Monday, May 03, 2004

nicu nack-you everywhere a nicu

Thoughts that were running through my mind my first day of NICU, during rounds in particular:

"What the hell are you talking about?"
"What the hell are these abbreviations?"
"What the hell are those numbers you're reciting?"
"What the hell is that? Oh, it's a baby."
"No, seriously, what the hell are you talking about?"

Orientation to the NICU is disorientating at best and completely panic-inducing at worst. It's such a strange other planet that you might never know about unless you had a real reason to work there, even if you've been in the hospital for years (which I kind of have, counting med school). First of all, it's the quietest nursery you'll ever be in. Almost fifty babies all in one large, ovoid, track-like ward, all almost completely, eerily silent. There are the babies that look like normal babies; maybe they were full-term, or grew to be, maybe they needed surgery or feeding or whatnot, but are otherwise good to go home pretty soon. These are the exception. The majority are scary little bird babies, all pink and translucent with closed eyes and squirmy movements and little old man faces, who look like they might be screaming their heads off if 1.) they had the lungs to do it, and 2.) if they didn't have that damn tube down their throat. If you like cute little pink fat babies with adorable little reflexes and, oh, OPAQUE SKIN, then the NICU is not the place for you. Well, maybe I shouldn't presume that. It could be the place for you. The real question over the next four weeks is whether or not it's the place for me. But either way, even if it's not, I guess there's really nothing I can do about it.

The one good thing that I've learned from the NICU, even on the first day, is that everyone who works there is really calm in the face of a crisis. Or maybe they have different levels of crisis than we're normally used to. (Crisi-tunity!) During rounds today, the fellow's code pager went off, and she charged over to the bed of the baby who decided at that moment, for whatever reason, to stop breathing. The baby's nurse was, very calmly, bagging the kid, and everyone went about (deliberately and expiditiously, but not running, not spazzing out), collecting the intubation tray, getting more oxygen tubing, checking the equipment. Finally, after what seemed like an eternity (maybe three minutes) of waiting for the kid to come back himself, they intubated, and we waited for a few more moments (probably another full minute) for the sats to rise from the teens back into the 90s.

And that's not even the real story that I wanted to tell you. The REAL story is that the parents of the baby next door had brought a whole tin of marble cake for the nurses station, and while this whole little drama was going on, almost everyone who wasn't involved directly in the code was eyeing this cake, discussing the cake, planning when to eat the cake. I noticed that no one actually touched the cake while the code was going on just a few feet away (that would be a little too bread-and-circus, I suppose), but after the kid was stable on the vent and the respiratory therapist was taping the tube down, we each grabbed a slice, got our stuff, and resumed rounding.

The NICU. Stranger than fiction.

Currently reading: Finally! "The Spirit Catches You And You Fall Down" . It took more than a week, but it came! I guess the 24 hour delivery in Manhattan is not the same option as "Free Delivery." Well, shoot.

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