The Intern Blues(140)

So what’s life like in the NICU? It’s wonderful, great, like a vacation in Cancún during the rainy season. The unit is really very small. You can walk from one side of it to the other in about ten or fifteen steps. But packed into those ten or fifteen steps are some of the sickest patients you could possibly imagine. It’s one disaster after another. There’s a roomful of preemies who don’t do anything all day but seize and try to die; there’s a roomful of cardiacs [babies with congenital heart disease who are being evaluated for or are recovering from cardiac surgery] who only rarely seize but who always are trying to die; there’s a room of miscellaneous disasters; and a fourth room, filled with social holds.

And the unit continues to stay full, mainly because of the topnotch obstetric service. OB is run by a team of killer midwives who are really heavily into what they call “the psychosocial aspects of childbirth.” What that means is, they encourage the mothers to hold their babies right after birth to make sure they bond, no matter what’s happening to the kid. On Saturday, Eric Keyes [a senior resident who was cross-covering the unit] and I were called to the DR stat for fetal distress. We got there and found this tiny midwife pushing on the belly of an enormous pregnant woman. The midwife told us she was applying external abdominal pressure. This pregnant woman must have weighed at least three hundred pounds, and the midwife weighed ninety at most. As she pushed down, it looked as if the midwife was going to be swallowed up by the pregnant woman. Anyway, we looked at the fetal tracing and saw there were late decels [late decelerations: a heart pattern indicative of fetal distress], so Eric suggested maybe they should think about doing a C-section. The midwife gave him a look I was sure would instantly turn Eric to solid rock but apparently it didn’t, because seconds later, when the membranes ruptured and meconium started splattering all over the room, Eric immediately said, “Holy shit, let’s get ready to intubate!” A little while after that, this tiny baby came flying out. The midwife caught it, wrapped it in a towel, and immediately handed it over to the mother.

I thought Eric was going to blow out his cerebral artery right then. He looked at the midwife for a second, then he looked at the baby, who was blue and not breathing, and he yelled, “What the hell is going on here?” The midwife turned to him and said, “Bonding. Shut up and go away!” Eric immediately grabbed the baby away from the mother, brought it over to the warming table, and we started working on it. The kid wasn’t breathing. Eric intubated and sucked out a huge glob of meconium and then we started to bag the kid [blow oxygen through an endotracheal tube directly into the baby’s lungs]. The baby picked up at that point and cried for the first time since birth. His heart rate came up, he started breathing on his own, and he turned pink, which looked much nicer on him than his original blue. It looked like a save.

But that wasn’t the end. Just as we were finishing, the midwife came over and started yelling at Eric, telling him his grabbing the baby away like that severely disturbed the mother-child relationship. Eric said something like, “Oh yeah, sure, anoxic brain damage would have markedly improved the mother-child relationship, right? Bonding to a blue baby is much better than bonding to a pink baby. How stupid of me to interfere.” They then got into a real big shouting match, right there in the DR. Eric told me later the midwives are always like that. He said you can expect to get into at least one argument with them a night. He said he thought there must be a required course in blue-baby bonding in midwife school.

Thursday, June 5, 1986

Today was the Pediatric Department picnic. The people in charge actually gave us the whole day off just to go and have a good time. It’s so out of character, it’s almost frightening!

This morning at about eight-thirty, our attending, Laura Kenyon, showed up and told us just to sign out to her and get the hell out of the hospital. Elizabeth and I were out of there instantaneously! If an attending’s offering, we aren’t about to give her a chance to reconsider. So we drove up to this camp in Chappaqua where the party was going to be. When we got there, we couldn’t believe it. It was acres and acres of green grass and trees. It was great!

The picnic was actually a lot of fun. Just about all of us were able to go. We played softball, ate hamburgers and hot dogs, and drank much too much beer; in other words, we did all the things normal people might do if they were on a company picnic. We did a good job of pretending we were normal, at least for a few hours. It gave us hope that someday we might be able to shed this schizophrenic outer coat we’ve grown and return to the Land of Normalcy.