Saving the unsavable

Ruby Ravichandran, Ajitha

Deputy Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, India

*Correspondence: [email protected]; Tel.: +91 99429 65597

One lesson that I could never forget in the course of our nursing education and service was this: We are not allowed to get attached to our patients because that is against the code of conduct.

But we are human, and a nurse would tend to cry over the frustration of seeing a patient not doing well. The happiness and satisfaction the nurse feels when she sees a patient doing well is immense. Come to think of it, both our training and instinct are directed toward saving lives. To watch a life being lost despite what our hands, hearts, and minds could do is a tragedy that often unfolds in our profession. That is the moment we feel hurt, hopeless, and helpless. We feel we are never good enough. That level of frustration brings out our tears.

The World Health Organization (WHO) declared the Covid-19 outbreak a pandemic in March 2020. Since then, the nurses fighting on the frontline have faced several challenges including a critical shortage of nurses, medical supplies, and a variety of mental health challenges such as burnout and fear of infection.

Covid itself is a huge challenge to manage; but managing a mother infected with Covid, and with a new born exposed to Covid, was a very tough task. Hence, we share here the great efforts we put in to protect the life of a young mother and her tiny baby.

This is the story of a 28-years-aged mother, with an 8-month-old premature baby, and with multiple co-morbidities-Hypothyroidism and obesity. She came to us with breathing difficulty for 2 weeks. She had a history of contact with her father and mother who were COVID Positive. Her RT-PCR was positive for Covid-19. HRCT showed severe COVID 19 with a CT severity score of 30/40; almost her whole lung was almost involved. She had tachycardia, was hypoxic, and needed high oxygen support. Antenatal scan showed single live intrauterine fetus corresponding to 29-30 weeks of gestation, with severe oligohydramnios.

Early identification of fetal bradycardia, and an emergency LSCS, saved both mother and baby. She delivered a live male baby weighing- 1.16 kg. But the newborn was preterm and was immediately shifted to NICU for close monitoring.

The mother was shifted to Covid ICU and connected to mechanical ventilation in view of severe ARDS. She was treated in prone position for three days. We did intense monitoring of her pressure points and additional nursing care was given to prevent breast engorgement as she was not feeding the baby. We also had to monitor her closely for per- vaginal bleeding.

Despite all the difficulties we as nurses faced to wean the mother from ventilation (she was very obese 90 kg and had poor respiratory effort), we motivated her continuously to perform breathing exercises and were finally able to wean her off the ventilator after 14 days.

Our greatest goal as nurses, in this setting, was, in addition to clinical stabilization, to meet the psychological and emotional needs of the mother, to see the mother and child safely through the ICU phase, and prevent/manage post-partum psychosis. She was ambulated early, with great effort and support. The baby was monitored carefully by our expert team at the NICU.

When the mother met her baby for the first time after two weeks, it was a sight to behold! All our eyes were wet as tears of joy poured off our eyes!

Saving the unsavable

Saving the unsavable

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