Breathe Again.

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"Dr. Maitreyi Mahapatra, you're welcome to the Paediatric Intensive Care Unit" declared the Head Nurse at Apollo Hospital, New Delhi, in the wee hours of a solemn Monday morning. After being greeted warmly by the staff, I was intricately briefed about every patient in the Unit.

As soon as I heard about Nanki, a one-year-old infant, my interest was piqued.
She was a case of Spinal Muscular Atrophy. I had never encountered a patient suffering from that disease, but I had thoroughly read about it. Spinal Muscular Atrophy is a rare form of the genetic disease with no cure. These children don't
survive to adulthood and usually succumb to respiratory failure. They come frequently to the hospital after contracting infection, have difficulty breathing, and usually require ventilators to survive.

At noon, I went over to Nanki's bed after I had finished writing case sheets. I smiled fondly at the child, wiped the tears trickling down her pink cheeks with one hand, and used my other hand to pin both of her hands tightly on the bed, for the nurse to administer an Intravenous injection.
I was trying to comfort Nanki by rubbing her chest and talking to her when I noticed a tall and slender woman impatiently peeking through the window. I realized she was Nanki's mother and signaled her to come inside. She thanked me, nervously wiped her tear-stained face, and introduced herself as Mehak Brar. I saw Mehak dithered. I gently squeezed her shoulders.

"Love may move mountains, but it isn't enough to save the people you love" Mehak sighed with sorrowful eyes and left the room.
I realized I couldn't agree more... But, as a doctor, the race against time and odds wouldn't let my compassion pitifully tone down my efforts to keep her daughter alive.

Nanki had been admitted for 36-hours with no signs of improvement and it was time to take a call. We could either remove the tube that helped her breathe and see how her lungs responded or we could wait... but waiting would mean an increased risk of infection. Either way, she was hovering very close to death.

While sitting in the doctor's lounge, all doctors ended up discussing Nanki's case management and her survival probability.
"I wasn't even sure if the child would survive following the removal of the endotracheal tube when she was brought in, but I couldn't risk the merest flagging of her Mother's spirits. I administered some antibiotics and bided my time. I usually cast a quick glance at her vitals every time I crossed her bed" to which all the doctors replied in unison, "We're all hoping for the best".

I had barely slept the previous night and the night before because every child demanded attention. Those soft, small hands asked for help while tears brimmed from their twinkling eyes in anguish.

On Thursday morning, Nanki couldn't tolerate the pain any longer. She was too angry to be patient, kept howling, and tapping her fingers on the bed... unable to move, as that was her only way to protest.

The Medical Superintendent was taking rounds when he saw Nanki's agony and sternly requested her parents to arrive at a decision, a little faster.
He said he realized it was never easy to decide the way anyone's child should die, but we couldn't be selfish as parents and doctors to let the child heartbreakingly suffer every second of the day. Especially, knowing that another such attack could prove fatal. After the emotionally magnanimous discussion, Ankit Brar, Nanki's father, signed the consent form.
He wished to meet me as I was the doctor in charge of removing his daughter's tube.
To my surprise he just wanted to let me know that the family had decided to not opt for tracheostomy in case Nanki stopped breathing. He said he had quit on being selfish and was done seeing his beautiful daughter suffer every day. He was ready to let her go, become a star, and shine upon him. He sighed and in a scarily calm voice whispered, "Everybody has to say goodbye sooner or later". It was clear that he was besotted and broken.

The nurses asked Ankit to take Mehak away from her suffering daughter's bed.
The doting mother, unable to let go. She held on her child and wept. Ankit dragged Mehak out of there. Mehak ruffled Nanki's hair affectionately...one last time before leaving.

My lids were soaked and I choked while I scrubbed for Nanki's procedure. I stiffened my back, pursed my lips, like a soldier honored with the most important undertaking. Duty call made me stand resolute with a calm demeanor.
I needed to save the child. I needed my wits about me.

