I Hope

Today was like any other day for the first half. We went around and did the whole gathering labs and patient info, making our orders, and finishing with our notes. The only thing to report is that the little boy I’m taking care of keeps getting sicker. It’s not real appreciable; it’s a really slow kind of “getting sicker”. It seems like every couple of days we have to increase the oxygen or augment his diet, little choices and decisions that by themselves don’t speak to a serious problem, but more and more are worrying me, namely because we don’t have a solid reason for it. Today we got a lot more aggressive with therapy, which I’m happy about. For the last several days we’ve been making little changes and increasing therapy by small increments, which have driven me crazy, but you don’t often jump straight to conclusions with medicine, which I’m bad about. What you do is try the simple stuff and then move to the bigger guns. I often want to go straight to something I KNOW will work, the problem with using higher powered therapy straight off is that you are wasting a lot of resources if you could have done it with a lesser therapy, the higher powered therapies usually have more side effects, and the last (and more “artsy” downside) I think without gradually stepping up therapy, you have no idea what you are dealing with. If you are gradually raising the level of therapy, you are also gradually ruling out the lesser and smaller problems that could cause what you are treating. Today we ruled out all the “We’ll wait it out” or “We’ll just adjust XXX” problems and we had to switch our diagnosis to something a bit worse, BPD (Bronchopulmonary Displasia) which is the neonatal form of COPD (what smokers get). The infants don’t get it from smoking though…they get it from us, among other things.

When these babies are born so small we have to do everything in our power to keep them alive. The lungs aren’t well developed and haven’t produced the right chemicals yet, so they collapse easily. To keep them open we put a tube down their trachea and put in the chemical they need, which is kind of like soap (I’ve heard it tastes like hot dogs…but I won’t try it), we then have to give them oxygen at higher pressures than normal to keep them alive until they can survive on their own. It’s thought that this pressure is one of the causes. In keeping them alive, we have to take the risk it might hurt their lungs…it becomes a necessary evil (like breaking ribs when performing CPR…you just have to…they never show that on Grey’s). The up side in all this is that if we can get him through this rough period his lungs will continue to grow and, by age 8, the damaged part will be a very small portion of his total lung volume.

While it’s possible this is what is causing it and honestly I hope we’ve finally nailed the cause, I’m sitting here wondering, whether our changes to his therapy will work. He’s got about 2-3 more days till we’ll see measurable improvement if it does work…it’s really bugging me…occasionally throughout the day it has occurred to me several times to call my senior (upper level resident) on-call and see how that baby is doing. But I let it go, the baby isn’t going to crash overnight, and we’ve got to give time for the therapy to work…I hope we’ve got it this time, I hope tomorrow when I come back he’ll be better…I hope.