And I don’t know what you’re supposed to feed these things. I don’t know how much they’re supposed to eat, how much they’re supposed to pee, nothing! If it weren’t for the nurses, who, thank God, seem to know what the hell’s going on, I’d probably have managed to kill off every last kid by now!
And even if I did know all that simple, obvious stuff, there’s all this other information I don’t even have a clue about. There isn’t one word that they use in there that even sounds like anything I’ve ever heard outside the unit. It’s like they make up terms just to make our lives more miserable, if it’s possible to be more miserable than I already am! Every one of those kids has biochemical rickets. What the hell is biochemical rickets? I have no idea! And besides that, who cares?
As you can tell, all these little annoyances aside, I’m really having a lot of fun. I’m really enjoying taking care of these bags of protoplasm. My favorite patient is this kid Moreno. He’s a three-month-old with congenital hydrocephalus. [Hydrocephalus is a condition in which an excessive amount of cerebrospinal fluid, the substance that normally bathes and protects the brain and spinal cord, accumulates in the skull. Usually it is due to obstruction of flow of the fluid from the brain, where it is produced, to the spinal cord, where it is absorbed. When hydrocephalus occurs at birth, it is usually caused by an abnormality in the formation of the brain.] This kid is all head! He weighs twenty-five hundred grams, and about twenty-three hundred of those are housed above his neck. And of those twenty-three hundred grams, 99 percent of that is fluid. His cerebral cortex looks like a ribbon around a water balloon. And that’s after he had a shunt put in that seems to be working. [A shunt is a piece of plastic tubing, one end of which is placed in the brain, the other end of which is placed in either the abdominal cavity, the chest, or the heart, that drains the cerebrospinal fluid out of the brain in patients with hydrocephalus.] His head circumference today was forty-nine centimeters. [Normal head circumference for a newborn is thirty-five centimeters. At three months, the head circumference should be about forty centimeters.] This kid’s got a great prognosis!
So anyway, Moreno’s mother called me today. I wasn’t in a very good mood, having been up all night and not having understood anything anybody has said to me in nearly three days, so I wasn’t really in much of a mood to put up with her. She calls every few days to ask what the kid’s head circumference is. She’s fixated on his head circumference. I told her it was forty-nine centimeters this morning and she got all panicky, saying it was only forty-eight centimeters on Sunday and now it was a centimeter larger, and wasn’t I worried about it, and what was I going to do about it? I calmly explained to her that no, I wasn’t worried about it because it had been forty-nine centimeters when I got there on Monday and it was still forty-nine centimeters now and he wasn’t irritable or vomiting and he didn’t have any of the other signs of increased intracranial pressure, and since the neurosurgeons and the neurologists had been by to see him and neither of them had been upset by his head circumference, I wasn’t going to do anything about it. I think I also told her that I was happy that his head circumference was forty-nine centimeters, I was pleased as Punch, and if she wanted to find someone who wasn’t happy, I suggested she call the neurosurgeons or Ed Norris to see what they think. I think I said that, but I’m not sure because, like I say, I was kind of tired and I haven’t been making much sense over the past few days. But I’m pretty sure of one thing: I don’t think Mrs. Moreno is going to be calling me much during the rest of the month!
Well, there is one saving grace about working in this torture chamber. Some of the night nurses are extremely cute. One in particular: dark, brown hair, really beautiful. Damn! She almost makes it worth staying up all night. But not quite. Nothing could really make it worth staying up all night.
I must say, my progress notes have deteriorated significantly. I never really wrote very good notes in the first place; in fact, my progress notes have been voted among the worst ever seen at Mount Scopus Hospital. Recently, no one’s been able to read any of them. But at least they used to be short. Now, because of all the problems these kids have, instead of my usual three or four lines of unreadable scribble, I now write whole pages of unreadable scribble.
What a stupid thing to do to us, throw us in the middle of this unit when we don’t know what the hell we’re doing. And Norris screams at us that they’re our patients! Bullshit! He should be thrown in jail if he really thinks they’re our patients! None of us knows what the hell we’re doing with them. All right, show us around, give us a week or two to figure out what’s going on, then you can think of them as if they were our patients. At this point we can have virtually nothing to do with their care, because we know virtually nothing about how to care for them.