[Top: Shots of TNP report on Dora's experience.]

By Ng Wan Ching

SHE would have been dead within an hour if her parents had not taken her to hospital right then.

And even when she got there, she may not have survived if the right doctors were not at the right place at the right time.

But little Dora, 7, was fortunate, and eventually pulled through.

Her recovery was nothing short of a miracle, and she had to endure a long, hard fight for her life.

In doing so, she became the longest paediatric patient here to have stayed on the Extracorporeal Membrane Oxygenation (Ecmo) machine.

This is a heart-lung machine which gives the blood oxygen from outside of the body.

Patients usually stay on the Ecmo for between three and five days.

But Dora stayed on it for a record-breaking 502 hours, all of three weeks.

Dora's first words, after 22 days of sleep, were written.

The little girl's father, Mr Chan Chin Ann, 39, an air force officer, recalled: 'She could not talk immediately but she got us to bring her a paper and pen, and struggled to write, 'Later when you pray, tell God that He is very, very, very good. :D'.'

Ill for a week

Dora's illness had started with sporadic diarrhoea and loss of appetite for about a week.

She then developed a fever with some breathing difficulties and her heart was beating fast.

Mr Chan and her mother, Madam Annie Tan, 38, a housewife, took her to see a GP on 30 Sep.

Besides prescribing flu and fever medication, the GP, who felt she was weak, prepared a referral letter for the Chans to take to a hospital in case her condition didn't get better.

'We thought it was unusual of her to look so lethargic compared with how she was in the past when she was ill.

'She couldn't even lift her own hand,' said Mr Chan.

He and his wife decided to take Dora to KK Women's and Children's Hospital (KKH) the same evening.

It was a decision that saved Dora's life.

Dora was diagnosed with acute viral myocarditis, which causes the heart muscle to get inflamed.

At the hospital, she was quickly put on the Ecmo machine.

The hope is that the heart can be relieved enough for self repair and recovery, as there is no medication to counter the viral attack.

Dr Sriram Shankar, senior consultant cardiothoracic and vascular surgeon at KKH, recalled how he had walked into the intensive care unit that evening as he was about to go home.

'My colleague, head of KKH's cardiology service, Associate Professor Wong Keng Yean, said don't go away, there's a child coming up and her heart function is very poor,' he recalled.

Said Assoc Prof Wong: 'Her heart was contracting irregularly and there was destruction of heart tissue as her enzyme levels were very high.'

Dora was put in KKH's intensive care unit immediately.

Perfusionist (someone who operates the heart-lung machine during surgery) Anne Ho and a nursing team, led by Sister Teo Guat Leng, rushed to the hospital to help with putting Dora on the Ecmo.

'The response time of the team was incredible,' said Dr Shankar.

With their help, he inserted flexible tubes into the great vessels of Dora's neck and connected them to the Ecmo machine.

Within an hour, Dora's heart was flat.

'There was no pulse, no ECG, nothing at all,' said Dr Shankar. 'This was because all the stress hormones and adrenaline that were keeping her going evaporated, once her own heart and lungs were out of the equation.'

The next day, Dora's condition worsened.

Said Mr Chan: 'The surgeon told us that the chances of recovery for such cases were about 60 per cent.

'From past experiences, we should be seeing positive results by seven to 10 days if everything turned out well.'

But he and his wife were also told that complications due to using the Ecmo machine may cause damage to Dora's other organs.

(Page 1 of 2)'Day by day, my wife and I were in the children's ICU taking turns to be at Dora's bedside to pray for her and keep her company,' said Mr Chan.

By the end of the first week, there was some hope, as the cardiologist performing the ultra-sound echo saw some signs of recovery.

Three days later, their hopes were dashed. Dora's heart had fallen back to the condition it was the day she was admitted.

It was a blow for the Chans.

It was around this time, said Dr Shankar, that they realised they were 'in for the long haul'.

'I'm not in the business of giving up,' he said.

By the time the end of the third week was coming up, there were still no signs of improvement. Some doctors were saying that perhaps it was time to take her off the Ecmo machine.

Said Mr Chan: 'The surgeon revealed that in Singapore, the longest survival under Ecmo was 21 days for an adult patient. But for a 7-year-old to last that long on the machine would prove to be too much.'

However, on the 20th day, when doctors checked on Dora's heart again, they detected a little sign of improvement.

'The cardiologist said 'it was amazing!'

'The next day, the signs of improvement persisted, and the meeting to discuss the options was called off,' said Mr Chan.

After 21 days on the machine, doctors decided that Dora's heart should be able to function on its own.

Said Mr Chan: 'One doctor told me, 'I think God has answered your prayers.'

His church members and pastors had supported the family throughout the difficult time, with prayers.

'Even my bosses were very understanding, telling me not to worry about work but just to focus on my little darling,' he said gratefully.

After another 12 days of recovering and step-down observations, Dora was finally discharged from KKH, on 2 Nov.

Now, things are looking up again for the Chans. They have much to give thanks for this Christmas.

'My girl is at home, recuperating well and fast,' said a relieved and happy Mr Chan.

Timing is key

Early diagnosis is critical for acute viral myocarditis.

Said Dr Sriram Shankar: 'Even with a little delay, a life can be lost.'

But the trouble with the diagnosis is that often, acute viral myocarditis looks just like gastric flu.

'You have to be aware if the viral fever turns out to be slightly different in its course. You get fever, your tummy hurts, people think it's just a gastric flu,' said Dr Shankar.

But if you are not getting better, you feel lethargic and your tummy hurts, you should get to a doctor quickly.

Since 2004, when KK Women's and Children's Hospital started the Extracorporeal Membrane Oxygenation (Ecmo) service, eight children, aged from 2 to 12years, have been on it for acute viral myocarditis.

The last five survived.

'The first three patients died because there was a delay before putting them on Ecmo.

'For the next five patients who recovered, the time between admission to hospital and being put on Ecmo was very short,' said Dr Shankar.

Machine serves as patient's heart, lungs

1. Flexible tubes are inserted into the great vessels of the neck and connected to the Extracorporeal Membrane Oxygenation (Ecmo) machine.

2. Machine temporarily takes over the heart and lungs; functions of circulating and oxygenating the blood.

This article was first published in The New Paper on Dec 9, 2008.