Dr. Paragas: “With a CT Scan, we might have been able to save her.”

January 11, 2007

The Kaselehlie Press

KOLONIA, Pohnpei - On Thursday morning, December 14, 3 year old Nikkita Higgins was a happy, playful little girl riding piggy-back on her grandmother’s back in the Ohmine neighborhood that she called home in Pohnpei. By Saturday morning at 8:20 she was dead.

Two weeks later the shell shocked family sat fifteen feet away from Nikkita’s diminutive burial place telling the story. Marcy Higgins, Nikkita’s grandmother said that she and Nikkita were playing as they often did. Marcy told Nikkita that she needed to get down but Nikkita wanted to stay on her grandmother’s back. “She was always so playful”, she said. Nikkita slipped and fell hitting her head on the floor. Children have accidents like those all of the time but it was obvious to the family that this time things were different. Nikkita began, not long after the accident, to vomit and had trouble staying awake.

Grandfather, Raymond and mother, Noreen Jack Higgins took Nikkita to the Pohnpei State Hospital emergency room at approximately 1:00. As part of the procedure for head injuries an X-Ray was taken at the hospital. Though no fracture was found, Nikkita was admitted to a hospital ward for observation, another standard procedure at the hospital. Nikkita’s family said that the hospital did not administer an IV. IV’s are Hedson, Chief Surgeon at the hospital said that he didn’t know whether or not an IV had been applied but that the information would be available in her chart.

According to the family, hospital staff told them that they were trying to locate a doctor, a specialist in the field to check into her case. Nikkita’s symptoms continued at the hospital for the next four hours. According to the grieving family, other than the on duty doctor who first saw her only when she was admitted no doctor attended to her during that time.

The doctors at Pohnpei State Hospital all have cell phones and each also has a home phone. Dr. Hedson, whose office conducted an investigation into Nikkita’s treatment said, “the staff told me that there may have been difficulty locating the specialist on that day…I admit that sometimes there is a delay in getting treatment.” He said the family checked Nikkita out of the hospital “against medical advice” at 5:30 in the evening. Raymond said, “No one was talking to us or telling us anything.”

Dr. Myra Anne Trinos, Pediatrician at Genesis Family Clinic was on duty when Nikkita and the family came in. She ordered X-Rays and a full workup for the injured child. The X-Ray done at Genesis also showed no fracture in Nikkita’s skull. The clinic administered an IV to restore fluids and also to apply two different medicines prescribed by Dr. Trinos, to reduce swelling that might have been going on in the brain.

The family settled in for a long night at the bedside of the only daughter that Noreen will ever have. Nurses, and the on duty doctor at Genesis monitored Nikkita throughout the night.

When Dr. Trinos, who like all Genesis staff doctors, lives on the premises, arrived to check on her patient at 8:00 in the morning the family pointed out swelling on the side of Nikkita’s head. Although her vomiting had stopped, Nikkita was having a difficult time staying awake. When she was awake she seemed to be coherent and knew the names of the family members with her which, according to physicians at Genesis, is not an uncommon thing for patients with severe head injuries.

By midnight on Friday, Nikkita’s condition had deteriorated significantly according to a level of consciousness scoring that physicians use in head injury cases. Surgeon Dr. Rocco Paragas who had been consulting on Nikkita’s case decided that the best course of action would be to perform surgery. Genesis staff explained to the family that if surgery was not done Nikkita would almost certainly die but that there were risks involved with the surgery. She might die anyway.

The family decided to go forward with the dangerous surgery but Nikkita, whose blood type was “A”, needed blood donors. Genesis physicians told the family that despite the difficulty of locating family members in the middle of the night surgery could not go forward until at least two quarts of blood of her type was available for the surgery. Nikkita’s father, after being screened and cleared, gave a quart of blood which is all that can be safely taken from one donor. Surgery began with that one quart while family members frantically searched in the middle of the night for another donor which they did ultimately find.

Dr. Paragas found a long, thin fracture above Nikkita’s right ear that no X-Ray would have found. Additionally, he found that both an artery, a blood vessel leading from the heart, and a vein, a blood vessel returning to the heart, had small tears in them which led to clotting and further pressure on her brain. The clotting and swelling resulted in what is known as a transtentorial herniation of her brain in which the brain tissue that controls respiration (breathing) gets choked off and stops functioning. Nikkita’s respiration stopped on Saturday morning, December 16 and at 8:20 she was pronounced dead.

Dr. Paragas said that “when a patient receives a serious blow to the head followed by unconsciousness they should receive a CT Scan”. CT Scan machines which monitor the intricacies of brain activity cost in excess of a million dollars and there are none on Pohnpei. “With a CT Scan, we might have been able to save her”, Dr. Paragas said. When asked if delayed treatment at Pohnpei State Hospital hurt Nikkita’s chances for survival, Dr. Paragas said that possibly with the presence of a specialist her chances might have increased infinitesimally but that he doubted even that.