Clash Of Cultures

12. Maternal Overdose

Noor

If you loved the sun and hated windowless rooms, you would have had a very hard time rotating through the Neonatal ICU (NICU) at our hospital at this time of the year. Of all the units, this was the only one that did not have outward facing windows. With daylight saving in effect, sunrise was at 6:30 am and sunset at 4:30 pm. The problem: my NICU rotation started at 6 am, and ended at 5 pm. So I essentially did not see the sun, unless it was my day off.

And my last day off had been Thanksgiving.

I took a deep breath as the memories of that day came flooding back. I had spent less than 5 minutes with Sal and yet had replayed every word he had said in my mind. Part of me felt sorry for him. Kimberly had told me about him being rejected by his family as a young adult. It sounded like his teenage years were pretty miserable as well. Kimberly did not know all the details but it was clear that his dysfunctional family dynamics made him deeply resent his parents. 

Not that using alcohol to 'calm his nerves' was going to solve anything!

Thanksgiving wasn't all bad though. The alumni dinner had gone much better than I expected. I hadn't realized how accomplished some of the Pakistani physicians were in different academic centers in Illinois and surrounding states. In speaking to them, they all had the same challenges as myself with the medical culture of the US healthcare system. But once they were settled in, sky was the limit!

I even met an old friend, Omar Khan. Our fathers were close friends so we had known each other since we were kids. He was a couple of years older than me, and because we had taken a similar route to medical school, he had always been my go-to person for any advice. He even helped me prepare for my medical school entrance exam. In a way, I owed much of my success to him.

We lost touch when he graduated and moved to the US. Turned out he was pursuing his PhD at a University in Wisconsin. We spent most of the evening chatting and catching up on our families. Before leaving the dinner we had exchanged phone numbers promising to keep in touch. 

Unfortunately, my pleasant thoughts about the alumni dinner were soon interrupted by the blaring sound of a code pager. A code pager going off in the NICU usually meant both a mom and her baby were at risk of dying. And today was no different. 

"Noor grab the code kit and let's go", Carla, the fellow who was doing a subspecialty training in neonatology, called out.

As we ran down the stairs towards the ER, she filled me in on what she knew about the expected patients. 

"The ambulance is about 10 mins away. A 7 month pregnant mom was found unconscious and without a pulse at her home by a friend. Mom has multiple needle marks on her arms, and at least one syringe was found near her on the scene, so she likely overdosed. The paramedics gave her Narcan, but it had no effect"

Overdose at 7 months of pregnancy? This was not going to end well.

"Any idea how long mom was down for?" I asked. The chances of a baby being unharmed decrease exponentially the longer a pregnant mom was pulseless. 

Carla shook her head as we reached the trauma bay. I looked around the familiar bay where Kimberly and I were patients here just a few months ago. 

The room was filling up fast, as we all waited for the ambulance to arrive. Carla and I along with the NICU attending and a nurse made up the NICU resuscitation team. I set up our code kit near the radiant warmer, a small infant bed with a heating lamp over it. Keeping an infant warm while we worked on resuscitating them was of utmost importance. 

In situations like this, it is vital for every team member to know exactly what their role would be. This increases efficiency and decreases the chances of error. So as we prepared for the worst case scenario, Carla instructed, "I will lead the resuscitation. Noor and nurse Molly I want you both to rotate between bagging the baby and doing chest compressions. Dr Patel could you help with getting IV access in the baby, if needed?"