As promised, quotes from call.
"Doctor, would you please see the sick babies last, it slows things down when they are seen first."
-kid you not. The "nurse" asked me to stop seeing the sick babies as they came in and instead make it a priority to see the well babies that I have to review first, so that they can be triaged out, and room made for more babies. That would be possible, if it meant that the "nurses" placed sats monitors on the babies and made sure the oxygen was actually flowing to the babies so that I didn't have to hover over the sick kids...
"I've had 8 admissions so far, and have only seen 5 of them."
-the very, very cool resident covering the transitional NICU (who is my back up) at about midnight, explaining how hectic her night had been, and kind of justifying why she hadn't been able to come over and help out a bit, not that I had really expected it, as I was holding down fort, barely. By holding down the fort, what I really mean was that all of the babies were oxygenated, hydrated, had normal blood sugars, and were warm. Plus (BIG PLUS) I didn't need bailing out to get IVs and bloods. Oh, by the way, of course I knew that she had 8 admission, I had admitted all 8 of those babies to the T-NICU.
"You have bad luck."
-Stating the obvious. The previous Sunday, the doc on that night got 6 hours of sleep! At one point I was 5 babies behind.
"FD in Theatre"
-Nothing like being in the middle of bagging a blue baby and knowing that I'm due in theatre in 5 minutes to be present at a delivery for "fetal distress." Most of the FDs that I've attended have been perfectly well babies. Thankfully, with some aggressive bagging, the blue babies usually pink up, and then there is a minor leap of faith as I hook up the O2 and sats monitor as I run to theatre.
"Doctor, ward 66 called and need you down there urgently"
Ward 66 is the equivalent of our transitional NICU. Of course, they don't tell me why I am needed down there "urgently" and I'm kind of pissed. If the nurses back home asked me to come urgently, I'd likely run. But I could be called down "urgently" because there isn't an order for something stupid. So I walk down. Of course, the moment I arrive, I get called by theatre for a FD. And the urgent call was for a baby who "stopped breathing while feeding" which is because being a "baby friendly" hospital these kids don't get bottles, but rather cup fed. Which seems so un-natural to me.. And the kid who turned blue, was being fed by NG. And even though there is no rational reason for me to do it as far as I am concerned, I do a -FULL- septic work up on the kid, and start him on antibiotics and make him NPO and start IV fluids. Is it likely that the kid suddenly became septic. No. Is it likely that I'll be humiliated in the morning for not making the kid NPO, doing a septic work up and starting Abx. Yes. So, do I treat the kid, or treat because of the expectations of the Bara way. Sadly, I do all this ridiculous stuff to avoid having to defend what would be my decision: to not treat and make sure the feeding tube is in the stomach . And quite frankly, I'm tired of defending my decisions, which are not the Bara Way.
"There are no students today"
-My post-call assignment is to cover the lying-in wards. Essentially, any kids that we are following who is "rooming in" with moms will be evaluated by a peds resident, and the students in the mornings. There are 4 wards to cover. I had no idea yesterday morning who many kids that would be, but figure that it was manageable, given that it would be me, and one or two students to round on the essentially well kids. These are kids who may have high bilirburins, or small babies who we just check up on etc. But sadly, Monday morning, at hour number 24 of work, I find out that this week there are no students. So, post-call, smelly and irritable, I get to see almost 40 FORTY, F-O-R-T-Y newborns.
But, as I leave Bara around 1pm, I had a tiny sense of victory. 3 calls done. No major fuck ups. One more to go.
Will I be a better doctor after this month. Doubt it. I've certainly resuscitated more newborn in this week and a half that I have in 3 previous months of NICU back home, but I don't think I've learned anything I didn't know before. What I've learned is that as long as patients aren't blue, as long as there is glucose in the blood, and as long as that blood is moving well enough, then really all is well.
