Seizing Baby

My last day at CHAD was on Thursday morning. I did outpatient clinic again. At first the morning was pretty slow and no really interesting patients were coming for clinic visits. I spent most of my time smiling at the cute kids that came in and out of the clinics. One of them even blew me a kiss as she left. She was the cutest thing ever. Then around 10am a young lady came in with a baby in her arms. She had her baby in a big green sweater suit. The intern I was shadowing immediately told her to remove the child's clothes so she could examine the baby. The young woman started describing to the doctor what I came to interpret was that her baby has been having seizures. They were speaking Tamil to each other so of course I couldn't understand what they were talking about but I could tell from the hand motions the young mother was making with her fists that her baby may have been seizing: She clenched her fists and made a jerking motion with them. Then she would roll her eyes back and tilt her head up. It turns out the child was only 8 months old and had one seizure episode this morning after suffering from about one day from a cold & fever. Mom wasn't sure what was going on so she brought the baby into the clinic.



The intern turned around for a second to look up some stuff on her computer about the ill baby. As I looked down at the baby I noticed that she was jerking and her eyes were rolling back. I started to freak out since I have never seen a seizing baby before. I have seen lots of seizing adults but no babies. So I quickly tapped the intern on the shoulder and pointed at the baby. Then I went and got the nearest attending and so they could tell us what to do next. The attending told us to take the baby to a back room and give it a benzo (I can't remember which one she said but I am going to assume it was phenytonin).



So we moved pretty fast with the mother and baby in her arms to a back room. The intern started yelling at the mother because she hadn't removed all the clothes off the child yet. The mom seemed a bit flustered and was having trouble removing the sweater pants off her baby so I helped her out. This amazed me: I was so suprised how calm the mother remained after being yelled at by the intern. She remained silent and put all her trust in the intern who was not relaying back to her what was going on with her baby. The mother did not shed one tear and just had a blank look on her face as the intern ran around the room like a chicken with its head cut off.



The intern than asked the nurse to bring her a syringe with a dose of phenytonin. The intern then administered the dose rectally. Then I thought in my head, how does she know what dose to give? We never weighed the baby. Sadly the baby had lost any form of rectal tone and thus started having a bad case of diarrhea. Thus the dose the intern administered did not stay in so she decided to give another dose and of course the same thing happened again. So me and the mom are busy at the other end of the table trying to wipe (without gloves) all the feces that were pouring all over the baby up with some toilet paper I found. The baby continued to shake on the table, but by this time neither myself or the intern could figure out if the baby was seizing or just cold. The whole time I was thinking to myself, I hope this baby doesn't have meningitis b/c I am all over its body fluids and would be really pissed off I ended up with whatever the baby had.

The attending finally shows up and tells us to move the baby to the ER. When we arrive at the ER, one of the resident finally decides to weigh the baby, which put me at ease b/c I was so afraid that the intern was overdosing the baby. The baby was not moving very much and was breathing pretty fast and I will assume she was in some sort of post-ictal state. The intern decided to start titrating a dose of phenytoin instead by IV, but via a syringe. So we literally had to sit next to the kid with syringe in hand and push only a couple of ccs at a time every so many minutes. The intern had to leave the room for a minute and decided to leave me alone with the baby. She was like "Here, hold this and make sure her respiratory rate doesn't slow down too much." I wanted to be like "Hey wait, what are you doing? I am not a doctor until May 18. Please don't leave me with this baby." But by the time I could say anything, she was out the room. So I did what I thought was most logical. I sat there with the syringe in hand and watched the baby's chest. I figured if the baby's chest stops rising that would be a bad thing. I tried my best to look like I knew what I was doing since the patients were hovering over me still in dead silence.

The intern finally came back and said we would leave the baby in the ER b/c we still have more patients to see. I asked her if she thought that the baby had menigitis or something. She said it was mostly like a febrile seizure. I was relieved to find this out, but still vigourously cleaned my hands with my hand sanitizer. I am not sure what happened to the baby after this, but I know the next plan of action was to perform a lumbar puncture. After the seizing baby, the rest of outpatient clinic was pretty boring so I left early.

Pictures above:

1) This is a picture of a girl outside my hotel in Chennai playing on the roof of a building. The building was pretty high up so I thought it was kind of interesting that someone would choose to play so high up.

2) This is a picture of the flower pot in the lobby of my hotel in Vellore. They are simply flowers cut from the stem placed on top of water. They changed the pot every other day and I think it is kind of pretty so I took a picture of it. I have seen similar displays in other hotels, I am not sure what it means.

3) This a picture of the garden by the girls dorm on the CMC campus. It is gorgeous. The building in the background is a church.

4) These signs are all over CMC. I think they are funny.

5) These cows are everywhere eating trash and in the way. Plus they poop everywhere so you have to watch where you step.

6) These monkeys are also everywhere. They are not very nice either. This one was eating paper on the side of the street. They look like the kinds of monkeys that carry Ebola or some crazy disease. I am more a fan of chimps.