Tuesday, April 21, 2015

April 21 - Dear Nicholas Sparks (Guest Blogger Shankari Murali)

Dear Mr. Sparks,

I often find myself saying, this is my miracle baby. The miracle seems to have begun real early. Everything about his birth was miraculous- in that I hadn’t even planned on his being born! I was quite upset when I was late. A quick lab-test after two weeks and my fears were confirmed. Ambled across to a Doc, and she casually mentioned a MTP. Yes, those of you who may be wondering, a Medical Termination of Pregnancy is quite a routine method of birth control in India! I was outraged at the terrible suggestion and within moments was determined to go ahead with the pregnancy, whatever it entailed.

Of course, it didn’t help that my husband was away for the first 6 weeks of this pregnancy. Those crucial 6th to 8th weeks of gestation was just when I was trying to come to terms with the fact that there would be another baby. And while I did feel tender and protective about the baby, I was rather embarrassed as I began to show too soon. The terrible nausea did nothing to help! But I was extremely regular about Folic acid and my diet comprised more or less fully of cherries, pears, salads and other such light stuff, which I was able to eat. Being a non-smoker and teetotaler, I had no fears of exposing the foetus to any noxious substance and just wanted to increase my hemoglobin levels, get adequate proteins and calcium and NOT get stressed about anything. By the fifth month I was huge (no polyhydramnios - just BIG) and the movements began. My daughter enjoyed the tiny movements and began looking forward to her sister! In the 38th week, I was huge and uncomfortable but going about all my work as usual. I was determined to work till the very last day but was so HUGE that I was making a lot of people quite uncomfortable by going about my work. The routine U/S at the 38th week showed a fully developed large breech foetus, head not yet fixed, nearly 4.00 kilograms and suddenly, unusual polyhydramnios. The radiologist appeared quite agitated and felt I needed to be induced IMMEDIATELY. Needless to say, I had high regard for his views. It was late evening and we rushed to my Doc, Dr. Saroj Aron. She is a nice gentle lady and wanted a trial of labour. She asked me to go in for yet another U/S (my fifth) on Monday, the 18th January, 2000 to assess the approx. fundal height and weight, to be performed in the hospital where I was registered. The radiologist, a senior and experienced person was very thorough. He was clear that it was a big baby, the breech resolved but brachycephalic and ready to be induced. He also confirmed the polyhydramnios and was warming up to the shadow in the pulmonary region when my Doctor, who was present throughout, intervened and whisked me off. I was very unhappy that this radiologist was seeking some abnormality where none existed (how naïve, I was).

They prepared me nice & early at 6.00am on 20th January, 1999 and started me on drip. At 11.30 the waters broke and how!!! The entire room was flooded- maybe 5 litres, maybe more.J After a smooth 38 weeks of pregnancy, 5 ultrasounds, I was blessed with a very sick baby boy on 20th January, 1999 after an emergency C-section (non-progression of labour and lower segment distention). I was not given the epidural I’d feebly requested so was totally out when this tiny guy got into my life! How I wish I’d insisted on an epidural but then again, that’s the way things were on that fine day. He was born 21” and over 8 and ½ pounds and the Apgars were 6 and 8 at 1/5 minutes and I am told that he was a big pink baby- no hint of blueness. He had a whimper of a cry for such a big baby and the heart was heard much better on the right than the left. I was told by other medical professionals that both these factors COULD have been overlooked as the baby ‘appeared’ healthy. Thank God that they were not! Enter our hero- Dr. Vivek Bagga, the Pediatric Consultant, who immediately rushed out to where my anxious husband and Mother were waiting and shared his fears. He asked for an immediate X-ray. Immediately, he shared the options available with my husband and once the pediatric surgeon was decided upon, he took it upon himself to contact the surgeon and asked him to come over and see whether the child was OK for surgery. Is it any wonder then, that we love that doctor?! In an hour, Dr. B.D. Dwivedi, a highly experienced and skilled Pediatric Surgeon, examined him and gave a fair prognosis. He was taken to the Indraprastha Apollo Hospital in an ambulance by my husband where a team was waiting for him. The immediate problem was the tremendous pulmonary hypertension (PPHN). He also suffered a few internal bleeds, though I’m not too sure if they were spontaneous internal hemorrhages or those triggered by some not so clean aspiration efforts. In addition to the High frequency oscillating ventilation, he received dopamine and dobutamine for the PPHN and antibiotics, morphine and painkillers for infection and pain management. There is, no NO used in India, at least for neonates. ECMO is still considered an exotic thing in India and the cost involved (in terms of the arteries sacrificed) is touted as the medical reason against the use of ECMO by the medical practitioners.

His surgical repair was performed on the morning of 23rd January, and he followed a textbook recovery. He was extubated on the 26th and was off oxygen on 27th night itself. I saw my baby only on the afternoon of the 23rd - I realized that I had been lucky enough to witness one of His miracles and that no power on earth could have stopped my son’s life as he was divinely blessed! BTW, that’s what Anugrah means- a divine blessing! Then came the next battle- of feeding him, warding off post-op infections and ensuring that he put on some weight before being discharged. The neonatologists, Drs. Sushma Kaul, Vidya Gupta and Anjali Kulkarni were extremely positive I moved into the hospital on the 27th and was glad that the EBM was being used to feed the baby thru’ his NG tube. All through the preceding days I’d been manually expressing and wasting all the precious milk, which was meant for my baby. He tolerated these feeds quite well. Breast-feeding was extremely difficult to establish because my primary engorgement made me hard and holding the baby with a drainage tube, plus scores of other tubes running this way & that was extremely difficult. He would get frustrated with my attempts at feeding him and would cry till his UAC started bleeding. I was extremely helpless and didn’t want to continue with what was a torture for all concerned. Thank God, Dr. Gupta intervened and offered a bottle for the EBM. It was an extremely trying time. Once a fungal growth was suspected in a blood sample and they wanted to do a dural tap for CSF. I was asked to sign the form for it and boy o’ boy, did I get into the mom from hell mode! (I came upon this perfectly apt phrase much later, thanks to Dawn) The Registrar, Dr. Krishnan (God bless him!) spent an hour trying to reassure me that he would do a clean tap and not fool around with my son’s Cerebro-Spinal Fluid. Soon the neonatologists were joking that with his increasing weight he should be in PICU not NICU! To cut a long story short, by the grace of God and thanks to the tremendous faith & support of all those around us, I went back home, with a baby, on 8th February, 1999. The major factors for his survival appear to be: full-term growth, good birth weight, late herniation and immediate detection of what was a huge defect. Anugrah is a really happy little kid with no feeding issues or developmental delays. The pectus seems to be resolving and there is no indication of scoliosis in spite of his terrible bowlegs.

Written by Anugrah's mom, Shankari Murali (India)

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