And even all that would have been okay if it hadn’t have been for the fact that the DR [delivery room] kept calling us to come down to deliveries. That’s the real ulcerogenic part of this job. The rest is just irritating, but the DR is downright frightening. At any moment, without so much as a minute’s warning, you could be called down there and find yourself face to face with a brand-new four-hundred-gram wonder whose only goal in life is to make your next two or three weeks completely unbearable. Also, there are all these little emergencies that come up in the unit, like kids deteriorating or spiking fevers, stuff like that. It’s all such fun!
Last night, I actually got myself in a position to go to sleep at about three o’clock. I was in the on-call room, in my winter coat, getting ready to lie down on the cot. The on-call room is an interesting place. They recently rebuilt the entire ICU and they made us this very nice place to sleep. The only problem is, they forgot to put any heat in there. The average temperature is about forty to forty-five degrees. Sleeping in there is like camping out in Alaska.
Anyway, I was on the cot, getting ready to lay down. I was lowering my head toward the pillow and just as my hair made contact with the pillowcase, my beeper went off, calling me to the DR stat. I went running down there to find it was an uncomplicated problem, a little meconium-stained amniotic fluid. The baby was out by the time we got there and he was fine, just fine. There was nothing we needed to do. So I went back to the unit, got back into the on-call room, put my coat back on, and actually got about an hour of sleep. At five o’clock, I got another stat page. We went running down to the DR, and what did we find? An obstetric resident with her arm, up to the elbow, thrust inside a woman’s vagina. What a romantic sight!
It turned out, this woman had wandered in off the street with a prolapsed cord. [The umbilical cord had come through the cervix and was lying in the vagina. The danger of this is that if the cervix should close up again, blood would stop flowing through the umbilical cord and the fetus would suffer from lack of oxygen, causing either death or severe brain damage.] The resident was trying to push it back up into the uterus while two other people were preparing to do an emergency C-section. The whole thing took about an hour, and when the baby came out, he was just fine! By that point it was eight o’clock in the morning and time for the day crew to show up. I finished with the work on that patient, started drawing the morning bloods, and then started rounds with the rest of the team.
We went on work rounds and then we had attending rounds. I tried to write my notes during all this because I had clinic this afternoon and I didn’t want to have to come back to the unit again after clinic was over. So I got to clinic at Mount Scopus at about two and I got home a little while ago, at about six. A typical thirty-four-hour day; at least I got one whole hour of sleep!
I’ve had some really terrific experiences in the unit over the past week. Really terrific! I’ve got these two kids who are essentially brain stem preparations. One weighed 525 grams at birth and from the very beginning had virtually no chance of surviving. So what do we do? We use everything we have to keep him alive. And all that comes out of it is a great deal of work for me and the other interns. The other kid was good-sized at birth, a thirty-three- or thirty-four-weeker, but the mother had an abruption [abruptio placentae: a condition in which the placenta tears itself off the wall of the uterus, leading to a great deal of bleeding and a severe deficiency of blood in the fetus] and the kid was severely asphyxiated, with Apgars of 0, 0, 3, and 3. Not what you’d call very good. Where I come from, we have a name for children like this: stillborn. So this kid is basically brain dead but we’re keeping the body alive to have something to keep us busy. As if I already didn’t have enough to keep me busy!
This rotation continues to have only one redeeming feature, that being the nurses. These nurses are fantastic. They’re young, real attractive, and real good at their job. Last week one of the night nurses handed me a prescription form. It looked like this:
I’ve been carrying it around ever since. I had lunch with her last week. She seems nice. I don’t want to jeopardize my relationship with Carole; Lord knows it’s already suffered enough! So I don’t think I’ll actually take this any farther. But it sure was nice to get that note. It made me feel . . . it made me feel almost as if I were a human.
Tuesday, February 25, 1986
I haven’t recorded anything in a couple of weeks. I look upon these tape recordings as kind of a funny running monologue, but I haven’t felt very funny over the past two weeks. Working in this unit has been terrible, just terrible, much worse than I ever imagined. We’ve had a lot of deaths and, even worse, we’ve had a lot of survivors, babies who should never have been allowed to live. I don’t want to think back on what’s happened, I just want to look ahead. In just a couple of days I’ll be done with the NICU, and then I’ve got a month in OPD at Mount Scopus, two weeks of vacation, and two more weeks of OPD after that.