TPN Pharmacy

They were the cutest thing on earth – their small fingers grasping at thin air, their little legs kicking energetically against pampers that looked bigger than their bodies. They lived in transparent egg-shaped incubators and had so many lines wired to them that they looked like some futuristic androids. They were the premmies – or babies being born premature. The smallest of them weigh 750 grams, smaller than a pack of sugar.

For the last two weeks, I had been starting my day by visiting the nursery. It was part of the routine in the TPN pharmacy rotation.

TPN stands for Total Parenteral Nutrition. As the name suggests, it is basically nutrition - a liquid form of glucose, amino acid and fats being delivered directly into the body via a vein. It needs to be sent this way as some babies cannot eat or digest the normal food we eat for some reason or other, for example, a blocked intestine.

And yes, it is a pharmacist’s job to make up these nutrition in a bag for the babies. Believe it or not. And it’s hard work.

After visiting the babies, we usually went back to the office and did some maths homework. This is the time where all those mmols and mLs and all the pharmacy calculations we tediously pore through in Uni came into practice. We need to calculate that the amount of food the doctors prescribed for the babies are correct.  It had to be a balanced diet. Something wrong and you might just send the frail baby to heaven.

After the calculations its often time for an early lunch and then  change into spacesuits.

This is because as the nutrition will go  directly into the body, we cannot afford to have any bacteria at all or else the baby will likely to suffer an infection. Everything had to be sterile. We gowned up and scrubbed in like surgeons wanting to perform delicate operations. Even washing hands took around 5 minutes. The end result looks like this:

It was then off to the clean room when there are no excuses to escape before the work is done – be it a bursting bladder,  dry lips or growling stomach. This is because the space suits are damn expensive and its a big hassle to scrub in again anyway. The longest stretch I had in there was 8 hours. Yesterday I clocked out at the unholy time of 9pm.

In the clean room we inserted all the individual components of the nutrition into a bag. That’s the easy part. The difficult part was to get all the bubbles  out of the bags. It was akin to herding hundreds of naughty lambs back into the barn at sunset. Doing a bag usually takes around 30 minutes. By the time I did the last bag of the day, my arms were so tired that I don’t even have the energy to break off an ampoule.

The next day, its back to the ward again, looking at the TPN bag with your handwriting on it being put up on a stand next to a baby and seeing the yellowish solution dripping slowly into their tiny body, giving them strength to fight for another day.

And sometimes, if you are lucky, they opened their eyes and smiled at you. I swear one did that other day.

And this little gesture is enough to make all the hard work worthwhile.