".......room 453 decreased fetal heart tones."
It's three am and in being woken up I barely catch those last few words on my in-house pager. I'm wondering if I imagined it, but as the fog clears in my head I realize that they were calling for me...I know you are supposed to be scared, I should have been but I was too groggy to be scared (this was my first night on call by myself, so I should be). I hustle down several hallways to where I think the room is at. There's a woman screaming and people telling her to push. A nurse asks for my name and title, still groggy I say my last name and then say the letters "M.D." behind them...that woke me up. I'm standing at the head of the warmer, this baby's coming to ME, and I better be ready. I check my equipment as best as I can, ask for patient history, and in the meantime I hear a scream...but from a much smaller person (that's a really good sign for me who is now frightened to hell and back). They bring the babe over and all that fear is for nothing. A perfect baby. We wipe him down, give him bulb suctioning, he pees on the RT beside me (close call ;P) pretty much normal and routine. While all this is happening the attending (my boss) rolls in, I report apgar's (a overall sign/rating of how well the baby is doing acutely) to the nurses and my attending says "thanks, I'll grab the paperwork..you can go back to sleep if you want"...WOW. I say "WOW" not because it was exciting (it was definitely that) but because of how big of an ego boost that was to walk in, control the scene (by myself) without my authority ever being questioned, and then my attending speaking to me as an equal...what a rush.
Flash forward to 30 minutes later. My pager goes off again. This time I'm awake. The nurse has lab values and an X-ray of a baby that I am covering for the night (usually you have your own patients, on call you cover everyone's). I check the labs over, look at the X-ray. This little boy was born a "bit" too early and developed a nasty pneumonia, which has been resolving. Looking over the labs I see some trends in values that I don't like, the heart rate is trending just a bit higher than normal for the kid (maybe I'm overreacting), I check respiratory rate which is decreasing along with the O2 sats. Checking the X-ray it looks much improved compared to two days ago. I look back at all the values/vitals and they are "acceptable", buuuutttt I better go down and see the baby. When I get there I see the tiniest human you've ever seen, hooked up to this extremely large mask and machine that's helping him breath. I wash up and listen to him with the stethescope over his chest..."what the hell was that?!?!"...sounded like a little bird tweeting in his lungs. I check his vitals, still right where they were, not helping decide at all on this one. I go out and talk to the nurse, nurses are awesome. I tell her that I am hearing a musical kind of stridorous* sound in the babies breathing, I ask her if she thinks we aught to give the racemic epi prn that one of my co-workers has ordered (I would check that decision with my attending before I did it - I'm pretty high on myself at this point but not that high thank God). The nurse is completely nice, but I think she knows I'm really jumping to conclusions (even if I havn't figured that out yet), so kindly she says "I didn't hear any stridor when I was in there." The respiratory therapist happens to walk by and the nurse and I talk with her, she also doesn't think epi is necessary (I thought the nurse was pretty sure the way she said it...it sucks being wrong, by this point I figure I probably am overreacting), she says the machine sometimes causes the weirdest sounds if there is water in the tube. She goes in and shakes the water out of the tube connected to the babies mask. I listen again and it's miraculously gone. (how stupid am I?) Granted I still don't like the trends I'm seeing in labs and vitals (which are still acceptable), also the nurse notes that she thinks the baby is having more retractions (when you're using more of your muscles to breath harder - a sign that it's more difficult to breath). By this point, I've had a quick reality check.
It's three am and in being woken up I barely catch those last few words on my in-house pager. I'm wondering if I imagined it, but as the fog clears in my head I realize that they were calling for me...I know you are supposed to be scared, I should have been but I was too groggy to be scared (this was my first night on call by myself, so I should be). I hustle down several hallways to where I think the room is at. There's a woman screaming and people telling her to push. A nurse asks for my name and title, still groggy I say my last name and then say the letters "M.D." behind them...that woke me up. I'm standing at the head of the warmer, this baby's coming to ME, and I better be ready. I check my equipment as best as I can, ask for patient history, and in the meantime I hear a scream...but from a much smaller person (that's a really good sign for me who is now frightened to hell and back). They bring the babe over and all that fear is for nothing. A perfect baby. We wipe him down, give him bulb suctioning, he pees on the RT beside me (close call ;P) pretty much normal and routine. While all this is happening the attending (my boss) rolls in, I report apgar's (a overall sign/rating of how well the baby is doing acutely) to the nurses and my attending says "thanks, I'll grab the paperwork..you can go back to sleep if you want"...WOW. I say "WOW" not because it was exciting (it was definitely that) but because of how big of an ego boost that was to walk in, control the scene (by myself) without my authority ever being questioned, and then my attending speaking to me as an equal...what a rush.
