Call night... and the end of week 1... never trust a preemie

Wednesday night I completed another first on my list for the summer. I took call with my attending physician. I actually carried a resident pager, slept in house, and responded with the residents/nurse practitioners. It was super cool - very little sleep involved, but very much worth it. I've learned in just a week that I am EXACTLY where I am supposed to be doing EXACTLY what God has called me to do. It is an amazing feeling... a blessing, and huge responsibility. I couldn't be happier. Even with the story I'm about to share.

Almost as soon as I clipped the pager on wednesday night, a baby started "crumping" (medical terminology for falling apart with no known cause). Blood gases were off, oxygen sats were bad... the kid just looked sick. Really sick. She'd been sick for a while (and touch and go a few times), but suddenly I found myself watching a full out resuscitation effort. The IV access was poor and it was determined that she wasn't receiving all her meds (causing the other problems), so the nurses and doctors tried again. And again. Finally surgery was consulted to put a line in. For what seemed like an eternity, the ventilator was off and Andrea was hand-bagged while the surgeons tried to get access. It took much longer than anyone anticipated, and she lost a lot of blood. A lot, in the nicu, is about the equivalent of what you and I would get if we sliced our finger open. Not even enough to go to the hospital for stitches. But this kid needed blood, and fast. All the appropriate tests were run and the blood was brought up. Enough blood to fill a medium size syringe. Wouldn't volume-expand a grown person at all - but it was enough to replace Andrea's entire supply. And mind you, she was a "big kid" (once again - "big" is relative... in the NICU, >3 lbs is big and 5+ is huge). With central access and medications finally being delivered, she seemed to improve slightly. Not enough to admit success, but enough to return her to the ventilator, and for us to return to the family in the waiting room (who had been called from several hours away to be at the bedside). Deep breath, babydoc. Put on the white coat. Get ready. This is the not fun part, my attending says. It's never easy to gently tell a family that their baby may die. Or has died. You don't have to come with me, she says. But I put on my coat, she puts on hers, and out we go. To do the job no one ever wants to have to do. Even at this time, it was admittedly easier than I expected. The family has experienced these "crumps" before. She'll come around, they say. And who are we to say otherwise? Preemies can never be trusted. You really just don't know.

At this moment, the delivery pager goes off and I race upstairs to find quite the opposite - a bouncing, beautiful, perfect, and HUGE healthy newborn. Couldn't be pinker. Couldn't have better APGARs. This one gets to bypass our unit directly. And transition. She's a direct admit to the newborn nursery, or mom's bedside. We smile and coo with her... encouraging the first-time parents and sharing in their intimate moment.

It's how things change in neonatology. It's the moments of birth and neardeath, often intertwined, with no fine line of delineation. The uncertainty of medical knowledge and the certainty of God's ultimate healing - no matter what our role in that may or may not be.

The night continued fairly quiet, with a little (about an hour) rest in between. Post call, I left the hospital about 9-10 and had a full day off. This morning, I returned to the hospital fresh. In Grand Rounds, I sat with a couple of my classmates who are also doing my program but are in different areas of the children's hospital. Close to time for conference to start, the residents I'm working with filed in. A sat down next to me, and I asked how his call night was. "Baby Andrea died" was all he had to say. And I knew. "She went peacefully, and very quickly, early in the night... by the time the nurse took her off the vent to listen for any signs of pulse/breath sounds/heart sounds, it was over."

But for me, she didn't go quickly. A baby born too soon, and taken too late. It's never easy, I suppose. Part of me wonders if it would've been easier if she would've been a micropreemie, a <1 lber, a brand new admission. The other part knows it wouldn't have made any difference. It was my first live patient to lose. I held her hand for that treacherous hour, while the surgeon desperately attempted to get us access so she could get the drugs (and now blood) she had to have. While my attending tirelessly hand-ventilated her, never growing angry, never showing fear or trepidation (Stay calm, always, she said. The babies know. They always know. If you're afraid, they're afraid). We worked as a team - doctors, nurses, xray, respiratory, surgery - and kept her alive night after night. But preemies can't be trusted. They decide if they are going to get better, they decide if they are going to die. Personally, I think they've got a direct line to God. Andrea decided that sitting in His lap was better than in her incubator, surrounded by all that medical technology and the twenty-first century had to offer. And once again, the preemie knows best. She is healed and perfect, resting peacefully in His arms.

And I will never be the same. I know it'll never get easier, and yet I can't imagine a life of doing anything else. I'm home in the NICU. I'm home in the quiet and "scary" parts of the hospital, where no other outside physicians like to go. I've found my calling doing God's work here. And I'll never be able to forget that it is indeed HIS work, not my own, that I am doing. Goodnight, baby Andrea. I can't wait to meet you again in Heaven!