And just when I thought it couldn't get better...

I had the best day today... an emotional high from early this morning well through getting home this evening. Starting at the beginning... (because generally that's a good place to start)

When I got to the unit and pre-rounded on the babies I'm following, everybody looked good. I made the decision that I thought one was ready to come off CPAP, and cleared it with my attending. Yay for tube-free babies!
Then I went to look up labs, xrays, etc to prepare for rounds and was talking to one of the residents when I found out that not only were none of them on call today, the three that were there this morning had clinic in the afternoon. This means there was a lonely little delivery pager going to be sitting all by itself.... or not :)

Clipped the pager on about 8:30... finished prerounds and plans and started rounds. We were about halfway through when the pager went off for the first time. Off to the delivery room. Big baby, fairly healthy, just a little extra work of breathing. After watching him for a while, the NNP decided to send him on to the transition nursery. The rest of rounds went by without issue and we got done really early.

My amazing mentor/attending then called to take me to lunch for my last day :) We had a great lunch and then went over my presentation for tomorrow, giving it the final touches. I told her I wanted to hang out in the unit for a while and see if anything interesting would happen because the delivery board was full and several of them were preemies.

Went to check on the twins and ok'd mom holding... for the first time. This was what I thought would be the most inspiring and rewarding moment of my day. Then.....

Got settled at my desk about two to review test results and... beeep.. 911. That means RUN, not walk, not elevator... scale the stairs two to three at a time. When I get in the room, it's just me and the delivery nurse... and in runs the resident OB with a tiny bundle. On the warmer is delivered the smallest person I've ever seen. For what seemed like an eternity, I got the initial heart rate and had the fleeting thought of fear as an NNP hadn't responded yet. Thankfully, she was there almost as soon as the thought went through my head. I gladly stepped back from the head of the bed on that one and had her take over for the intubation, assuming a first-assistant role. Fast forward through all the medical details and you'll be pleasantly surprised to know that AMAZING child, God's perfect creation, looks more alive than anyone ever thought possible. A fighter, we say. And even though the odds are stacked against him, this part deep inside of me is almost sure he'll make it.

As he's settling into his bed and I'm beginning to catch my breath, beeep... 911. Adrenaline rush, straight back to the second floor. This one we at least beat to the room. A little bigger, a little stronger. But still tiny. Heart rate, intubate. And in the meantime, realize the child's head is bleeding... profusely. Stitches in the resuscitation room? Has that ever been done? The prayers go up. Pressure is applied, the intubation is complete, we watch and wait. The bleeding slows and the baby improves. It's off to the transport incubator, and down to meet the new friend across the hall, who was born less than an hour before, 7 weeks more premature.

As I signed out tonight, returned the delivery pager to the front desk, and said a few goodbyes, I found myself less sad than I thought I'd be. Maybe because I was exhausted, but maybe because God allowed me to have an amazing last day, showing me how much work He's done in me this summer and the endless blessings He has in store. This time last year, I said I wanted to be a neonatologist and save babies. Now I've tried my hand at it. Is it stressful? Of course. Trauma-heavy? Definitely. Hardcore? Some say so. Devastating? Some days. Rewarding? Everyday.

I may not be spending 8-10 hours a day in the NICU in the coming months or years, but I'll be there as much as possible... and my heart will never leave. I carry a tiny footprint to remind me of what's on the other side.

This IS the rest of my life. Welcome to it. :)

Today is gone. Today was fun. Tomorrow is another one. Every day, from here to there. funny things are everywhere.

I thought i'd finish up the "one fish two fish" reference from the previous post...

It was an amazing week in the NICU. Carrying my own patient load is just wonderful - i've learned so much about fluid and electrolyte management, lab values, sepsis workups... and those two little angels in general. The thought of returning to the classroom soon is just UGH.

