Last weekend, I was on call. During the afternoon, I heard about a little baby in a remote location who had collapsed and was rushed to hospital. It turns out this little one (just a few weeks old) had an undiagnosed cardiac (heart) problem and his little heart had finally had it. He seemed very ill and so his mom took him to the small hospital in her town. The doctor there decided that he should be rushed immediately to the larger center a few hours away. He held his own during the transfer, but LL (Lucky Little one as I started calling him) arrested upon arrival at the larger center. Arrested! As in his heart stopped! I can only imagine what that would be like for his parents. Luck was with him! There happened to be a couple of new doctors who had just recently started working at the larger center and they managed to get that little heart started and stabilize LL. They called us at our tertiary care, pediatric hospital to say that if they could get LL to us, he would need an urgent cardiac catheterization.
This is where I come in. A cardiac cath is where a cardiologist accesses an artery and snakes a catheter or small tube up into the heart – either to see what is wrong and/or to fix it. You can imagine how delicate a procedure this is in a tiny baby – those blood vessels and tube are not very big. So we are the center in our region that does this. In order for a cardiac cath to be successful, patients must be very, very still – therefore they need an anesthetic!
And so I heard about LL late afternoon. Everyone was talking about “if he makes it to us”. Think about this: this little baby was at home with his mom eating, pooping, learning, cuddling, and suddenly it was “if it makes it to us, we will do this to try to save him”. I went home around 7pm, and to bed around 10 awaiting the call that LL had made it to us.
Around 12:30 am I got the call, the helicopter had landed. I got in my car, backed out, smashed the side view mirror (another story and I cannot blame it on rushing, I wasn’t) and went to the hospital. LL was there surrounded by the transport team and the ICU team. He actually looked better than expected. Sure he was on a lot of medications to support his blood pressure, and he was on a ventilator, but he was here! Off we went to the cath lab.
I was sweating only a little. After all, LL’s luck had held out thus far: to remote hospital in time to be transferred, to larger hospital in time to meet new specialist doctors, and now to us in time to go to the cath lab. OK, maybe I was sweating a lot.
We got him all settled and the cardiologist began his work. As he was working, things started to get challenging for me. LL’s carbon dioxide started to rise (this is the gas you breathe out), and it became harder to get air into his lungs. We sent off a blood gas which would give us more information as to how we were doing managing his respirations. Turns out we (I) were not doing well at all. His pH was very low (should be around 7.4 and it was much lower) and his carbon dioxide was high. I tried everything I could think of and then decided to change ventilators. The cardiologist asked me if he should stop and I said no because I just wanted this to be over!
We changed ventilators just as the cardiologist managed to open a blocked heart valve, which was causing LL’s trouble. Within seconds everything improved! It was unbelievable. We all looked at each other and realized what had been going on. I was unable to improve LL’s ventilation because his lungs were filling up with fluid, because his heart was failing. There was nothing I could have done. LL had been dying. A few more minutes and it would have been too late, it wouldn’t have mattered what the cardiologist did to his heart.
The valve had been opened in the nick of time!
I left the hospital at 4:30am, feeling tired but satisfied. LL’s heart had already regained some of its function and it was no problem to manage his ventilation now. I am happy to report that he is making a full recovery. As for myself and the cardiac cath team, we will not ever forget that moment that happened just in the nick of time. Someone should tell LL to play the lottery when he is older – he definitely has luck on his side.
One of those days that reminded me why I love my job, even at 4:30 am.