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.

the little things...

a workup on a sick baby yesterday... normally, we are worried about sepsis, staph, etc.

"Mr x's workup is back. he has an ear infection"

and I smile. because underneath it all, under all the high tech medicine, these babies are still babies. and normal things make us happy.

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“Father asked us what was God's noblest work. Anna said men, but I said babies. Men are often bad, but babies never are."

“Father asked us what was God's noblest work. Anna said men, but I said babies. Men are often bad, but babies never are." - Louise May Alcott, Little Women

It's been a trying two weeks for me personally. We had quite a scare with my grandfather's health that only the good Lord brought him out of. Thanks to lots and lots of prayers and his strength and resilience, today marked the end of a tumultuous and long hospital stay. He's home and doing well! Due to those developments, I spent the better part of last week playing doctor- but not on the babies. I went home to be with my family and try, to the best of my ability, to fill my role as the family rock. It's hard to be the one everyone looks to for medical knowledge, especially just one year in. There's still so much I don't know. However, just one year gives you a lot of pull in the hospital environment. I was able to follow more - and help more - than I ever thought possible. Once again, I thank my Heavenly Father for that.

As far as the NICU goes, this week has been wonderful - a great learning experience. My attending is still off service, so I've spent each with rounding with a different attending... this week's was incredibly intense teaching-wise and I learned a ton. I was also able to make it to all of the Pediatrics meetings (Grand Rounds, Case Management) this week and those are also good....

Rounds today were crazy. What usually lasts 90 minutes or so was complicated by an intubation, cardioversion, and delivery. I got to assist a bit (as in hold stuff) on the intubation, and I'm looking forward to being certified Monday.. hopefully I'll get to do my own first intubation soon! I finished my written test for certification this week, so it's just practice on Monday and meet all the new residents.

I'm settling in nicely and my research is going well. I'm looking forward to the next month and continued involvement throughout the next couple of years, M4 rotation, and residency & fellowship. Is it June 2013 yet???



Random quote from an unnamed in the unit:
"Honey, siblings aren't allowed back here..[in the NICU]. Where's your mom or dad?"
...
"I was just bringing my baby some breast milk"

And so it goes in today's society. Insert foot in mouth, unnamed.

quotes of the day

"it'd be easier to cannulate a moose"

"why are we talking about poop?" "because we're doctors, and that's what doctors do".

and it's only lunch...

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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!

To all those who thought I couldn't, look at me now!

Saw a follow up kid in clinic today that was originally born at < 1 kg and way, way too early.

Said kid is now walking, talking, smiling and singing.

God is everywhere. I saw Him today, in the eyes of a beautiful and very healthy all-grown-up-now NICU grad.