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...