Call night. Some nights I read a little to stay ahead of the patients I'm covering, mostly I study for about 45 to an hour. Tonight I just finished studying and it's been about seven hours of on again,off again studying (in between deliveries, a lumbar puncture, and a partridge in a pare tree)- I don't think there is anything more I can learn about NEC from a text book or research article...nothing that is going to help my patient anyway.
I came in for call yesterday, after 1 whole day of blissfully doing nothing. I went to a movie, called my family, and hung out at my wife and I's hotel room. I sat on my butt all day and it was great, no worries. When I woke up this morning I felt really "ready" for the day, a day that was probably going to be like every other call day...after all our service was full, totally full of babies that for lack of a better description were also sitting on their bums doing nothing. My six kids were probably the least eventful of the bunch, and that is saying something. So with that in mind, I was making plans for the night, what to do with my spare time...I should have known right then and there how it would go.
When I walked into the resident room, my senior, Maria was pacing the room talking to someone over her pager (Pacing is a bad sign). She looked "out" of it, with dark rings under the eyes and frizzled hair (none of this her normal smooth composure). I could tell her bad night was about to become MY bad morning.
She finally collapsed into her swivel-chair and recited the happenings of the night...it was a really long one for Maria, full of deliveries and pages, mostly about one patient...my patient. A.J., who for the first 7 days of his life, the 7 I'd known him, had been the most normal patient on the NICU...now he was trying to act up on me (and by act up I mean DIE on me).
A.J. is a little 33 week old premie, here mainly to grow and get bigger (what they call a "feeder/grower"). As previously mentioned, he has been easy-peasie. I simply increased his feeds every day and watched him eat, sleep, and poop in happiness (actually sounds pretty awesome huh?). But in the day that I was hanging out relaxing, his bowels were getting into trouble and now I come back to an infant who is pooping blood, vomiting green stuff every couple of hours, and is just generally not a happy camper.
Over the course of the next 30 hours this little fella proceeded to do to me exactly what he had done to Maria, which is to crank my switch from "Relaxed" allllll the way over to "Basket Case". Throughout the day, I skimmed 2 small books on NEC (Necrotizing Entercolitis), looked over the academic websites, poured over ways to diagnose NEC and (most importantly) looked over the ways to treat it. I did know a lot of this from previous experiences with other babies, but A.J. was MY patient, if he tried anything I didn't want to spend a moment in thought as to what needed to be done. At one point it was very touch and go, we had to load him repeatedly with fluids because he was going into shock (where the heart is beating faster than normal to keep blood pressure up, but it can't beat fast enough...that's bad :P). Thankfully, right before we would have brought in the big guns (drugs to help the heart and vessels) he started responding to the fluids. Suddenly, it seemed that as quickly as he had been deemed "really sick" by my senior last night, he had switched over to being "stable" with me (THANK GOD!!! SERIOUSLY...THANK YOU!!)
Everything magically started to get better for this little troublemaker at about 1am last night and hopefully (fingers crossed) that won't change for my little buddy. So with my "To Do's" checked off, my sign-off now signed out, and my patient sleeping soundly (as he should); a frazzled resident with dark baggy eyes, will now leave the call room once again. This resident is just as tired as the last, but happy in the thought that, at least for now, his babies are going to be alright.
Newbie-Doc
