Head of the intensive care unit premature Olga Babak nearly thirty years save children born prematurely. The smallest baby, whom she held in her hands, weighed 450 grams, and the girl is now ten years old. November 17 – the international day of prematurely born children.
Olga Babak. Photo: Yefim, Richman
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Olga Babak nearly thirty years save children born prematurely. Seventeen of them, she manages the intensive care unit prematurity Perinatal center at the Moscow city hospital №24, formerly hospital No. 8, which in 1974 opened the first in the USSR the Department of nursing these children.
Even as a nurse she saw, as he fell near the entrance to the hospital from cardiac arrest. It warned: “If you’re going to treat their work, you’ll end up like Makarov”. Then Olga died with every patient. But years later realized that “the salvation of prematurity” is a complex process with not always predictable result. So you need to give the job your all, but in some situations the doctor will be powerless.
In the study by Olga Babak – children’s toys and photographs of former patients who are now already in school. Staffroom doctors also decorated their children’s photos. Five minutes before an interview with Olga colleagues and I just finished discussing the tactics of antibacterial therapy. They seem to live here for days.
27 weeks, three months of life in intensive care, and loss
– You started working in this Department in the mid-90s. that’s true, then what premature called “fruits” and “miscarriages,” and you have them saved as children?
– Then was the situation when the child is born weighing up to 999 grams, and have not lived for seven days, were not subject to official registration, only a week later he was considered born. It was decided to call them “fruits”, now there is another term – “extreme”. But now and then we treat them like children.
Even during his studies in residency I started working in the intensive care unit of maternity hospital No. 8, all infants with extremely low body weight born on the third floor. We said, “Want to – do. Floor your chair with you.” And our head – low bow to her – wasn’t afraid to let younger colleagues and said, “let’s try”. And we tried to do what I could.
There were kids who were born before the 28th week of pregnancy, with individual heartbeats as they said, “late miscarriage”. I remember standing near the incubator and cry over it. Saturation falls – the child is not saturated with oxygen. Talking head: “Galina, what else can I do?” And she answered: “Nothing. Let him go”.
And you were released?
– No, of course. To that must still be reached. But then I had children’s ideas about the profession, our – “he must live”. But we all can in our lives. I do think that with the feeling that you can do it, you can’t live in medicine, especially in extreme.
About one child do you think he needs to live and to please his parents, and he just goes away overnight, and then you get a histological study and don’t understand how he ever lived. This is not an isolated situation, but, thank God, is still rare.
Here’s one such story: premature baby girl after the operation of ligation of ductus arteriosus was admitted to our Department. Long and hard was treated in the walls of the intensive care unit, and finally the long-awaited transfer to the Department of nursing further! All was well, and suddenly there was a sharp deterioration, transfer to the intensive care unit within two hours of the best doctors are fighting for life, and… death.
It turned out that the child has the anomaly of the coronary vessels and infarction, as in the elderly. It is a rare pathology. About the other think that doesn’t stand a chance, and despite that we will do everything possible, as usual, and this child then you have come to visit.
For me, my work is a complex process, not always with a predictable ending. And give all that I can do all honest, high quality, at a high professional level, put your knowledge, soul, emotions, and the result is accept as is. And the doctor in some situations, is powerless. You don’t know when it will come, what the situation will be the wall that you can’t overcome.
– It is said that modern technologies allow to nurse those who earlier could not.
– According to the statistics of our Department in the past year, from 376 91 children born with extremely low birth body weight, 126 children – less than 1.5 kg, that is almost 50%. And so from year to year. The number of our patients is not reduced, although it would seem that the demographic decline.
But, from the point of view of technology, nursing premature is certainly a rapidly growing trend of obstetric technology stepped forward. Yes, changed the ventilator, there is a non-invasive respiratory therapy, intensive care but the main objectives remain – the heart must beat, the lungs must breathe. The question is, where will it end, when you did everything you could, whether the patient is alive and with what consequences will come of this.
Our children are hard-won and long-awaited children. Infertility, nevynashivanii. There are, of course, situations where young parents first pregnancy, but they have a premature birth and… loss. It’s a shame, a pity, but why? Why one child is 26 weeks survived, and the other not? I have no answer to these questions.
– But still- what is the medical causes of preterm birth?
– The reasons it’s difficult to say, it’s still largely a question for the midwives. In General they can be divided into two blocks – the state of women’s health and the health of the fetus, and at the junction of these problems can occur premature birth.
There are data on the degree of importance of the problems leading to premature birth. In the first place – diseases of the mother: her gynaecological, hormonal, genetic. On the second complications this pregnancy. And, sadly, the third abortion, they can lead to complications in future pregnancies.
