The team had a very rough afternoon on Monday and many lost sleep as they thought of this young patient and our friend Bill and how hard this was. Last night at dinner, Anesthesiologist, Bill Motter asked me if he could share the story on my Blog. Of course, I said....
In Bill's own words:
"On Monday, my 12 y/o patient died. Mitesh Prajapati had no known past medical history - a healthy boy coming in for a simple inguinal hernia repair. The safest anesthetic, given our lack of anesthesia machines, was a spinal block with sedation. Mitesh smiled all the way into the OR. The block was easy, and I used conservative doses of both spinal medication and sedation. Forty five minutes later, as Dr. Alvear placed the last stitch, I noticed Mitesh was turning blue-grey. The BP from 2 minutes ago had been normal. The pulsox still said his blood oxygen was OK. Then he died.
I said to Dr. Alvear, "I think we have a problem..." He placed the dressing, took down the drapes, and used my stethoscope to listen for heart sounds as I called for help (specifically Dr. Parikh), ordered medications, maintained an open airway and asked Lindsey, our SRNA, to assemble the Ambu bag with O2, so that I could breath for him. Meanwhile, Dr. Alvear had already started chest compressions. We gave epinephrine and lidocaine, and, a minute after chest compressions started, he had a strong heartbeat. I placed an LMA (airway) and continued ventilating until he began breathing on his own. Duration of resuscitation was less than 7 minutes.
Mitesh awoke and began crying, but clearly something was wrong. His neurological reflexes appeared to be intact, but his mental status was not normal. In the PACU he showed signs of increased brain pressure, which we began to treat, but he continued in his barely conscious state. Mitesh received invaluable help in the PACU from nurse Bansari Mandalia and surgeon Adnan Alseidi.
Mitesh's family, especially his father, was devastated. A simple surgery had severely damaged their child. I'm a dad with two sons. I felt his pain; but worse, I felt as if, perhaps, I had caused it. What had I done wrong? I couldn't figure it out.
I accompanied Mitesh to the ICU, where I told the story yet again. The ICU doctor was very attentive, but I knew it didn't make sense to anyone - the sudden cardiopulmonary collapse; it didn't make sense to me, and I was there when it happened. Mitesh was no better when I left the hospital that night. Had I killed someone's son?
The next morning I accompanied Bansari and Adnan to the ICU. There was Mitesh, looking slightly sleepy, but otherwise normal. Adnan looked at the CT scan performed overnight, which was normal except for... a mild hydrocephalus. That was it. Mildly increased pressure in the brain from birth which would only show itself if it worsened, or if someone did a spinal block or tap, lowering the pressure below the brain, allowing it to herniate into the funnel of the Foramen Magnum. By lunchtime Tuesday, his family said Mitesh was completely normal again. He was eating, talking, walking, smiling and joking.
The incident with Mitesh demonstrated to me that I was working with a well trained group of people who, despite different backgrounds and working in a foreign country, could function as a strong team. I was at a good hospital with well trained local physicians, all of whom played a huge role in saving the life of Mitesh. It reinforced the importance of basic resuscitation skills, including immediate, modern CPR. And it made very clear to me how fragile life is.
Thank you to everyone involved in bringing Mitesh back to life and returning him, as a normal boy, to his family. With awareness and treatment of his underlying hydrocephalus, he should live a long and productive life."
- Bill Motter, MD
Thank you Bill, thank you Team, thank you God
