Corona and the Cobra – it was never about the Ventilators
It was probably my first independent night as a junior resident in Pediatrics. I froze in horror as the dad rushed into our ER carrying his 12 year old daughter (same age as mine ) in his arms as she took her last gasp.
Out of a jute bag he removed a dead cobra; clearly the culprit ( and the biggest I have seen) and burst into tears. Now I had never intubated anyone ever before. And years later; my regular life support updates in London would teach me, the right approach would be to “shout for help” as loudly as I can.
But the resus trolley was at hand and clumsily I opened her mouth and one thing lead to another. I had miraculously performed my first intubation ( the procedure in which doctors put a breathing tube through a patient”s windpipe) as if by divine intervention!
By now our seniors were on the scene and a lot of anti snake venom later (anti toxin to the poison in the snake bite) brought the question; how do we ventilate her? The children’s department had only 1 ventilator which had stopped working. So after much convincing, we managed to get her a bed in the adult intensive care unit.
Now cobra bites are neurotoxic ( paralyse your muscles ) and unfortunately 5 days into the ICU stay on the ventilator; she still didn’t wake up at all. In the developing world, a constant shortage of ICU beds means priority is given to the person most likely to survive.
Despite our protests, it was decided our patient was unlikely to make it and we were asked to take her back to the children’s ward and withdraw life support. Now this sounds incredible and it is! My co resident doctors and I hand bagged her with an Ambu Bag (the bag in the picture) connected to the tube I had inserted, for the next 16 hours taking turns and to our complete astonishment she started waking up!
She gradually recovered fully and the family went home jubilant in a couple of days! Only later, they recounted their agonising drive for 5 hours in pouring rain, in their neighbours old car on their way to hospital when they were almost too late.
Fast forward 20 years and we are seeing a tragedy as never before unfold in the Western World. I have heard some sad stories; of young people who didn’t make it. Not because there weren’t enough ICU beds. But they didn’t reach the hospital in time. And when they did, it was far too late. Not because they lived too far. Not that they didn’t have transport or that their loved ones didn’t understand they were unwell. Someone somewhere just didn’t take the right decision.
And while we focus on producing more ventilators and newer drug treatments; the question really is have we got the big decisions right?