The assisting staff's eyes conveyed curiosity as I entered the Operating Room, and carefully examined Nanki. They had seen the poor baby being admitted to the hospital five to seven times since the day she was born.
Nanki seemed weaker this time around but we had to go ahead with the procedure. I carefully removed the tube. I felt her heartbeat quicken as I listened attentively. I was horrified to see Nanki not being able to tolerate, turning blue, and getting uncomfortable. I called out for the Senior Pediatrician's opinion regarding re-intubation, but she dissuaded me from doing so. If I could not re-intubate, I had to give morphine to ease Nanki's pain...Maybe her time had come.
Her parents were brave enough to let go of her and I wondered why was I struggling to hold on... So I extubated her and put the oxygen mask on. Her O2 level plummeted further, lips turned pale, tiny extremities turned cold.

I waited for a few hours by Nanki's bedside.
I could hear Mehak weeping bitterly and Ankit begging her to keep herself together.

It was almost 7 o'clock in the evening when Dr. Niharika had shown up to relieve me. I hurriedly returned to my cabin, changed into a beautiful Banarasi Silk Saree, and neatly tied a bun at the nape of my neck.

My husband, Major Aman Mahapatra was going to pick me up for an official party.
He was never late. As he stood at the hospital exit door at 7:30 PM sharp, I waved and ran towards him. He flexed his biceps as he sucked in his breath and puffed his chest, displaying his muscular and well-toned physique.
I whistled and patted him on his shoulder.
He bowed his head theatrically, "Thank you, kind Miss!".

I smiled broadly at him and with stunning swiftness, he caught me unawares and made me squeak when he lifted me in his arms. He asked me to lower my voice reminding me that we were in a hospital. I rolled my eyes and gave him a chagrined smile, to which he replied softly - "My transcendentally beautiful wife is required to accompany me to a boring party where my Commanding Officers' wife would be asking her to make a diet chart for her yet again... Only to not follow it". He stuck his tongue out and I snorted like a pig as I entered Aman's Isuzu.
I switched on the light above my head and applied mascara. Aman clutched my hand and asked what I saw in the mirror of my compact powder. I mechanically replied, "A haggard and tired woman."
He clicked his tongue in disapproval and corrected me by saying, "That's a Goddess there, in her Mother's exquisite blue saree."
I melted at his observation skills and gave him a peck on his cheek.

Before stepping out of the car, I had promised myself not to think about Nanki and tried to block Mehak's condition out of my head. I was shaken back to the present when Mrs. Sandhu asked me to sit beside her. "You look tired! Get yourself a drink... I can't even imagine standing in a place where blood and death go hand in hand. And that's your workplace. Must take a toll on you?" Mrs. Sandhu, the Commanding Officers' wife, asked with genuine concern.

"I've gotten used to it but it still gets heavy sometimes", I replied calmly in striking contrast to my tumultuous day.
I excused myself and instinctively went to look for my husband; he was surrounded by children, listening to his adventurous stories and the places he had traveled to with rapt attention. Our eyes met as I entered the Anteroom.
Aman grinned while Mihika, his Seniors three-year-old daughter comfortably sat on his lap and playfully boxed him on his abdomen.
She sneezed, while chewing french fries and Aman shot his head back to avoid the spray of droplets mixed with food on his face.
"Always battle ready", smiled Aman with nonchalance.
I laughed softly as Aman's frenetic activities cheered me up. His charisma and support made me strong enough to face the rigors of a demanding life as a Paediatric Specialist.

Three painstaking days later, Nanki defied all odds. The nurse came shrieking, that Nanki had started breathing on her own. I rushed to the child's bed and touched her hand lightly and noticed that her gaze traveled beyond me. On turning I saw her mother peeping through the glass window. Mehak ran inside the room, wrapped her arms around me, and yelped with delight.

Death had indeed missed her baby by a tiny whisker. I was overwhelmed to sign Nanki's discharge slip and to meet me in the clinic for a follow-up. Seeing Nanki's smile after everything she had been through... Made it difficult for me to not believe in magic.