830am: Rounds start and our team gathers around computers on wheels. The resident reads off numbers and tells us what happened with each baby during the day and night before. I enter orders into the computer (so convenient!) and the attending writes their note. Everything is electronic which is supposed to make things streamlined but not without some hair pulling and keyboard jabbing. You know, the harder you hit the enter key, the better the system works.
11am: Rounds wrap up and I'm thinking about what I'm going to have for lunch when I get called into a room because a breathing tube has slipped out of a premature baby who in fact, does need that breathing tube to live. These things happen sometimes which is why we have experienced respiratory therapists who never leave the unit. They have a new tube ready for me before I even walk in the room. Breathing tube replaced, crisis averted. Mmm, now for lunch.
1230pm: We get called to the delivery of a 33 weeker whose mom was induced 2 days ago (yikes!) for high blood pressure. The baby comes out stunned and not at all happy to be born. So unhappy in fact, that she refuses to breathe for a good 2 minutes. I know she'll come around eventually so I support her with positive pressure ventilation (oxygen by bag and mask) while the nurse stimulates her and dries her off. She gets the whole breathing thing down and we put her little hat on and show her to mom before we whisk her away in her isolette (a heated incubator). I get her settled and draw her blood which involves a radial arterial puncture. So far everything is going smoothly in NICU-land.
7pm: The afternoon has been filled with a smattering of issues here and there. Most of my attention is focused on a baby with suspected Noonan syndrome. She has a heart defect that causes her oxygen depleted blood to mix with her oxygen rich blood coming from her lungs. She also has RDS (respiratory distress syndrome) due to being a bit premature and kidney issues. She's currently on a high frequency oscillating ventilator so we are checking blood gases every few hours. Her big brother and dad visit and I answer their questions as best as I can. Her brother asks me if he can touch her and I want to give him a big hug and tell him that everything will be fine. But I don't, because I don't think it will.
830pm: We are called to a delivery because the OB is going to use the vacuum to help this woman finally have her baby after 5 hours (oy!) of pushing. The vacuum is attached to the top of the baby's head and the OB pulls and pulls and the woman screams and screams and finally this 10 pound baby is born and is pink and fat and doesn't need us at all. I decide to have an elective c-section when the time comes.
9pm: We get a call from labor and delivery that they are going to take a woman who is 27 weeks pregnant for a c-section because she has a placental abruption and is bleeding. I ask when and they say in the next couple of hours. Thankfully, I know not to trust pregnant women who are bleeding. I rally the troops and get a breathing tube ready, order up surfactant and scan through the mom's chart to see what we are dealing with. Her water broke a week ago and she has been on bedrest since. Uh oh. The longer the mom has been ruptured the higher the stakes for the baby.
920pm: See, a couple of hours turned into 20 minutes. The woman began bleeding more heavily and now they are taking her for emergent c-section. We're ready. The baby is larger than we expected (good!) and tries to take a few breaths on her own. I intubate her on the first try (I must be feelin' it tonight) and the resuscitation goes smoothly thanks in no small part to the team of experienced nurses on with me tonight. We take her up to the unit and prep her for line placement. I insert catheters into one umbilical artery and the umbilical vein. Her first blood gas shows that she's doing well and I don't suspect she'll need the ventilator for very long. The whole process takes a couple of hours but without any issues yet, I think she'll sail through the night.
Midnight: Oh it's my lucky night. The nurses are having a party for the July birthdays and there is a potluck going on in the lounge. A snack is just what I need right now. There's nothing that quite mimics my enthusiasm for potlucks in the middle of the night. Ritz crackers and cheese have never tasted this good.
1am: I'm done with my night rounds and find that the sickest baby needs one of her umbilical lines adjusted a bit. Meh, no problem. I'll do this and then head off to bed. Ha! Famous last words. In the process of mucking around with the line a hole appears and the line starts leaking. Please tell me this is not happening. I ask the nurse what meds are going through that line. She says "everything". You know how people say "you are your own worst enemy"? Well not tonight. I know by the way that nurse looked at me when I told her I somehow poked a hole in that line. I take a deep breath and gather all the supplies I need to replace the line. My plan is to thread a new line right beside the old one so that the vessel doesn't close up when I pull the old line out. Seeing as how I haven't had to do this often, I'm a little nervous. But, what can I do? I have to solve the problem I've created. After an hour and a half of MacGyver-like maneuvers I successfully replace the line and everybody is my friend again. I'm bone tired and sweaty but so relieved I almost skip to my call room to take a well earned nap.
230am: On the way to my call room a nurse stops and tells me the micro lab called and one of the babies has a positive blood culture. Ooohhhh darn. I review the baby's chart to see why the blood culture was drawn in the first place since I knew he had been pretty stable. Turns out he had some apnea the day before and as a precaution the team drew a blood culture and complete blood count. Well, now we know why he had apnea. I ordered antibiotics and did another radial artery puncture to send more blood for testing.
330am: Whew! Everything seems to have quieted down and my eyes are getting scratchy. I notice that my stomach is rumbling again but I have neither the desire nor the energy to go in search of food. We are called to a delivery for meconium. The baby comes out not breathing and covered in poo (for lack of a better description) and I intubate to suck out any that might have dribbled below his vocal cords. Nope, nothing there and the intubation was sufficiently obnoxious to him that he lets out a lusty cry and our services are no longer needed. We clean him off a bit and hand him over.
4am: As I cruise back into the unit a nurse stops me and says that the baby we delivered earlier, the 33 weeker, has a positive blood culture for gram negative rods. I'll be honest, I'm a little deflated at this point and hope that she's joking. She's not. Because this type of bacteria can also cause meningitis in neonates, I have to do a lumbar puncture. Did I mention this baby weighs 1200 grams? No probably not because I didn't expect to have to stick a needle in her back! Now, my tried and true method of LPs in infants involves inserting the needle as slow as you can. And then slower. Doing it this way, I rarely go through the space creating a bloody tap. My favorite NICU attending in residency showed me this and I am forever indebted to him. However, the nurse holding the baby in position is not a huge fan of this method. Sorry, getting spinal fluid trumps your charting. I'm feeling a bit tart at this point in the night, errr, morning. I also do an arterial stick for a repeat blood culture and order up some antibiotics.
530am: Getting into my call room bed as the sun is coming up is pure joy. My feet are throbbing (I need to start gellin') and my eyes feel like they are sunken into my head. I have a sour stomach and even more sour breath. I am sticky with dried sweat. Yum.
620am: My alarm goes off and all I can think of is putting both feet on the ground and moving forward or else I'll roll over and close my eyes against the bright sun and even brighter lights of the unit as the day shift nurses roll in with their freshly washed hair and casual chatter. I feel like a troll. I sign out to the oncoming resident and attending. As soon as we finish there's a call for a delivery. I look at the resident and say "It's your turn now." I gather my things and head for the train that will take me home. Home sweet home.
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