Sunday Call

It's my second to last call ever in the NICU. And I have mixed feelings.

I would rather be fast asleep in bed, and then go for coffee and read the Times and have brunch w/ friends... but weekends in the NICU (while they can be outta control) are often not too bad.

When I left on Friday, I had 15 babies. I know there have been a few more admissions since then. So, I'm sure the list it at 17 or so by now. It's going to be one of those busy days, I just have that feeling.

The Power of Lasagna

5:00 am- a feeling of total helplessness. A pH of 6.8 is almost not compatible with life. Holy shit this baby is about to die right in front of our eyes and our best efforts may not be enough. Work hard and fast and somehow this baby pulls though, at least as of this morning.

10:30-I'm a patient in my own clinic. More on this later. First visit to a primary care physician in years. Need a physical for my VISA application. I pick one of the clinic docs I work with. Role reversal....

1300-unwind in the gym.

1600-start prepping food for dinner tonight. Invited one friend over for dinner, and just kept inviting friends. People are tired. It's nice to just have some delicious lasagna and wine and relax. It's nice to just take a night off in the middle of the week, cook a nice meal and unwind with friends/colleagues. We all take joy in entertaining Karins 9 month old and 2 year old children.

It's one of those days which was set up with potential badness, but had ended with a group of friends taking a mid-week break and unwinding...

Maybe we should take a mid-week break more often. Maybe a Wednesday Lasagna night would go long way...

Filling up the House

Friday, 9:30 am

"Well Doctor..." (whenever the chief of neonatology wants to banter, he calls me Doctor-we banter very well back and forth, much to the puzzlement of many of my co-residents who terribly misunderstand his great sense of humor). "you're not that busy this morning."

He wants to give us a lecture/tutorial this morning. I have raised a protest. I'm on call. The second year resident and I are covering the team, and thankfully she is here all day today.

The Chief is giving me a hard time. It's 9:30 am, and we've already admitted 2 new babies to the NICU, and Sarah is headed out in the ambulance to go pick up a newborn at a nearby hospital.

I kick into smart ass mode. "Well, I'm going to do my best to admit 7-10 babies today!! I guesstimate that we only have about 7 or 8 beds open right now. And I'm kind of in that invincible mood. I've been here a week. I have a 600 gram baby on an oscillator and a couple of kids who have other various troubling issues, a few more aren't really going to hurt!

He grins...

Friday 9:15 pm.
I am in a nearby hospital picking up a baby. This is our second trip here today. This will be our 6th admission in 12 hours.

I am NOT popular in the NICU. I hear mutterings of my black cloud returning... I also have a slight adrenaline rush every time my pager goes off. Since this am, we have been expecting a woman to deliver who is 23 weeks and 4 days pregnant. The parents want full resuscitation. I'm on the fence as to whether this is the right thing to do...

We arrive back to our NICU, baby/admission #6 in tow. "What's the rumor I hear your goal was to admit 7-10 kids today?" I can only grin. I fucking deserve it. Being a smart ass always gets me in trouble, and today I'm paying the price. It's non-stop. I'm tired. We haven't even done evening rounds.

I ask about the 23 and 4/7 baby. No word yet. Well, I profess, that will be admission number 7, then I've hit my goal for the day, and then I'm done.

Midnight. Orders from rounds are done.

3:30 am I go and look at the kids I've admitted today, and look at the babies I've been taking care of all month. It's just soothing watching sleeping babies..

I'm satisfied. And I make my way to my call-room.

My pager goes off at 6am. I don't even think, I grab my glasses and step into my clogs and start thinking what size tube I'll use to intubate this 23 and 4/7 baby. Is a 2.5 going to be too big? I'm in the hallway and I look to see what room the NICU code has been called to..

My page reads: "HI BRIAN! We're meeting in the medicine resident room and going for omelets. YUMMY! Hope you got some sleep last night. Come Join Us!" It's a page from Karin.

I page her back. I can get 15 more minutes of sleep or I can eat breakfast...

I vote for sleep.

Admission #7 didn't happen. For once, not hitting my goal is a good thing.