But there are women who, despite everything, want to be a mother and go about this the hard way through loss and suffering to the end. The birth of first child at 27 weeks, three months of life in intensive care – loss, the next attempt, the same 27 weeks – 8 days of life, and it was all over. Finally managed to overcome this ill-fated figure, to convey to 37 weeks, the woman again in our nursing home, she offered to open an amniotic bubble, childbirth is delayed, in tears, she calls me, not knowing what to do.
When I walked in the prenatal, she threw herself on my neck, to the surprise of my colleagues, obstetricians, because we did not save her children. This time all ended well, and resuscitation was not required.
We need to save and to heal, not to think whether the child is disabled
– And you think that these children that you care for can stay with a disability? Eye disease, cerebral palsy, lung disease, breathing problems…
– If you think about it, you can do nothing at all because the likelihood that there will be problems, very high in infants with extremely low body weight, the highest percentage of mortality and disability. Yes, people often do not understand why to save these children. But if I work in the intensive care unit premature, I have to save and to heal, and to talk about whether the child is disabled, I can’t. My goal is to do everything with minimal losses.
And every time you start to treat the child with extremely low and very low body weight, we live through certain stages: first week survived – great respiratory distress syndrome behind, another week has gone through – like anything.
Live up to 3-4 weeks – bronchopulmonary dysplasia; after a month of problems with the eyes, there is a risk of osteopenia, when the child have spontaneous fractures, I must say that they are well fused, and without consequences. It will all be.
However, it happens the other way – we now have in the first box so the baby is lying in traction, callus not formed, and we geneticists understand that this is a genetic disease or temporary metabolic abnormalities, which we will pererastet.
Despite all these difficulties on the way to the house, these bustler has a future. According to the statistics of our institution, from year to year survival is growing, and this year it amounted to 83.5% among children born weighing up to 1000 grams, and among other prematurity – 98,3%.
– But consequences – this is probably the first thing parents think?
– I wouldn’t say that. Of course, parents need to talk about everything, but when they stand near your child and see it, they don’t always know what it will end in the future. Most importantly, they want to live! Yes, parents are scared, they cry, they feel sorry for the child, yourself, your life, which didn’t turn out as they imagined.
With each family we live a period, often a very painful and dramatic, where every day is an event, and if the child goes away crying and the parents and the doctors. And often parents say: “Thank you that we have time to be parents.”
Many of my colleagues do not understand, but I believe that if a woman with a fetus, which is obviously unpromising, decides to give birth, because she can’t do abortion it is her right, and our duty is to help her not only give birth but to live with your child as much as given by God.
But often, these women experience the pressure and condemnation from the relatives, doctors remain misunderstood. Of course, it is important the work of the psychologist, but, unfortunately, in our medical community on the issue of “unpromising” pregnancy, the answer is almost always clear – cut for medical reasons.
– How long have you nursed these children?
– Have children lay and weeks, and there are marked 3 or 4 months. The duration of stay in office is determined by the severity of main and concomitant diseases. The average for the year – in the range of 17-21 days. Recently in the children’s Department transferred seven-month-old child who has a severe combination of problems due to the severe prematurity. Seven months he was with us!
Once established all the vital functions, we transfer the child for further care and treatment in the neonatal unit. Although often our patients come from small step over the neonatal period (28 days after birth) in the walls of the intensive care unit. To discharge a baby home should be observed by a lot of conditions need further rehabilitation in our hospital, we have a counseling center, but it is better to talk to the neonatologists of the children’s departments.
– Heard that the access of parents in the intensive care unit to the child in your office is encouraged. Is that so?
– Yes, every day for two hours the parents can be with the child in the box. It’s their time, they are unable to touch them, to hold the arms and legs, if the condition allows, we give them to the hands of mom or dad, they change diapers and feed at will. Someone reads the story, some hymns and prayers, and someone quietly singing. There, at the bedside of the child, we tell the boy’s parents about the health status and changes that have occurred during the day.
Now a lot of talk about the open intensive care unit – for me! But first, let’s create the conditions for parents and staff. By the way, not all parents are willing to be near the child for two hours someone, getting information, following the doctor out of the box, and someone is not kicked and after 3 hours.
For parents whose children are in the Department for a long time, for very heavy patients, we make an exception, if they wish, they come to their children before two hours late and leave two than spelled out, in the end, 6 hours. But not everyone is ready for this, and this is not a reproach, it is a fact. But we are not ready to open the doors for 24 hours.
– But in your perinatal center can’t get everything. But what parents are not allowed in the intensive care unit, do not explain what happens to the child, what to expect?
