A Promise To His Daddy

I was on a military airfield in Scotland, about to board a flight to Haiti, when far, far away, I heard the distant ringing of my Haitian cellphone.

I woke just as the ringing stopped. Disorientated, I reached for the phone. It was pitch black outside. I glanced at the screen display. 3:48am, and I had a missed call from Cami, the night nurse in the NICU. I knew she wouldn't call unless there was an emergency.

I was on my feet when she rang for the second time. 'You need to come and see Louna, She's not doing well.'
'Louna?'

I had treated Bianca for heart failure 12 hours before. I had been afraid that the medicine I gave would make the potassium levels in her blood fall. I worried that this could affect her heart rhythm or cause seizures. Louna was sick?'Yes. Louna.'

Louna had developed a mild case of diarrhoea overnight. It was a very, very mild case, but her oxygen levels were low and she was breathing very fast. The night nurse had started oxygen. She didn't have a cold and her chest sounded normal. It didn't make sense. The night nurse said she could not get Louna to feed. The baby, had been unusually sleepy over the past week, and she looked pale now. We ran a blood test.


Louna was anemic. Her hemoglobin was 8. It had been 16 four weeks ago. The baby would not suck. She wasn't dehydrated, but at less than 4lb, we know that she soon would be. We put a feeding tube down and gave some fluid to replace what she had lost through the diarrhoea, then began drip feeding donor breast milk. Before I knew it, the sun was up. It was 6am.

A few hours later, Charilson, a 3lb 11 oz baby boy arrived from Cazale. The baby was 3 weeks old. I had hesitated to say 'yes' to him the day before. We had an outbreak of diarrhoea and vomiting in the NICU, and herpes in some of our other rooms. I didn't want to expose a fragile baby to these infections unecessarily. The centre that referred the baby here still felt that it was in Charilson's best interests to GLA. His mother had died a few days before. We all knew, when we heard this, that his situation was urgent.
The baby was skinny and pale, but bright eyed when I met him in the waiting area. I expressed my condolences to his grieving father. This was his only child, he told me. Charilson was a precious son. He wanted him to live. I assured the baby's father that we would do what we could to get the infant strong and healthy. ' I am just so glad,' he told me, 'that there are people who can help us.'

I returned to the NICU to find Bianca having a seizure. I had all ready ran some blood tests on her. Her potassium levels were low, and I had increased the amount I was giving to her to correct this imbalance. Her Mother, had gone home the weekend before, suffering from a high fever. I tested Bianca for malaria. The test was negative.
It was a busy afternoon, with Bianca requiring constant monitoring, Alaine not feeding well, Louna on oxygen and tube feeds, and now, tiny Charlison in the mix.

4:30pm: Bianca was having several seizures and they were lasting longer and longer. I gave her some medication rectally to stop the seizures. She wasn't able to retain it. As I was giving her an injection, a nanny whispered to me that there was a baby downstairs with his aunt. The aunt wanted a nurse to see him because he wouldn't open his eyes. I smiled and said I would see him as soon as Bianca stopped seizing. Her colour was ghastly. Every time I've thought I was losing you baby, you have come back to me. Please come back now. Just then, her seizure stopped.

Downstairs in the waiting area, I unwrapped a tiny, premature infant. I couldn't believe it! We were really pressed in the NICU as it was. The baby had been born that day, in the 7Th month of his mothers pregnancy. A green, blood stained discharge was oozing from his swollen eyes. 'I can't make him open his eyes!' the Aunt exclaimed. The baby was icy cold and he was working hard to breathe. I told her I needed to take him up to the NICU, right away!

The baby was chubby, and he had a deep red colour. I knew that as he warmed, he would have even more trouble with his breathing.He needed IV fluids, antibiotics and CPAP. The Haitian nurses were going off shift. How was I going to get ever thing done myself?

I sent out an SOS, and Katie, a Paediatric Nurse from Australia, who is volunteering at GLA just now, answered the call, graciously foregoing a dinner out with the rest of the staff and volunteers, so that she could help me with GLA's newest admission.
Although we got him stabilized, his heart rate plummeted at 9pm. It was still dropping after 3 fluid boluses. I gave a dose of epinephrine to bring his blood pressure up. It took another 3 fluid boluses to improve his condition. He was dehydrated, cold and he had an infection. His body had been going into shock. I'm so glad, little man, that you wouldn't open your eyes. If you had, no-one would have brought you to us and you would be dead by now.
It was almost mid-night. Time to go to bed.

The next day, our premature boy was looking better. Bedside blood tests showed that he needed some minor changes to his IV fluids, but that CPAP was correcting his breathing problems. Bianca was hungry, still on a fluid restriction to keep her out of heart-failure, and not appreciating this in the slightest. Charilson was sucking well. Louna was drinking again too but she still needed her oxygen.

Over the afternoon, we had some trouble keeping our preemie boy's blood sugars up. He was well enough to start receiving small amounts of breast milk but his mother was extremely reluctant to express. The oxygen on his CPAP was being weaned down. At 8pm, I was exhausted but relieved to note that all of our fragile little ones were doing well.

They continued to improve overnight. This morning, I took, Louna off of her oxygen. Gave IV antibiotics, and made some CPAP adjustments. I went downstairs to do some chores.

Two hours later, a nurse came to find me. Charilson was very dehydrated, she told me. I could hardly believe that. He had looked so well earlier this morning.

Upstairs in the NICU though, I learned that Charilson had developed watery diarrhoea. He was pale and sunken-eyed. His skin was looser than usual and he had lost 8 ounces of weight. A few hours can change everything, I thought to myself, as we tried, unsuccessfully to start and IV.

Charilson is being re-hydrated with IV fluids, delivered a drip at a time down a feeding tube. His fathers words, spoken to me two days ago, and my promise to him drifted back to me as I settled Charlison. I really wish we had been able to get an IV line into him.