Monday, January 21, 2013

The Little Itty Bitty Ones: a.k.a. premies in the NICU

I didn’t think it would happen but I fell in love with my Neonatal Intensive Care Unit babies. Here’s how it went down:

Sign out prior to the beginning of the rotation: From the Intern finishing up her rotation: “everyone just survives this rotation, be prepared to write lots of total parenteral nutrition orders (TPN).”  Sign out ended with me congratulating myself that I hadn’t started crying just hearing how sick some of my new patients were.

Day 1: Examining those tiny babies had to be the scariest thing I have done in my life. I’m used to 6 pound babies in newborn nursery, not 1 pound babies who are ventilated and in incubators. I made it, my patients made it. I’m used to talking about urine and stool counts and giving breast feeding advice. I’m not used to talking about glucose infusion rates, assist control ventilation, bubbles CPAP, and making split second decisions based upon arterial blood gases and urinary output.

Weeks 1 - 2: struggled with patient management, presentations, note writing (many nights I finished around 10pm), and TPN. Struggled with missing Zo’s bedtime.

Weeks 3 - 4: started getting used to the routine and began enjoying deliveries (dry, stimulate, and ventilate). I also began enjoying the daily mechanics of managing my “feeders and growers” and even got to do a really cool creamatocrit to assess the nutritional content of a patient’s maternal breast milk. Surprisingly, I also started to really like managing my complicated patients and the daily brainstorming that goes on with our consultant specialties. Establishing relationships with the parents was really the best thing about this time and the staff who work in the unit are outstanding and know their trade exceedingly well. On the homefront, I still had not gotten used to the lack of sleep and was really started feeling badly about how junky our house was becoming and how my husband had essentially become a single father.  

Week 5: started feeling the first tinges of confidence or was that my upper respiratory illness superimposed with sinusitis and a head full of medicine? I guess I’ll never know, but I was sad on my last day. Sad that I had to sign out to another Resident (who I totally trust but still they are “MY” patients and families). Sad that I was just starting to become confident and then bam, on to the next rotation. Sad that I wouldn’t see the daily progression of the little itty bitty babies who had surprisingly stolen my heart.

5 comments:

  1. Thanks so much for this post! NICU is my first real rotation back in med school after finishing my PhD, and I'm a little freaked out about how little I will see my daughter, and how much there is to know. It's good to hear from someone who enjoyed it in spite of both of those things.

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  2. I really appreciate this blog. It is very timely for me in that today started my last week in the NICU. What was a scary rotation looming ahead has now become a potential career path. I thought general pediatrics was my calling, but somewhere deep within I am fighting the desire to go into neonatology. I am just not sure that I can explain to my husband and son that I need 3 more years. There is definitely something magical in the NICU, and I am not ready to give up "my babies".

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  3. Well now Ladies, enjoy enjoy enjoy! Don't forget the big picture as you get caught up in the details. It really is a heart-wrenching/nerve-wracking rotation but it is so great to see the little mini victories. Sending you well wishes. Have a small calculator handy and if you can, this is the month to get outside help (grandparents, friends who will spend time with your spouse, a cleaning person, etc . . . ).

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  4. This made me reminiscent of the magic of my childhood. Dad as neonatologist - his job never ceases to amaze me. I went up to the NICU recently to check in with him about something and got sucked into his rounds. The little ones truly resemble alien life forms, and I am amazed at the doctors/my dad that nurture them into personhood. At 6'4" he can still palm most of them like a basketball, and the advances that have been made during his lifetime in their care and treatment are nothing short of a miracle. As doctors we find some common ground in conversation, but his depth of knowledge in his field remains impressive and daunting. The mental health support he provides to the parents is amazing - a lot of doctors have to do this but as pathologists we are somewhat shielded from the person and family behind the tissue. Neonatologists have to be scientists to their patients and psychologists/educators to the parents/caregivers.

    Having said all that, I can also empathize with the time he had to spend away from our family. There are pluses and minuses to this career choice. He warned me away from it, probably knowing I was going to be a mother someday. I hope that there are part-time jobs or family friendly ones out there these days for women and men who find this their true calling.

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  5. As a neonatologist and mom to a 3 year old...I LOVE my job. Wouldn't want to do anything else. And, I find that many neonatologists, especially in private practice (which I'm not), have much more free time than general pediatricians. Yes, I will be on call for the rest of my life, but I love what I do.

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