Wednesday, February 23, 2005

early this morning

I got to work this morning to find that one of my patients had died just a few hours earlier. It wasn't totally unexpected, but there certainly had been nights where I would have expected it more. Nights that I went home thinking that she'd definitely be gone by the morning, only to come in the next day to find her tenaciously hanging in there, for what it was worth. She had a congenital malformation that was (the euphemisms to beat all medical euphemisms) "incompatible with life." We knew she was probably going to die, and we knew that it was going to happen soon, but still, I was surprised to hear it put so plainly this morning. "Oh, your patient just died." It's ultimately a good thing, the right thing, all the nurses were saying, or some version thereof. Her body just gave out. She'd had enough. And they continued to pack up the baby's things for the parents to take home--the stuffed animals she never got to play with, get well cards she never got to see, pictures of the family that never got to hold her. Behind closed doors, her parents were grieving privately. And out in the lounge, a bevy of grandparents were keeping an eye on the patient's 2 year-old brother, who was singing and running around the family lounge in the same footy-pajamas he was wearing at 4am, when his parents pulled him out of bed and bundled him into the car to race to the hospital in time to say goodbye.

I don't think that being pregnant has changed how I feel about having one of my NICU babies die. Certainly, I'm more paranoid about various congenital malformations and such, seeing nothing but the sickest babies in the tri-state area day in and day out. I'm guilty of scrutinizing my 13-week ultrasound to comfort myself that all of Cletus's abdominal organs are actually in the abdomen, and that everything else is basically where it needs to be. (Disregard the fact that I actually have no idea how to read an ultrasound, or the fact that the FASTER ultrasound didn't get the right views anyway.) So sure, I'm paranoid about my own kid, but the human tragedies of other people's kids still strikes me the same way. I'm sad for them, scared to intrude on the family's privacy, and second-guessing things that we could have done sooner or faster or better, if not to save the patient, then at least to lessen the suffering all around. I'm not more sad now because I'm going to have a kid. It's already sad. Maybe it'll change when Cletus joins us out here in Gaseous Oxygen World, but I don't want it to be more sad for me than it already is. We may lose one kid on the unit, but we can't forget about the fifty-odd other kids that we still have to take care of. I don't know if this ability to compartmenalize makes us callous or jaded or evil or what. I've worked in clinical medicine for the past three and a half years now, and I still don't understand how they (we) do it. I don't know how other people maintain persepective and equilibrium in these situations, but one thing that works for me is just to keep looking forward. Hey, it works for preventing carsickness too.

A few hours after my patient died and the spot had been cleared, I passed by that nursing pod again. Sure enough, there was already a new patient there in her place.

* * *

We have our anatomy scan tomorrow, a.k.a "The Big Ultrasound." We've already had two ultrasounds, but this one is supposed to be really detailed, so that we can get a good look at everything. And I mean everything. Though I have high hopes for spying little bits and pieces that might clue us in on whether Cletus is a gal or a fella, I'm fully aware that 18 weeks might still be a little to early tell with any certainty, or that (depending on ultrasonographer skill) prelim gonadal sightings may be totally off the mark. Part of it depends on Cletus too, and whether s/he decides to be slutty (spreading legs accomodatingly for ultrasounds waves) or prudish (covering up the goods). Joe's scheduled to be in the OR tomorrow, but hopefully his case will either end early or start late enough for him to run across the street and watch the scan with me. But even if he misses it, there's a Peds ER attending who's working on getting certified in ultrasound, and therefore offering to sono anyone and anything in sight. We just may take him up on that.

Currently reading: "Black Hawk Down." Forget my job. How do those guys do it?

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