I had only one admission to the unit on Wednesday, a thirty-weeker [thirty-weeker: a baby born ten weeks prematurely] who did pretty well. We were in the DR when he was born. The obstetric residents thought he was only going to be about twenty-six or twenty-seven weeks; my knees were shaking while I stood in the delivery room waiting for him to come out. The resident and I were very relieved when we saw such a big baby come out. He weighed about thirteen hundred grams, which is gigantic for the NICU. And he didn’t get too sick: He had a little bit of respiratory distress but nothing terrible. All he needed was a little extra oxygen, so we put him in a headbox [a cylindrical Lucite box that covers the head of an infant and through which oxygen can be provided] with 40 percent oxygen. [Normal room air contains 21 percent oxygen; therefore 40 percent oxygen provides about twice the normal concentration of oxygen.] He never retained CO2 [babies with respiratory distress syndrome, a major complication of prematurity caused by underdevelopment of the lungs, develop a buildup of carbon dioxide, or CO2, in the blood], so we didn’t have to intubate him. He should do fine. His mother is seventeen years old and already has a one-and-a-half-year-old at home. She lives with her mother, who essentially takes care of her and the baby as if they were siblings. It’s a funny social system here in the Bronx. Most of our mothers are under twenty, and most live with their mothers, who wind up taking care of the children.
Well, the apartment is quiet. Sarah’s asleep, Larry’s watching TV in the living room. I’m going to go to sleep. I’ve got to be up early tomorrow morning so I can be on call.
Saturday, January 18, 1986, 10:00 P.M.
I haven’t recorded anything in a while. I’ve been very tired and very busy. I’m really enjoying working in the well-baby nursery; it’s the first thing this whole year I could actually see myself doing for the rest of my life. The problem is, there’s no way to do it without doing a fellowship in neonatology first, and that is something I definitely do not want to do. So once again, I’m kind of stuck.
I’ve gotten along very well with a lot of the mothers. They seem to trust me. They trust me even more when I tell them I’ve got a baby of my own who’s almost nine months old. I guess they feel they can identify with me. Frankly, I’m not sure how you can be a pediatrician and give advice to mothers without having your own child. Anyway, it’s been a very rewarding experience.
I’ve pretty much gotten my work down to a routine. When I arrive in the morning, I look at the list of babies who were born the night before. All of these kids need to have physsies [physical exams; all babies get examined within twelve hours of delivery and then again right before discharge]. I find the babies and do the exams. When I’m done with those, I find the list of babies who are supposed to be discharged that day. I find those babies, and one at a time take them out to their mother’s bedside and examine them right in front of their mothers. I found that that gives the mothers the chance to ask about anything they don’t understand or anything they’re concerned about.
It’s amazing how many strange things these women come out with. I had this one woman, a nineteen-year-old who had had her first baby, who asked me about the strawberry hemangioma on her baby’s back. [Strawberry hemangioma is a birthmark composed of a mass of blood vessels; they are very common and usually are of no medical significance; most disappear by the time the child is six years old.] I told the mother it was just a birthmark and that it wasn’t anything to worry about. She asked me three times if I was sure that that was all it was, and each time I told her I was positive. Finally, I asked her why she was so worried about it. She wouldn’t say anything at first, but finally I got her to tell me the story. She said she had heard that some people with AIDS had a skin disease that might be the first thing that’s noticed. I told her that was true, that the skin disease was called Kaposi’s sarcoma. I also told her that babies almost never got Kaposi’s and then I asked why she was so concerned. At first she said it was because the baby’s father had been using drugs for years and she was worried that he might have AIDS, that he might have passed it along to her, and that she might have passed it along to the baby. I worked on her for a while, and I finally got her to admit that she had used drugs a few times about a year ago and that she and the baby’s father had sometimes shared needles. Ever since, all through this pregnancy, she had been scared to death that she had AIDS.
I spent over an hour with her. I asked about all the signs and symptoms that might indicate AIDS. She didn’t have any of them, and I told her that was a very good sign. But she said she had been having trouble sleeping at night for a few months because she was so worried and that it was starting to affect her schoolwork. She goes to Bronx Community College. She told me she wanted to be a lawyer but she honestly didn’t think she was ever going to make it because she was going to die of AIDS. And then, when the baby was born with the strawberry hemangioma, she had become convinced that not only was she going to die of AIDS, so was her baby. She started crying and I held her hand and comforted her.