mother's womb, I'm sure. A safe, warm, watery place, where she floated, and where there was no struggle. Where her mother's heart beat consistently and reassuringly above her head. I hope she knew in those moments that I held her, that she was loved dearly, and I hope I communicated to her in a way she understood, that everything was going to be OK.

At 9:53 yesterday morning, Edna was pronounced dead.

My dream came true, and then it was dashed. But oh, that is a small thing, compared to the dreams of Edna and Sandia's parents.