Saturday, April 9, 2011

Blood, Guts, and Baby Butts

I never realized that I would end up on a neonatal intensive care rotation at the end of my medical school career. I only have a couple months left before I graduate and go on my residency. So here I am, fulfilling my last pediatrics requirement in a NICU.

NICU is hospital standard for works excessively long-spawned-by-satan-hours with territorial nurses, flirtatious respiratory technicians, a couple nazi lactation specialists, and lots of babies.

Neonatal Intensive Care Unit, or NICU, is the place where the babies whom are premature, have jaundice, or have serious heart and lung problems are brought to in order to keep them alive. If you manage to gain access to a NICU-- it's like Fort Knox on a good day--you must first scrub your hands clean for hours with a scouring pad. Keeping the germs out is important. The little ones are so tiny and delicate that even the smallest bug could kill them.

The NICU is an endless maze of little glowing pods with tiny baby butts in them. Some of these pods, or nesting units as we call them, glow more than others. The brighter pods use blue lights and have little iridescently lit baby beds that put Tron to shame. These babies are are our community sunbathers. Wearing seriously cute shades, they chill it out under lights like burgers at McDonalds. Do you want fries with your baby?

These tiny munchers have hyperbilirubinemia, which is due to the destruction of their blood cells. The sunbathing, or phototherapy, breaks down the bilirubin and the baby can go home after a few days.

As a medical student working in the hospital, you tend to want your patients to go home. It's the first concept that residents teach their students: do everything you can to send the patient home. Residents feel that the most important thing that they can pass on to the next generation of doctors is cynicism. It's like the intern motto. "Be cynical. Be all cynical you can be." Well, that and "Talk isn't cheap: Charge your patient $100 for every minute and it will be worth listening to them."

But as any good medical student wouldn't do, I resist those notions, especially on this rotation. I like having my baby patients. They are cute, adorable, and you just can't help but say every freaking five minutes, "Ahhh how cuuuute!!!" It drives the attending physicians nuts.

That and the nurses have to check your purse every time you leave just to make sure you are not carrying out a baby in it. Yep, most of these babies are so small that you can actually fit them into a normal sized purse.

The downside to this rotation other than the terrible 14 days in a row shifts of 12 hours per day (seriously we only get 4 days off the entire month)... weekends? What are weekends? Anyway, the biggest downside is when the babies die.

This is where a team of doctors, nurses and technicians crammed around a tiny baby the size of a basketball player's palm, trying to shove tubes down its throat to keep it from dying... while three bewildered medicals students stood afar off in stark terror. You ever feel your face turn white? I never thought I would know how that would feel until that day.

I've seen adults code. Adult heart attacks are like a free for all, every one pushing to get a chance to save the patient's life. Medical students have been known to go all Mike Tyson on each other just so they can be the first one at a code. Heck, you rush in there, practically trampling your colleague... (getting ten stitches won't kill her, she'll live)... just so you can jump on the patient's chest and perform that amazing CPR which you've been dying to try. And even as the patient's bones crack under your hands... yes, if you are doing CPR right then the patient's ribs will break... you don't stop, because you are saving a life.

But when a baby starts to code, medical students all go silent... like soulless zombies. No one rushed in, kicking the snot out of their best friend to get to do the CPR. Not one of us was man enough to jump into that case. Okay, so we were all women, but that's not my point... the point is that we were all to afraid that we would make a mistake.

Not one us felt we were able to handle CPR on a baby whose chest was no bigger than an Iphone. This was not a case of "you break it, you buy it." This was a baby.

And fortunately, that baby lived.

I admire neonatal docs.