Took my "last" call on Thursday night. It was a crazy day... I rounded on the kids, gave my presentation to the residents during their morning lecture, then we had regular grand rounds... by then things were starting to get crazy. I went to a delivery during that and by the time I got back we had a kid falling apart on one side of the nursery with surgery at the bedside doing a repair... then we had a significant problem on the OTHER side (and since my attending was on call and that one had left we were covering all 95+ beds). I got to see a pretty neat procedure over there. It's funny, because there's a set of twins on that side that are similar to the ones I'm following - just a couple weeks earlier and sicker. I've learned a lot about twinning lately. :)

It never really settled down through the night - I slept for a couple of hours. By the time it got quiet, I couldn't settle my head down and sleep, so I helped with late night feedings. There just isn't anything sweeter than rocking a baby while you coax them to eat. Especially looking at that baby realizing that three months ago, it was highly unlikely he would survive, much less make it to this point. "I was unconditionally and irrevocably in love"

One more week. It ends too soon, but I must return to the classroom. Time to get it over with.

One fish, two fish, red fish, blue fish

During my last post, I wrote of the excitement of following my own baby for the first time. Due to the complexity of the medical conditions, she survived only a day after admission. I finished my differential dx thoughts at least, and anxiously await chromosome studies to see if I had any of the right ideas.

In the meantime, we had a set of "grower-feeder" twin girls come in and I was assigned both of them! (Hence the one fish, two fish title ;)) It's a lot more conducive to learning because they are acting like typical preemies, so I'm able to figure out the nutrition, respiratory management, etc. I'm learning the art of teeny-tiny physical exams and what to look for each time I see the patients and learning what makes "grower-feeders" tick in general. It's great. In case you guys missed it, I LOVE my job :):)

In other news, my research project is finished, my powerpoint is getting polished, and Dr. K and I have started the next project. I'm grateful for the opportunities I've been given and look forward to staying involved in the newborn medicine department in the coming years :)

159 (class/tests days in M2 year)

159 days of class and tests in the upcoming year.
This translates to 257 total days, including weekends and holidays (most of all which will be spent studying).

These numbers are discouraging and encouraging. With two weeks left in the NICU, I'm already fighting a heavy heart going back to the classroom. However, I know it's necessary evil - something that must be done in order to reach the ultimate goal. I know I'll be able to visit and stay involved in pediatrics as much as my study schedule allows this year - I just hope that is at least occasional. I'm going to do my best to stay on top of the work, not get behind, and have an amazing year. /End future-freak-out-moment.

As for this week, it's been wonderful. I went to the OR three days this week with three different kids from the NICU. Ended up being with three different specialty surgeons (peds general, ENT, and neuro) and getting lots of OR/anatomy experience. It's not as bad as I thought it might be. In fact, surgery is almost fun. It's definitely not something I can see myself doing for the rest of my life, but at least I'm not freaked out about/dreading 3rd year rotation anymore.

I also learned NEODATA today, our charting system. Dr. K is preparing me for 4th year externship - for that I am really, really excited. Granted it's totally early... but as quickly as last year passed I know it'll be here before I know it.

With experience comes freedom, and responsibility... which is a little intimidating but leads to more experience and the circle continues. Today I was assigned a patient to follow with a NNP. "My" baby isn't a full term grower-feeder or even a micro preemie. It's a really, really complicated case. I'm slightly intimidated by the complexities of it all... but the NNP's are wonderful and she'll be making the decisions - I'm just allowed to verbalize my thoughts first and see if I can come up with the right ideas. So here I am on a Friday night, formulating a differential and planning to go up to the hospital both days this weekend to do a physical. Some call it crazy, some call it love.... but I'm soaking up EVERY possible moment.

a post in numbers (following my good friend M's last one)

7:37 - time I headed to the operating room this morning
2 - big brown eyes asking "what's going on?" - that baby is a heartbreaker in the making!
86 - minutes from "timeout" to final sutures
80 - fingers and toes counted on discharge exams
20 - carseats, diaper bags, and other misc "patient belonging bags"
4 - happy, healthy infants released home today from our side of the unit
89- current census (AFTER the discharges)

What an AMAZING day in the NICU :)
It was my first time to go to the operating room with one of our kiddos, and it was fun (for me, probably not so much for the baby). Our pediatric surgeons are awesome and the baby did great and is recovering quickly. We'll be adding another to the "homegoing" list very soon!

