An unforgettable day
This is an old story but it remains indelible in my mind, stuck in my brain and branded into my heart forever. Only one single action shaped my day for ever on this fateful day. One single action that taught me an unforgettable lesson.
The day started well and I was actually excited to be at work. Not unusual since I am always happy to see clients with neurological problems. Finding solutions to back pain, neck pain, headaches, seizures and neurological deficits from brain or spine issues intrigues me. Each day is different and challenging. Especially in Nigeria!
Baby with Hydrocephalus
Anyway, a little child had presented to me a week earlier with history of vomiting, irritability, fever, persistent crying and of course, development of a big head. The child was only 2 months old. The brain scan confirmed hydrocephalus. This means too much water in the brain. So, we offered the baby an operation which was performed successfully. We inserted a piece of plastic tubing with a valve, called a ventriculo-peritoneal shunt into the baby. This device removes the water from the baby’s brain and in a controlled fashion, deposits it into the stomach (peritoneal cavity).
The operation required a small cut on the head to bury the device under the skin. We used stitches to close the skin. The baby was therefore brought back to the clinic a week later for removal of the stitches. That was where my troubles began on that day.
The mother gave me the baby and we set about removing the stitches. The baby was crying so much that I decided to numb the skin. I got a small amount of local anesthetic and injected it in the wound. It worked and the baby stopped crying. We were able to remove the stitches and I returned the baby to the mother.
What happened to him?
Immediately, the mother asked me, ‘Doctor, what happened to him’? I asked her, ‘What do you mean’? She said, ‘He is not moving’. I said, ‘Here, let me see him.’ Lo and behold, the baby was indeed limp and not moving a muscle. He was not breathing; the heart had stopped working and the baby had died!
The baby that died
I immediately started mouth to mouth resuscitation (kiss of life) and cardiac massage for the baby. The nurse called the anesthetist and we took control of the situation. The resuscitation took an hour before the heart started working again and the baby subsequently came back to life. He stayed in hospital overnight and was discharged home safely the next day. He came to see me recently, all grown up. Oblivious of course, as to how close he had come to death.
Oh boy! A simple act of injecting local anesthetic into the wound to quieten the baby had nearly killed him. The local anesthetic was too much for the baby’s heart and stopped it cold. Luckily, the mother raised alarm and we reacted quickly with continued resuscitation, till the drug wore off the heart. I would have stayed all day!
Naturally, the rest of the day went by in a blur and everything else I did was completely overshadowed by the baby. In fact, I cannot even remember doing anything else worthwhile on that memorable day.
A life-long hard lesson and two important points came from the situation. The first was that no amount of local anesthetist was good for a baby. Any amount is too much for a little baby and much better to let them cry and restrained for simple procedures like this. The second of course, was not to apply stitches that need to be removed in the first place. Our stitches can certainly be absorbable stitches or buried inside the skin.
In fact, a friendly neurosurgeon, Claire Nicholson, always preached against using skin stitches and skin staples in our wounds. Especially in babies. She would say, ‘Only a lazy neurosurgeon uses skin staples’.
This was a lesson learnt for all time and never to be forgotten. Of course, if the little man keeps coming to see me, I’d surely never forget how I nearly killed him.
A day, never to be forgotten!
Dr Biodun Ogungbo, MBBS, FRCS, FRCSEd, MSc, a Contributor to Newspackng, is a neurosurgeon with Brain and Surgery Consortium at 8 Buchanan Crescent, Off Aminu Kano Street, Wuse 2, Abuja.