When I heard four newborns at the neonatal intensive care unit (NICU) at Ewha Womans University Hospital died almost simultaneously a few months ago, I was reminded of that day. That day, I was in my third year as a resident, just like the physician who took care of the four infants at Ewha hospital.
On that day, I was an attending doctor at a NICU at another hospital as a pediatrics resident. On a Saturday night, I was on a night shift at the NICU. Three out of 10 babies hospitalized at the NICU had a bad condition. As I was the attending neonatologist, I knew the status of the babies exactly. To care for the newborns, I couldn’t take a rest and kept staying at the NICU. I made it sure to remind two junior residents that they should be on full alert to execute a CPR in any second that day. The one doctor was in second-year residency on night duty at a patient ward, and the other in first-year residency on a shift in the emergency room.
At 4 p.m., Baby A started to show dangerous signs.
“Doc, the baby’s heart rate is falling.”
The nurse’s urgent tone of the voice made me dash to Baby A. The heartbeat was crashing, and the baby did not respond to any stimulation. The heart rate went below 100.
“I’m staring CPR (cardiopulmonary resuscitation) now. The second-year resident is on ward duty. Contact him to get here now and call the baby’s guardians and tell them about the situation.”
I started the first CPR on that day.
While I was doing CPR for 30 minutes, pressing on the tiny chest and pumping in the oxygen, I heard a nurse shouting, “Doc, the baby’s heart rate is plunging!”
It was a voice from another nurse from the other side of the corner. I let the junior resident keep doing CPR and rushed to get to Baby B, who was suddenly crashing.
“I’m on CPR now! Call the first-year residency on emergency room duty and if there is no urgent patient, ask the doctor to come up here! Contact the guardians! Did you call the professor in charge of NICU?”
The second CPR started. The other doctor was still on the first CPR.
After the first-year resident came and joined the second CPR, I explained about the situation to the guardians of the two babies and went ahead to continue the CPR. The professor leading the NICU was on his way to the hospital. The two newborns were struggling between life and death. Three pediatricians and four nurses were doing everything they could to make them stay in this world.
After about 30 minutes, Baby A was stabilized. The first-year resident went back to the emergency room. The professor, who just arrived, explained to Baby A’s parents that the newborn needs constant monitoring although the CPR was finished. Baby B’s parents had to wait for more. Then…
“Doc, the baby is weird! She’s showing no response to the medication!”
It was Baby C, who was born with a heart problem. The baby did not respond to the drug, which used to be administered to treat arrhythmia.
“We’re on a CPR on the baby!”
The third CPR started.
At around 10 p.m. on that day, all the babies were stabilized. Fortunately, the three babies were still breathing after CPR. But after the CPR is the scariest part. Somehow we brought them to life, but they might go back to the brink of life and death again.
|Newborns are treated inside the incubators at a neonatal intensive care unit at a hospital in Korea. This photo is not related to the article.|
At 11 p.m., the second-year resident went back to the ward, and the professor went back home. I was sitting at the NICU. I was scared to go to another room and take a rest.
I think I dozed off sitting for a minute. Suddenly, a nurse shook me up.
“Doc, the baby is not responding to the drug again!”
Baby C was on the line between life and death again.
“We’re starting CPR now! Contact the second-year doctor!”
At 2 a.m., the fourth CPR began.
Baby C was born the day before. The mother was still hospitalized in a ward next to the obstetrics/gynecology department. At 3 a.m., Baby C’s heart didn’t beat again, despite the one-hour CPR. I let the second-year doctor to continue CPR and went to the ward next to the Ob/Gyn department. The baby’s parents stayed up all night worrying about their baby.
Quietly and calmly, I explained about the status of Baby C. I told them that we were doing CPR for an hour, although we don’t have hope if the baby doesn’t get back from a 30-minute CPR. I told them they’d better say the last goodbye. The parents who were told earlier in the evening that the baby might not come back quietly nodded, with their eyes welled up. The father moved back to the NICU his wife who used a wheelchair who had difficulty in motion due to the labor the previous day.
Baby C’s chest was bruised blue and purple, due to the two times of CPR. The parents said goodbye to their baby, sobbing, and asked the medical staffs to stop. The CPR stopped, and the baby’s heart did not beat. Everyone in the room looked at me.
“Baby (C) pronounced death at 3:27 a.m. on (month, date).”
I always choke up when I have to pronounce death. When pronouncing the death of newborns, who spent only a short time of life at the NICU only, I choke up more.
I conducted four times of CPR on three babies on that day, and one did not make it. If the three of them had died, would I have appeared on the prime-time TV news program? Just like in the Ewha hospital incident where there was no first-year or second-year doctor, could I have saved the two babies’ lives? If we had to do the CPR because of contamination in the nutrient injection that the babies shared, could I have even saved a single baby?
Korea’s whole medical system is collapsing. I’m not sure the public knows this, but I’m sure physicians do. The four departments – internal medicine, surgery, Ob/Gyn, and pediatrics-- praised as the essence of the medicine that directly involves with life, are languishing. The four departments are short of applicants every year although they are called oxygens and the major pillars of medicine. Provincial university hospitals are getting rid of residency in the four departments. In other words, specialists in the four areas are disappearing.
Surgery department makes growing losses due to low reimbursement on operations. Ob/Gyn is losing popularity after a court ruled that a doctor should take 30 percent responsibility for a baby’s death at delivery even when the doctor had no fault. Internal medicine, the most revered area in medicine, started to shrink five years ago as talks about remote medical services curbed an increase of reimbursement.
Pediatrics still had many applicants because many physicians chose it just because they liked treating children. But today, the government is letting pediatrics collapse, too.
NICU is the apple of the eye in pediatrics. All of the pediatrics’ most difficult and hardest treatments are performed at the NICU, where everyone is trying to save a child who is just born. That’s why it takes hard working at NICU. If you’re in residency, or fellowship, or just assisting, you have to get to the NICU if a baby shows a bad sign. Therefore, people who are serious about saving babies’ lives choose to work at NICU. (I didn’t choose it because I didn’t have a strong commitment to sacrifice my life for decades.)
At NICU, most of the patients are newborns. Babies there spend more time with medical staffs than parents. Medical staffs pour their energy and affection on them as much. At the NICU I work for, we shoot a lively and congratulatory video if a premature baby comes out of the incubator for the first time after one or two months inside of it.
They are born with a weight less than 2 kilos, sometimes less than 1 kilo, and spend two or three months at the NICU. If they weigh more than 3 kilos for the first time, we delightedly tell them, “Hey, you could go to school tomorrow.”
If a baby who just got in the NICU can’t breathe and gets uneasy, I would whisper into the incubator, “Come on, man! If you’re born in this world, you should have a drink at least once!”
In a tiny baby weighing less than 2 kilos, we see the future of the baby. We treat the baby firmly believing that this baby will get out of the NICU, have the first birthday party, participate in a kindergarten’s festival, go to elementary school, and become an ordinary adult.
Nobody wants this baby to get out of the NICU in a small coffin.
Four newborns died. The weight of their deaths is heavy. And people would need someone to hold accountable.
However, people should be careful if they want this tragic incident not to occur again. Blaming someone for their death, punishing them, and forgetting about the incident is not a good idea.
What made the four babies die? Why do physicians claim that it was not the fault of the arrested professors, the residents and the nurses at Ewha hospital?
If we fail to identify the real causes, the tragedy will continue.
And Korea’s medical system will keep collapsing.
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