"Call the pharmacy and put in the order"

"Call the pharmacy and put in the order". Said like it was just another day, another doctor. Someone who'd been there forever. But it wasn't just another doctor. It was ME... Not only am I not a doctor (merely a quarter of one), but it was my first order, handed down from an attending, during a crisis situation.

So what do all good doctors-in-training do? Follow the order. Ask for help when you need it. And realize the impact of what you've learned when you finally have time to breathe, days later.

"Dopamine, such-and-such loading dose with such-and-such mcg/kg/hr?" I yelled across the unit to the attending at the baby's bedside. He nodded and smiled.

And even though someone else checked it and signed off on it, I put in my first order. Of course if I wouldn't have been standing there, anyone else could have done it... and probably more confidently. I was honored to have had the chance, for one moment, to participate in trauma care.

It was one single moment in everyone else in the room's life... and a moment that will never be forgotten in mine. It was perhaps the first moment that medicine leapt off the textbook page and into the incubator. I wasn't doing something because it was exactly what we'd done for every kid all day, but because it was what SHE needed at that particular moment.

I'll never quit asking questions, and I'll probably never quit questioning myself - at least a little. But with every day and every learning experience, my confidence is growing. My faith is stronger than it's ever been - God is closer than I've ever felt him. As long as I stay this close, I can hear His directions, those of the ultimate Attending. And He will never lead me astray.

Happy birthday, sweetheart...

Happy Birthday... it's something we say every day in the NICU. The lullaby plays over the Women's Hospital loudspeaker, another baby has been born. It's another Happy Birthday.

Sometimes those birthdays aren't quite so happy. If a birthday comes too soon, the human part of each of us may be wondering exactly what the baby is doing here. The part that believes in God's ultimate plan never wonders that. Sometimes I find myself a little too human, a little too heartbroken. I suppose I'll struggle with that for the rest of my life. However, it's a struggle that fits - a struggle that feels right. You take the good with the bad, you hope you can make a difference, and you pray. A lot.

Back on the subject of birthdays... we recently had a baby celebrate their "third" birthday with us. You see, almost everyone celebrates their "first" birthday here... that's Day 1 of life. Then there's the "second" birthday. That's the day you were SUPPOSED to be born. Your due date. More often than not, that birthday is spent here as well. But the third... that one is rare. So we celebrated. Like any family celebrates their child's true first birthday. Ok, so our party attendees couldn't have cake - and couldn't actually attend the party at the bedside... but that child had more "friends" at his birthday party than any one-year-old I know! The next day, the sad reality kicked in. The banners were still up... "happy birthday"s all over the bed. But the baby had turned sick overnight, and we were all reminded exactly why it'd been a year that he'd been living in these walls. I pray your second year, and your "fourth" birthday, is happier and healthier, little one. And until you can make it on your own, we'll continue to hold your hand.. and God will always hold your heart.

first day "on service"

Yesterday was the first day of the summer that my attending physician has been on service in the NICU. I was excited about this because I knew I'd have the opportunity to be more involved - and boy was that an understatement!

We started rounding yesterday morning and I got to do a few exams... there's just nothing like putting your hands on a tiny patient <3. Yesterday afternoon, we had a new admission - and I got to help do lots of things handed down directly from the attending - for a few hours, I totally felt like a doctor. And helpful. Which is an interesting feeling that doesn't happen a lot... sometimes I feel more in the way than helpful, especially in crisis situations. There's just so much activity in the NICU and so many people involved when things go wrong. But yesterday, I was involved. Helpful. Useful.

And I can't wait for the next day. And the next.

In other news, M has started her ER rotation - and seems almost as madly in love as I am with NICU. Yay for the rest of our lives! I'm glad to have friends who want to do different things - that way the next time I make a stupid decision or trip over some flat surface, I have somebody I can call personally... before I have to show up and explain it in the local emergency room.