Thoughts from the NICU

08.08.07 | Comment?

For the last 4 weeks, I have spent my days in the cool darkness of the Prenatal Pediatrics Ultrasound Unit, at Columbia CHONY. Tiny kicking figures, fleeting across my monitor, at first incomprehensible but then slowly, delightfully human and complete. Evenings, I ran straight back to my study hole, where with Daniel’s constant encouragement, I worked through 2000 practice questions and related studying for the USMLE. July 31, I emerged from my cavern of ultrasound and study, and took the USMLE 2, culmination of what is termed the Major Clinical Year . It is a thing of myth and legend among those who strive to be doctors, and rightly so… by the time I stumbled home, all my bleary mind could think was “rest, I need rest…” Ah, but it was not to be… in a moment of sheer brilliance, I had signed up to follow “my babies” from the quiet and dark peace of the womb to the harsh, painful world of the Neonatal Intensive Care Unit, where per Columbia’s final requirement I am to prove my fitness to be an independent and trustworthy physician “capable of caring for the most critically ill patients 24hrs a day”. And now here I am. I feel we are struggling together, the babies and I. In their confusing world of needles and cold things and tubes and wires, I think we both feel lost. But despite the exhaustion, the pressure of stressed attending physicians and the “lostness,” beautiful moments of peace have a way of peeking through. One morning, while racing (literally) from incubator to incubator intent on filling out the TPN (total parenteral nutrition) sheets for each infant, I was arrested by the sound of a crying infant. This may seem strange to you–after all, am I not working in a NICU? But, sad to say, many of these infants are so small and fragile and in such respiratory distress that they are often too weak to cry. When they do cry it is a often just a tiny distressed squeeking, and this is what I heard amid the cacophony of alarms that characterize any ICU. I set down my sheets, “purelled” my hands and turned to examine the little one who was making herself heard. Her alarms were going off—Heart rate in the 180s-190s, respirations 70/min, oxygen saturation in the 70s. My heart caught in my throat at the site of this 1 pound baby’s apparent anguish, her tiny arms flailing — and fear on her miniature wrinkled face. The TPN sheets could wait. I unlatched the ports of the incubator, and with one hand gently swaddled the fragile thrashing arms. She is so small that I could stroke both arms and belly with one hand, while my other hand cradled and stroked her head. Suddenly, her crying stopped and the little body under my hands relaxed. She turned her red face to me and opened her eyes wide. My medically trained mind told me she couldn’t possibly see me, could she?—she has retinopathy of prematurity, yet I knew she was watching me intently and peacefully. Then both of her delicate hands grasped onto one of my fingers. She was not able to wrap her ten tiny fingers even half way around one of mine. Eyes wide, crying stopped, she stared straight into my eyes, following my face as I cooed to her. Her heart rate came down, her breathing relaxed and her oxygen saturation rose back to 99%. Peace.

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