Wednesday, January 31, 2007

Parental Instinct

I recently scrubbed in on a procedure that repaired a nasal congenital defect in an 8 month old baby girl. It was one of the most heartbreaking moments of my entire life.

As an intern rotating in ENT (Otorhinolaryngology -- Ears Nose and Throat to most folks), I assisted in the repair of the A in the acronym CHARGE. CHARGE is a syndrome of congenital anomalies that involve
  • the eyes (Coloboma of the eyes, a sort of defect or gap in a part of the eye)
  • the Heart (septal defects or what laymen call a "hole" in the heart)
  • the nose (choanal Atresia or a complete block in the back area of the nasal cavity, either on one side or both)
  • mental development (because of physical defects, a lot of patients are mentally Retarded)
  • the Genitals (micropenis or underdevelopment of the genitalia)
  • the Ears (low set ears, deformity in the hearing apparatus, etc

Choanal atresia is the malformation of the opening of the nasal cavity into the pharynx. Instead of an opening, there's a bone that has closed the entire cavity and prevents the nose from receiving and giving off air. The external opening is normal. The atresia could be on just one nasal cavity or it could be in both. Thankfully, our patient's atresia was unilateral, making it easier to treat. This abnormal bone was pierced and a stent or tube was inserted to keep it open. The tube was sutured into place at the vestibule/nasal opening.

After our part of the surgery, the ophthalmologists came in and explored her eyes. The mother had noticed recently that her baby was unusually tearing (not crying but still producing too much tears). They found out that the duct openings (punctum, or pl. puncta) that are supposed to be at the nasal side of the lower lids aren't there. (Look for them, they should be there; it's a small hole on the nasal side of each of your eyes, on the lower eyelid). They couldn't do anything about it at that time so after a little bit of exploration and ductal probing, they ended their part of the surgery as well.

The patient was very beautiful, notwithstanding the low set ears and malpositioned eyes. She had soft white skin and brown curly hair. She looked almost normal. But even as an 8 month old girl, she had already undergone surgery to repair her heart and has been stuck by more needles than I have in the whole of my existence. I've never been bothered by adults or even 8 or 10 year old kids being put to sleep by general anesthesia. But an 8 month old baby girl in a 6-foot long OR bed and in a hospital gown that's 5x her size is not a very nice thing to see. I guess it was the unawakened parent in me that was revolted by the sight. That's when I realized I can never be a pediatric surgeon or a pediatric anesthesiologist, or even a pediatric anything. I don't think I'll be able to handle the stress. Hehe.

The patient was discharged a day after the operation. She went home with a tube running from her right nasal opening, through the bone that we pierced, and then down to the back part of her nose into her pharynx (the cavity and wall you see at the back of your tonsils when you open your mouth wide). Because of malformation of her hearing apparatus, she's due for placement of a cochlear implant soon. A cochlear implant is a sort of hearing aid that will be placed into her cranial bones to help her hear. I think she's also due for more work-ups to check her kidneys and other internal organs.

The mother smilingly carried the patient in to the OR but before the anesthesiologists began induction, we had to ask the mother to wait at the lounge. As she was leaving, I just knew her heart broke, not for the first time, as she once again had to helplessly leave her daughter in the hands of people she never really knew. As she left the OR, she broke down in tears.

The patient being prepped by the anesthesiologists. The doctor on the left (yellow scrubs) is inserting an IV line.

***

On a lighter note:
I haven't been posting in a while. I blame inspiration shortage. Hehe. The medical board exams are 7 months away. I have a feeling my inspiration shortage is about to change. Also, my 2 friends recently started a new events company called ProjectCentral. Check them out.

1 comment:

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