– The issue of communication with relatives is very complex and ambiguous, for me it’s a matter of love and compassion to patients and their parents, and ultimately to the profession. Those who do not make parents their allies, not only allowing them into the office, but also showing and explaining all the problems encountered on the way their child lose a lot, the power of parental love often works wonders.
Western colleagues another way out of the situation: the physician should heal, and communication is the task of the whole staff of psychologists. We have obtained all the same shoulders – and save you, and explain and support the console, and where to get it. However, parents need to know that the letter of the Ministry of health of Russia from March 15, 2016 clearly reglementary the right of the relatives, not only in neonatology, to visit patients in intensive care units.
I used to die with each patient
– Parents ever accused you that are unable to come out of the child?
– Yes, of course. One mother shouted that I wanted nothing to do for her child. But it’s the same people.
You know, I can’t look at everything through the eyes only a certified physician, otherwise you can go crazy. I have four months of this year, died 20 kids. Can you live with it, smile, eat, drink, enjoy the greenery? If you have, under your watch, has killed children. Not if you treat our work with confidence “I can do anything, everything is in my hands”: it or “Hello, psychiatric hospital” or we need to leave because you couldn’t.
So I like the phrase: if you can change the situation – change, can not – accept, and most importantly – to distinguish one from the other. The quality of equipment and drugs is very important, but to say that I have to date is no drug, so the child died – wrong. It is not necessary to idle where you want them to act, and do not persist where you can’t change anything. And you can’t stop before it should.
You to this understanding came through faith?
– Of course. I’ve always had some kind of call to heart, I liked to go to temples. When we Institute a construction team went to the Czech Republic, they all laughed at me. I went there all the temples, there was, and the guys said to me, “Halle, look, even the cupola!”
And then when you are facing these problems… In my opinion, people who’re always on the verge of life and death, or come to God or become cynical or leave the profession.
In the Church we don’t go in joy we go there only in a state of despair, misfortune, run back headlong to put a candle.
I haven’t experienced any major drama, and if the Lord, through the path of suffering leads us to Himself, my grief, sent by God – that’s my job. He led me to Himself through the pain, when you realise that you can not do anything.
Many doctors say that in his youth “burned” at work because of this feeling…
I remember when still in residency was in the neonatal center filatovskaya hospital, on the way to work head of the operating unit Dr. Makarov fell on the Garden from cardiac arrest. The lawn between the buildings was white: the entire hospital went out. On the ramp of admissions, was the ambulance, and a friend of the doctor, thoracic surgeon, was right there trying to get his heart beating with the hands. And head of the intensive care Tatiana everstova told me: “If you’re going to treat their work, you’ll end up like Makarov”.
I was really going to die with each patient. But it is understood their place in the struggle for life, it is not the first, but very important. Just always say to ourselves and our doctors that we – not God, but our task is to do honestly your work and the maximum.
We have in the office hangs this saying: “God has no other hands but ours.” And maybe this is canonically incorrect, but it makes you remember that we hold in our hands and to Whom responsible.
– Why did you become a doctor?
– Well, I was going to Phys, and in the 9th grade I fell ill with jaundice and was in the hospital, and with me in the ward lay a woman is 25, she could not give birth, and her husband really wanted children and she feared he might leave, suffered greatly because of this. I comforted her, and then she told me that I’d make a good doctor. And then I snapped, and I decided that I was going to study medicine.
And in the summer my friend and I were going to earn money couriers, and my mom said to me: “Once you have rested, I want to be a doctor, then go to work as a nurse” to which I replied that if you go, then only in the operating unit, because to wash the floors I can. And my dad is the chief engineer of the plant persuaded the doctor to take me for a month in the factory hospital. My first surgery – traumatic brain injury with hematoma and craniotomy.
– Wow, how did it go?
I remember after the surgery removed the blood clots, see a doctor came in, after some time another one. Only then I realized that they tested fell in a swoon.
Then I decided that a good doctor will not, because the doctor should give yourself from head to toe to my profession, but I have so many interests, and determined that will come to the medico-biological faculty, one was in Moscow and the other in Tomsk, and I even found out what sort of climatic conditions, because thought does not arrive to Moscow. And at the last moment came for the direction in Lipetsk gorzdrav: “my Child, what do you here? All the directions already given”. And then looked at each other: “And remember, he never came? Let’s give up!” – “Come on. Will go to Moscow?” – “Let’s go.” Go absolutely Gaga for the Pope, who was waiting downstairs, and said, “Dad, I was in Moscow on my way.”
