I was post call as of 6am this morning. My responsibility then is to finish notes, orders, sign offs, and get out before 12, so at that point it becomes someone else's job to receive the babies from delivery...however that person wasn't here as chance would have it, when the pager sounded off "21 weeks gestational age, room 1B". I didn't think about the implications of what that said, I just got up and walked to the door. Just as I was about to go to it Karly stopped me and said, "Hey, you're post call, I'll take it." Which was nice of her, I objected I didn't have much to do at the moment, but she and I have a friendly competition to see who can do more while on service...because she would get this one, we would now be tied...I smiled and let her take it, letting it pass out of my mind.
Flash forward to 30 minutes later. I come in and find her sobbing. When they said "21 weeks gestation" over the pager earlier, I had simply thought, "another delivery.", what I hadn't taken into consideration is that a baby younger than 23-24 weeks is almost always non-viable (the cut off gets younger with technology getting better...this is where we are at right now). When I say non-viable, it's a cold way of saying the baby will die regardless of our intervention. She said the mother, knowing the baby wouldn't make it, didn't want to hold it or get attached...they had decided to make the baby comfortable as it passed on. The grandmother held it as it lay there in her arms, suffocating because it's lungs were not ready yet, it's brain not fully developed, pick a reason, the baby was dieing.
As rounds came Karly got back to business and probably pushed it to the back of her mind. Life went on. I have yet to experience a child's death. I've been faced with cancer patients who found out in front of me they weren't going to make it. I've seen a elderly person, with family gathered round, slip into a deep sleep. It's easy to say they've had a decent life or they chose that fate (smokers, alcoholics, ect.). I don't know how I rationalize a little person, just starting out, suffocating in his grandmothers arms. I don't know how I'd rationalize one of my patients dieing.
Kids in general if sick, get better. Even in pediatric cancer patients, most of them come around amazingly (the most common - leukemia[ALL] has a very good prognosis these days). I realized I've been insulated from death and I subconsciously have believed that this is some kind of movie and all of my patients will survive, that if I do everything right...then they will BE alright.
I was reading a pediatric diseases book last night, studying different diseases I was worried about while on call, making sure I knew what to do should XXX situation arise. I saw the percentage of N.E.C. patients that die of the disease (~25-30%). Numbers are a part of my life, I see tons of them all day long in labs, books, computers, ect. Mostly I quickly pass them over and make a decision based on them, even when I was reading over that death rate percentage as a student, it was just another thing I needed to know...but last night I stopped at it. 25-30% of patients with NEC will die, 25-30% of MY patients with NEC will die. It's like I had been a blind man and now I'm looking for the first time upon a tree.
Newbie-Doc
