She had been admitted the day before I was on call because she was severely hyponatremic [had a marked deficiency of sodium, an essential electrolyte, in her blood]. As soon as she hit the floor, all these consulting services came to see her: genetics, renal, neurology, and endocrinology, you name it, they came by. Harrison, the intern who had admitted her, signed her out to me, saying that nobody knew what the hell was going on with her but that it didn’t really matter because she was DNR, and if she crumped, I wasn’t supposed to do anything but stand by and watch. The only scut he told me to do was that if she died, I was supposed to call the neurologist so they could do a brain biopsy [take a specimen of brain in hopes that studying it would suggest a diagnosis].
It hadn’t been a bad night; things were pretty quiet. Then at about eight o’clock, a nurse came and told me and the resident that the baby’s breathing had stopped for a few seconds but then started again. The resident and I went in to look, and sure enough, she was having these long pauses in breathing. I did a quick physical exam and couldn’t find anything specific that was different except the breathing pattern. We asked the nurse just to watch her, and we went back to the nurses’ station.
About five minutes later, the nurse came running out again, saying, “Now she’s not breathing at all!” We went back into the room and found that the nurse was right; the baby wasn’t breathing; she was also bradycardic [had a slow heart rate]. The resident grabbed an ambubag and started bagging her and the heart rate started coming up again. Then all of a sudden it hit me: We were resuscitating a DNR baby. By that point it was too late: The heart rate had come back to normal.
I felt bad; I mean, this might have been the baby’s one chance to die, and by resuscitating her, we kind of screwed that up. No telling how much longer the baby was going to hang on now. I went back in to talk to the father, who had been sitting in the room this whole time, to tell him we weren’t going to do any more resuscitation. The father agreed.
About an hour later, the nurse came to tell us the baby wasn’t breathing. We went back into the room, but this time we just quietly walked over to the bedside and listened to her chest. She still had a heart rate, but there wasn’t much respiratory effort left in her. She was white as a sheet; I’ve never seen a baby that white before.
We stood over her like that for a while, occasionally listening to her heart, and finally, after about fifteen minutes, it stopped. The baby was dead. I looked up to the resident, expecting him to say something, and he just stood there with a goofy look on his face. I was thinking, You’re in charge, you’ve got to say something. But he didn’t say a word. It was very uncomfortable for a while, and finally I had to say it. I had to tell the father that the baby had died. There I am again, having to tell a parent that his kid was dead. I still have no formal training in it, but once again, the job fell to me. Why am I always the one? At least this time, everyone was expecting it, so it didn’t come as a shock. But it still made my skin crawl.
I took the father outside the room and let him sit by himself for a while. Then I had the nurses come back and together we cleaned the baby up, took out all the tubes and stuff that had been in her. We swaddled her in a blanket and cleaned up the room. I had learned to do this in the NICU; after babies had died in there, the attending always tried to put everything in order before letting the parents spend time with their child. It made a lot of sense to me. So when we were all ready, the father came back in, I handed him the baby and sat him down on a chair. He held the baby, and we all left the room so he’d have some privacy. Standing outside, I could hear him cry. I started crying a little myself.
After a few minutes, I went to call the neurology attending. She was a total bitch; she yelled at me for not calling when the baby had stopped breathing the first time. I told her I had been told to call her after the baby had died, not when the baby was dying. I thought I was doing them all a favor, and all I got for it was a bunch of abuse. She told me I might have ruined any chance of making a diagnosis because of the delay. Shit!
Well, that was my last night on call. I’ve been feeling a little better, though. I wasn’t completely depressed at work today. I actually enjoyed myself a little bit. I realized there are two things that make me enjoy work: sleep and not being on call. Being on call is the worst because when you’re on call, even if you get very tired and you have tons of work to do, you still have to do it, there’s no one around to help you out. It’s very stressful. Being postcall is next worst because you’re really tired and you always have a fair amount of work still to do, but you feel some relief because you’re finally off the hook. Of course, the best time is when you’re not on call and you’re not tired, like today. I really liked that, it was really nice. Internship could almost be good if there were more times like today.