The Intern Blues(18)
Andy
AUGUST 1985
Thursday, August 1, 1985, 12:40 A.M.
I just got off the phone with Karen, the only nice thing in the entire day. Three days of the NICU done, three and a half more weeks to go. What can I say? It’s another planet.
Saturday, August 3, 1985, 7:00 A.M.
I just woke up. I’m thinking about going back to sleep again, but I’ve got to get to work. Internship is turning out to be so much harder than I thought it would. The NICU is amazing; it’s only about twenty-five yards from one end to the other, and there are four little rooms off the central nursing station. In each of the rooms, which are about ten feet by ten feet, they have five or six tiny babies arranged with all this massive equipment around them. It’s claustrophobic and frightening because each of the kids is so sick. Being in the NICU so far has been a total shock.
I was on call the first day (Monday) and I actually got a couple of hours of sleep. I was on call again on Thursday and it was a horrible, horrible night. We didn’t get any sleep at all. And there were these three kids who kept trying to crump [deteriorating; trying to die] on us. We seemed to be doing a good job of stopping them, but then at about five in the morning, little baby Cortes decided to really crump. Cortes was one of the “ageless” preemies who live in the ICU. She was born fourteen weeks prematurely, weighing about a pound and a half, and she’d lived for four months right on the edge between life and death. We called a CAC [West Bronx’s and Mount Scopus’s term for cardiac arrest; literally, “clear all corridors”; also called a “code”]. I pumped on her little chest for about half an hour while everybody tried to put in IVs and get access. We called for epinephrine [a drug that stimulates the heart to beat], and we called for more epinephrine and we called for bicarbonate [a drug that reverses the buildup of acid that occurs any time blood stops circulating], and we tried to give bicarb intraosseously [through a needle directly into a bone, usually in the lower leg; intraosseous meds are given only in dire emergencies, when an intravenous line cannot be established] and we got a blood gas and the pH was 6.6 [indicating that there’s so much acidity in the blood that life is not possible], and then the heart rate kept slowing down and we gave intracardiac bicarb [through a needle passed through the chest directly into the heart; used as a last-ditch attempt]. And the heart rate came up again. Unbelievable! It looked like she was going to make it, but her color still was really bad. We bagged her [blew oxygen through an ambubag through an endotracheal tube and directly into the lungs] and we pumped her heart, but then she went into V-tach [ventricular tachycardia, a preterminal heart rhythm] and we gave her some lidocaine [an anti-arrhythmic drug, used to reverse an abnormal heart rhythm], and then the surgeons came and did a cut-down [a surgical procedure in which a vein is found and a catheter is placed into it, ensuring direct intravenous access], and we pumped some albumin into the femoral artery. We got another blood gas; it was still 6.6 and the kid had deteriorated into an agonal rhythm [a heart rhythm signifying impending death].
So we stopped the resuscitation. We had been working on her for about an hour, I guess. There was nothing more to do. I left the room and went back to try to finish up the evening scut before the morning shift came on. The baby died. And I felt really, really shocked. I felt stunned, like somebody had hit me over the head with a two-by-four. I had gotten so close to that little baby. She was so sick and so tiny. She was the first patient I ever did CPR [cardiopulmonary resuscitation] on. It’s a strange thing doing CPR on a baby that small. It’s kind of an intimate act. You’ve got your hands all the way around the chest and you’re trying to pump her life back into her. You’re trying to prevent her life from ebbing out of her. It doesn’t matter that the kid’s got snot running out of her nose onto your hands, it doesn’t matter that she looks like shit, you just want her to live so badly! It was terrible when she died.
Laura Kenyon, our attending, came in at about eight. She took a look at me and asked if I was okay. I told her I was fine, and she took me into the on-call room and kicked everybody else out. “Are you really okay?” she asked. At first I told her yeah, but then I said I was really upset and I started crying. I was crying for that little baby whose life we couldn’t save. I told her how much I liked that little baby even though I hardly knew her. I told her how I thought we were going to bring her back to life and keep her from dying. I told her I’d seen other people die when I was in medical school, but this was completely different. It’s different when it’s a baby. She told me it was okay to cry, it was okay to feel bad because it meant you really care about people, about your patients. She said that eventually you’re able not to feel so bad, you can internalize it, but that you always feel something, because each death reminds us of all the others that preceded it.