The first time was a chicken

“Come. Now.” The nurse grabs my hand a physically drags me to a cubicle. Inside, three nurses are gathered around a tiny baby. It is emaciated and dehydrated and has clearly a victim of gastroenteritis. And probably HIV.

One of the nurses looks up. “We cannot get an IV line doctor. You must try.” My heart sinks. If these guys cannot get a line into a 6 month old my chances are nil. I have an embarrassingly poor success rate of achieving IV access in babies. In fact, I don’t think I have ever successfully achieved it where the nurses failed.

The child clearly needs fluids urgently. Without any expectation I look at the baby’s hands and scalp. I cannot see anything remotely resembling a vein. “We will have to do an intra-osseous line,” I say. In children the bone marrow is fairly vascular and pushing a needle into it allows fluids to be given in an emergency situation. I rifle through the drawer looking for a suitable a needle and in the end settle on the tiny orange needle used for local anaesthetics.

“Have you done this before?” asks a nurse.

“Yes. Of course.” I do not mention that I have done it once. 10 years ago. In Liverpool. On a chicken thigh. From Sainsbury’s.

I palpate the baby’s leg and feel the tibia through the skin. Taking my needle I twist and push it through the skin. I cannot help myself wincing slightly as I do so. There is a grinding noise as it passes through the bone. Then a sudden give as it enters the marrow. I nervously feel the other side of the bone, suddenly terrified I might have pushed it right the way through the tiny tibia. Nothing there. I let go of the needle and it sticks there solidly, wedged in the bone. I connect a syringe and squeeze fluid through. It goes through. I feel the leg – it seems to have entered the bone rather than the leg. I push more fluid through.

Half an hour later the baby is looking distinctly improved. Hendy our paediatrician pops in. He offers to do a line. I am ashamed that there is a sense of relieved satisfaction when he give up on one hand and moves to the other. If a paediatrician couldn’t do it…

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In Sierra Leone

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