Flash forward to 30 minutes later. My pager goes off again. This time I'm awake. The nurse has lab values and an X-ray of a baby that I am covering for the night (usually you have your own patients, on call you cover everyone's). I check the labs over, look at the X-ray. This little boy was born a "bit" too early and developed a nasty pneumonia, which has been resolving. Looking over the labs I see some trends in values that I don't like, the heart rate is trending just a bit higher than normal for the kid (maybe I'm overreacting), I check respiratory rate which is decreasing along with the O2 sats. Checking the X-ray it looks much improved compared to two days ago. I look back at all the values/vitals and they are "acceptable", buuuutttt I better go down and see the baby. When I get there I see the tiniest human you've ever seen, hooked up to this extremely large mask and machine that's helping him breath. I wash up and listen to him with the stethescope over his chest..."what the hell was that?!?!"...sounded like a little bird tweeting in his lungs. I check his vitals, still right where they were, not helping decide at all on this one. I go out and talk to the nurse, nurses are awesome. I tell her that I am hearing a musical kind of stridorous* sound in the babies breathing, I ask her if she thinks we aught to give the racemic epi prn that one of my co-workers has ordered (I would check that decision with my attending before I did it - I'm pretty high on myself at this point but not that high thank God). The nurse is completely nice, but I think she knows I'm really jumping to conclusions (even if I havn't figured that out yet), so kindly she says "I didn't hear any stridor when I was in there." The respiratory therapist happens to walk by and the nurse and I talk with her, she also doesn't think epi is necessary (I thought the nurse was pretty sure the way she said it...it sucks being wrong, by this point I figure I probably am overreacting), she says the machine sometimes causes the weirdest sounds if there is water in the tube. She goes in and shakes the water out of the tube connected to the babies mask. I listen again and it's miraculously gone. (how stupid am I?) Granted I still don't like the trends I'm seeing in labs and vitals (which are still acceptable), also the nurse notes that she thinks the baby is having more retractions (when you're using more of your muscles to breath harder - a sign that it's more difficult to breath). By this point, I've had a quick reality check.
You are inexperienced. You don't know the difference between OK and dangerous. You are not staring as the lead character in your own movie. Talk to the expert before you hurt someone being an idiot!
I'm back down to earth. I swallow my pride and tell the nurse and respiratory therapist "thanks alot for showing me what that was, I had no idea about that. I really appreciate it." (you fight the urge to act like you should have known that...which I know isn't true...it's my THIRD day as an intern! I should be confident when I'm experienced, not confident because I'm arrogant. Dumb!) Now that I am also in understanding that I am the most inexperienced person on the wards, I let them know that just to be safe I'm going to let my attending know about the vitals/labs/retractions. I cringe as I walk back to the residents room to wake up the attending watching this little one. I tell him all that has transpired (I make it quick...conveniently leaving out the whole musical stridor thing), he sleepily looks over the labs/vitals and decides they are "fine". I thank him and come back to the resident's room to write this blog about how arrogant I was just a second ago and how pathetically easy it was to get my head swollen. It's hard to write about.
Regardless if the vitals/labs get better or worse for that baby (which I have confidence in my attending that they won't) I got a very small taste of what has turned alot of good and great doctors into egotistical snobs...some mean/rude to people under them because they simply can. I wish I could say I realized it from the start and checked myself immediately, then I wouldn't have to embarrass myself on this blog. It was so easy to fall into that "star" role in that first delivery. I realized when you tell the people around you (who don't know you) that you are a doctor, they assume experience and authority. The questions they ask you are phrased so much differently than when you are a student, they force answers, statements, ect. that reinforce that role, and if you are as inexperienced as I am, that can be very dangerous thing if it's not caught. It's embarrassing to write about, but it's a good lesson and hopefully one I don' t need retaught again, because I got this lesson for a very cheap price, just a little pride.
