Medical Imaging II

You know those moments when the world slows down, the clock in your head leaving an age between ticks?

The place: paediatric intensive care. It’s a large room, busy, 8 bays. In one, a 13 year-old girl lies unconscious as she has for the past 9 days, her mother by her bedside. In another, a sprightly 6 year old boy is waiting to go back to the ward. The room itself is a peculiar amalgam of childish colour and medical marvel, bright paintwork and impassive machinery. It is  an effect that doesn’t quite work; a jarring and false attempt to lighten what is at heart a place where the sickest of children come to live or die.

There is a small crowd assembling around one of the bays, at the centre of which lies a incubator cot. Behind its transparent walls is a tiny infant, no more than a few days old, with an alien piece of translucent material in the middle of his chest. It is stitched into place, a yellowy brown colour, almost scab-like, and there is a sense that something lies behind it just out of sight. It feels wrong.

The crowd has gathered; three consultants and a scrub nurse, the registrar, two other nurses and a medical student. The concentration of expertise at the top end of the cot is extreme. It gets quiet, even the shallow breaths of the 13-year old in the next bay are audible alongside the twice-a-second bleeps of the infants ECG. The tracing is etched in green above his head, regular, and it stays that way as the surgeon moves in with a scalpel blade to cut away that repulsive patch in the baby’s chest. The anaesthetist has done his job well, and the baby is completely still as the blade cuts through the black silk threads one by one, breaking the stitches apart, peeling the material away from the shadowed recess beyond.

There is not quite enough light in the room to see from the bottom of the bed. Here on the ward there are no operating lights, just the cheap fluorescent lighting tubes set into the ceiling. The surgeon shifts a moment and the removal of her shadow suddenly casts the cavity in the baby’s chest into visibility. There is no gasp from the assembled crowd. Time doesn’t slow down, and the clock in your head keeps ticking away. Nevertheless, easily seen within the chest of this tiny one week-old is his beating heart, each pulse shown on the screen above as the wave of the ECG trace. It is wondrous to witness.

There are a few seconds, gone too quickly, while the surgeon inspects her previous work. Satisfied, she turns to the scrub nurse and begins to close the chest.

The baby in question had been operated on previously for a congenital heart abnormality, I don’t recall which one. They leave the chest open to avoid having to re-open to sternum in case of bleeding etc from the surgery. To do that safely they have to cover the wound with a sterile piece of material to reduce the risk of infection, hence the patch. It really was quite something.

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