Another Half an Hour

HOUSE JOB DIARIES:       The story of a baby that suffered at the hands of the system, because she           was unable to afford expensive hospitals

(A True Story, but fictional names)

She had been lying on the bed of Paediatric ICU for hours, gasping, each breath coming in rales. Her mother, looking on at her wide eyes and flared nostrils, feeling as helpless as a snared rabbit, had already exhausted her lacrimal glands. The ICU was too filled with patients for the pair of House Officers to spare her more than a glance.

One house officer once came by. He looked at the file. She was admitted last night. Her breathing was noted to become gradually difficult. She had also had fever and coughing. It was a pneumonia case. He had seen too many succumb to this ailment. This would likely be another one of the many. 'Well, who's counting, anyway' he thought heaving a sigh. He checked the oxygen, and the medication list, and moved on. The mother's eyes followed him in despair.

It was time for the Round. The consultant was reviewing the plans for every patient. He eyed our patient with curiosity. There was something different with her breathing. Being so experienced, he could decipher in the poor quality x-rays what his juniors couldn't. And what he saw made him suspicious.

"Please try to remember very clearly. Did the problem start slowly or suddenly", the consultant asked.

"Slowly, doctor. She was feverish for a day before she had this problem", she said.

"No, the breathing... Was it laboured before? What was she doing when it started?"

"Sudden. She was enjoying with her cousins. They were talking, and eating peanuts. She was...."

The doctor's eyes shone with recognition. "Foreign body aspiration," he said. He turned to the house officer. "Dr Tahir, send a call to ENT. Tell them to come urgent!".

And the orders were followed.

"Yes, it is a case of foreign body aspiration." The ENT PG Trainee said after about half an hour. "However, while we have the anesthetist available, we do not have a bronchoscope for infants. She's 9 months old. You'll have to send her to Children's Hospital, PIMS, Islamabad. They have a whole department of Paediatric Surgery."

And while they discussed, the child struggled, the mother's eyes teared up, as her gaze alternated between the doctors, widening and despairing.

It was another hour later, when Dr Tahir had got an ambulance approved and ready. One hospital ambulance was elsewhere. One had no oxygen. There was no extra driver for the other two. He had had to wait, complain, and wait; and wait till the driver had come back.

They were in the ambulance. The key for the oxygen tank was missing. They asked 3 ambulance drivers. They asked a private ambulance parked outside. He had it. They were finally off to PIMS.

Another half hour had passed. They eyed the line at PIMS Paediatric Emergency Room. It was long. Dr. Tahir bypassed them, and yelled to the doctor, “Sir, I have a Foreign Body Aspiration from Holy Family Hospital.” The doc jumped up, took the baby to the retention room, attached oxygen flow, and took out his mobile.

A young female doctor in surgeon’s scrubs was there in five minutes. She assessed the baby. The mother was hopeful. The Surgeon asked for a fresh X-ray, commenting to Dr. Tahir that the Holy Family Hospital's  (HFH) X-ray was incomprehensible.

They had the X-ray in another 15 minutes. She evaluated the X-ray. She confirmed that it was indeed a Foreign body Aspiration. “Should I hand over her notes of HFH to you, then?” Tahir asked. “Oh no, doctor,” she replied while she scribbled, “we’re not keeping her. It’s not for the lack for expertise, but our bronchoscope for children aged less than 3 years is non-functional. I’m putting down notes, and then referring her to some other tertiary care hospital.” Tahir’s face formed a frown. Pushing down his anger, he asked calmly, “but, where then would I take her?” He wasn’t able to keep a note of plea out of his voice. She recommended Military Hospital (MH), Rawalpindi.

But Dr. Tahir knew there was no point, the patient was too poor to afford MH or Shifa or any other private facility. He started making calls to Benazir Bhutto Hospital (BBH). In another 15 minutes, he was in contact with a PG Trainee at ENT Department, BBH. She asked for a few minutes to confirm. It was another 15 minutes later that Dr. Amina called again. “Bring the baby. I have confirmed that the bronchoscope is available. You’ll have to get the anesthetists to agree. I’ll talk to the ENT guys.” Tahir whooped and ran. It’s always good to have a sincere doctor.

The ambulance was running on the newly constructed highways of Islamabad. Tahir eyed an advertisement from the Mayor of Islamabad that he was introducing a bicycle lane to the highways of the city. Tahir looked at the baby desperately. She wasn’t getting any better.

Another half hour passed. The ambulance was now entering BBH, Rawalpindi. Tahir got a call from an unknown number. She was a House Officer at ENT, BBH who introduced herself as Dr. Naheeda. “My PG Trainee has expressly said that there’s no need to bring the baby here. We don’t have the expertise for such small babies.” Tahir pleaded that he was already there. He was going to talk to the anesthetist and asked her to please consult with Dr. Amina.

Leaving the baby in the ambulance for oxygen, Tahir jumped into the ER. It took two minutes to get the baby’s receipt made and another two to get her referred to ENT. Tahir went straight to the DMS's Room (In-charge of Emergency Room) asking if he could get the names of the anesthetists. He had to discuss the case there. The DMS agreed to talk to the ENT guys if Tahir could get the anesthetist ready. Another twenty minutes had passed.

I should check on the baby before going to the operation theater, Tahir thought. As he peered into the ambulance, his heart rate increased. The baby was barely breathing…

It was another half an hour later that Tahir’s phone rang. It was the same House Officer from ENT, Dr. Naheeda. Tahir picked up the phone as he strolled towards the cafeteria for a cup of tea. He needed one for his headache. “Well, Dr. Tahir,” Naheeda said, “you can bring the baby. Have you talked to the Anesthetist? Our senior consultant Dr. Yaseen has agreed to operate on the baby if you can get the anesthetist ready. He can get here in…” “Dr. Naheeda,” Tahir said loudly, interrupting her. She stopped. “Yes?” she asked. “The baby is dead,” Tahir said bluntly, his voice tired and speaking volumes of despair and defeat. “Oh!” was all she said. What was there to say more?

Tahir sat down with the tea in his hand, reviewing his past six hours. He had rushed the baby to the Paediatric ER of BBH. They had attempted to resuscitate the baby but she had breathed her last in another half an hour. He had just broken the news to her mother and left her to mourn. He still had to take the baby back to HFH for documentation and discharge.

That night, the media discussed how the PPPP leader coming back to Pakistan would affect the political scenario…