Benjamin's Diary

 Benjamin S. Ha and Zion S. Ha were born as twin brothers on August 16, 2019, at Seoul National University Hospital. At birth, each weighed approximately 600 grams and were extremely premature. Emergent intubation was performed, followed by admission to the NICU. Despite their critical condition, they demonstrated remarkable resilience during their NICU stay.

 At the time, I was serving as a surgical fellow in the Department of Oral and Maxillofacial Surgery at Seoul National University Dental Hospital. I visited them daily, singing to them and praying for them.

 One night, Zion developed a tension pneumothorax, likely as a complication of early oral intubation. Initially, the severity of the situation was not fully recognized. Prolonged resuscitative efforts, including chest compressions, were performed for more than three hours. When I arrived, I immediately understood the clinical picture and asked whether I could put on surgical gloves to touch my son. With what seemed to be his remaining physical strength, Zion looked at me. I told him that I was there with him.

 Approximately an hour after my arrival, a surgical resident was called and performed re-intubation. However, his ventilatory status remained unstable. Within one to two weeks, we lost him. Later, upon reviewing the chest PA taken at that time, I observed a markedly deviated mediastinum consistent with tension pneumothorax.

 After Zion’s passing, I asked the attending pediatric fellow why CPR had been prioritized over immediate chest tube insertion, and futile attempt of FiO2 elevation and chest compression was continued over several hours during what is often considered the critical golden time. I also questioned why, once the decision -chest tube insertion, which was a life saving emergency measure- had been made, the chest tube was not inserted promptly by herself but instead she waited the arrival of a surgical resident for over an hour. Many further questions remained unspoken.

 Weeks later, a NICU professor requested a meeting with me. He asked whether I felt disturbed. Calmly, I asked him in my own surgical coat why the chest tube had been inserted so late. (I did not ask why the on-call surgeon arrived late, nor why the re-intubation had been performed imperfectly.) After several heavy minutes of silence, he said, “I’m sorry.” Following another pause, he added, “Very..very sorry. In fact...as you know..we do not have enough resources.”