It turned out to pediatric. But I never wanted to do neonatology though in the 90s it was very fashionable direction. The neonatology chose, you might say, out of despair, because the alternative was the precinct Pediatrics.
But the Lord is satisfied with everything in this life so that you don’t have options to become what should be. And so somehow happened that I did become a doctor. Although, of course, somewhere has to be a functionary, as I’m head of the Department. Now we have to think not only of patient – bed turnover should also be good.
Come children, as I remember them many years ago in Cubase
– You mentioned bed… By the end of 2018 in Russia promise to build more than 90 perinatal centers. Thus, it is believed that there is no necessary number of qualified professionals who will work there. In your opinion, what should be the ideal and well-functioning perinatal center?
– This is a complex issue, since Moscow – this is one story that centres a lot, but they are different, regions are a different story. In Kaluga, for example, the center one, but powerful. And in St. Petersburg itself perinatal center do not, but in the children’s General hospital children receive care at any level.
In fact, in Moscow and in other regions to date neonatal service is at a very decent level, and, frankly, the presence of enthusiasts in the regional center, on the basis of regional children’s clinical hospital where there are specialists of all urgent directions to create a perinatal center, fully corresponding to the needs of the modern “extreme” neonatology, often easier than in a city like Moscow.
In my opinion, the perinatal centre is a centre where assistance is carried out from head to toe. If, for example, the child needs to undergo a complicated brain surgery, the next should be the surgeon who will do it. And we have often the patient is moved to a specialist and not a specialist to it, and this, mind you, not within hospitals, and within the city, and then travel back, because there are hands there, and the intensive care unit, where ready to nurse, no. And the children go between the institutions as such “chelnoki”.
And, of course, staffing problems remain. Neonatal resuscitation, in my opinion, it is a separate specialty, and we have prepared, or anesthesiologists-resuscitators, neonatologists or. By the way, neonatologist easier to do “neonatal” resuscitation, rather than Vice versa. I can’t complain, but there are branches which do no work – four doctors in 18 children is just unreal! Therefore, in relation to perinatal centers must think about how best to do in each specific case subject of the Federation.
– When you walk through your Department, there is a feeling that you have a very friendly team…
– Yes, we have a friendly and warm staff, this family, although, of course, as in any family, there are unpleasant moments. But like any family that wants to exist as a family, they are ground, because there the main thing – love. And we have a love for their profession, the Department, in particular.
Colleagues joke that in our Department – an “epidemic” of fertility. The second doctor I went for the fourth child. Some people think that doctors go on maternity leave to relax because work wear. Of course, this is not connected. And most importantly – after the decree, the doctors return to their home team.
– How neonatologists at your center decided to hold a celebration – an annual meeting of their patients? It’s such a therapy for you to see the result?
– There is world prematurity day, and once a year in many hospitals such children to socialize, see the doctors, who both grew up. We thought about it, and technically such facilities, could come to such a number of people we have. And here in 2014, our hospital joined the city hospital № 24. It was a pretty painful period, so that people understand who we are and what we do. Just having a hard time with the big mountain to see some obstetrics. And, thank God, we were accepted. Now the midwives at hand are surgeons.
And every Friday the heads of all departments are going to the conference. Seeing this huge hall with a spiral staircase, I told the head of the intensive care unit № 1: “Olga, I think we need to spend a holiday in this area”.
So the idea was born. Come children, communicate, and someone I learn from, someone only thanks to my mother, but someone asked and only then I remember how many years ago was standing by the incubator. If we vyazhem 300-400 people, it is impossible to memorize them all (smiles).
– You feel in his place?
You know, I think that still in the profession I have held, in the sense that I love it. Once Richter Rostropovich said: “Glory, we’re happy people: do what you love, and for that we still have money to pay.”
Incidentally, to the question, why do we need it – to care for these children. Today got a call from the mother of a child who once lay at us, then he was operated on in the cardiac center named after Bakulev. After the first surgery my mother was very worried. And because our world is close, I called friend in the center and asked how’s the baby and heard the surgeons such light is not seen, it will not be removed from a ventilator. The baby was very distressed – lungs, heart, he survived three surgeries. But parents are happy that they have Senka. And his mother called me to clarify the dimensions of the mini-blankets for our patients, our grandmother took knitting (smiles).
– What weight was the little baby that you held?
– It was twins, Arseniy 930 g and Anna 450 g, and was received by the Department with a weight of 350 g. They have for 10 years, are rare at the festival they were once, but the annual calendar photoshoot Anna and Arseniy hanging in the examining room each year.
Talked Hope Prokhorov
Photo: Yefim, Richman