Full House

 
It's almost 11pm, and for the first time today, I feel caught up in my work. No orders to enter. No results to follow up. It's a hectic day. There are 3 of us residents on the team, and one resident left post-call at 8am today (that'll be me tomorrow), one went to clinic, which left me here today to hold down the team by myself. We have 2 kids on oscillator vents. I'm a bit rusty on managing vents, so it's been a lot of work today. But there is a small sense of gratification knowing that kids are in pretty good shape for the night. 
 
Went to a delivery where a baby was born breach. Ended up having to almost intubate the kiddo, but he perked up nicely with lots of vigorous stimulation.
 
I met up with a friend and walked down to the medicine call room, and whoa, full house. 3 other med-peds residents, one of whom is on call for pediatrics. So, the admit residents for NICU, Medicine Wards, and Pediatrics are all med-peds residents tonight. Kind of nice knowing they are around. And our chief resident is there, finishing up late admissions as well. Medicine is behind 7 admission, Pediatrics is caught up, but I hear they are full, and the PICU is filling up as well. I offered to help, but being in NICU kind of tough to be that far away from the NICU for long.
 
Well, going to go follow up a few blood gas results, maybe make a fine-tune adjustment to a vent or two, and then get caught up on some reading.

BPB

Anticipation

It's 10am.

 

"Good morning, we're glad to see you back in the NICU." I am kind of glad to be back in the NICU. Well, at least at 10am I was, 17 hours later I was ready to be done. "So, you ready for the gastroschisis baby?"

 

Whoa!

 

"Um," I look around thinking I missed something "What gastroschisis baby?"

 

"Oh, she's being induced now."

 

Gastroschisis.. It dawns on me that about all I know about gastroschisis babies is what the defect is, I hadn't actually every really expected to have to manage taking care of a gastroschisis baby. Gastroschisis is a condition where the abdominal wall fails to fuse completely, so the abdominal contents are exposed. I think of the scene with Hannibal Lecture in Silence of the Lambs, when he says, "Guts in or Guts out." I've taken care of a NICU kiddo previously who had a gastroschisis repaired, they tend to be in the NICU for a few months. I can guess what needs to be done when they are born, wrap the bowel contents in some kind of moist gauze, decompress the stomach with a NG or OG tube, get generous IV fluids going, intubate, and call the surgeons.

 

We're in the middle of morning rounds, I make a mental note to look up a bit more when I get a chance.

 

12 noon.

 

Running behind. Rounds took for ages. There are 3 residents on our NICU team (me, a second year, and an intern, and we're all med-peds so it's kind of cool), and the second year resident needs to get to clinic, so I'm taking report on her kids. There is still no word on the gastroschisis baby.

 

3pm. I finally get somewhat caught up. Eat or look up gastroschisis?? I chow while finishing up a few small tasks.

 

630 pm. I get paged. All day when I get paged I'm expecting it to be the code page for the gastroschisis baby. And this page is about the gastroschisis baby. They will take her for a c-section in 2 hours if she doesn't progress. Are you kidding me? Why not just section her in the am. Makes no sense. I call the surgeon to update him.

 

9pm. Delivery Code pager goes off, and we make our way. Almost 12 hours later. Beautiful Baby O is delivered, and aside from some loops of small and large bowel (which should be nicely hidden by the abdominal wall-but are dangling about) she looks great. The attending neonatologist comes to the delivery and coordinates wrapping the bowel. I pay close attention, knowing full well that if I ever see another baby born with gastroschisis, I'll be expected to manage the baby, solo.

 

The anticipation of worse-case-scenario has ended. We take Baby O to the NICU, get an IV. The surgeon comes to evaluate her in the NICU. I intubate her in the NICU (it's a confidence booster to get a tube on the first day), and we take her to the OR. Amazingly, an 90 minutes later we pick her up in the OR, and she has a small gauze bandage on her abdomen, and what will be a belly button. Mom and Dad come to the NICU an hour later...

6 Months

6 months from now is July 1, and that is my start date at Baragwanath.

 

Wow, I have a lot of stuff to get done before then!