The Intern Blues(87)

I waited until her crying stopped and then I told her that if she wanted, I could take some blood to see if she had antibodies to HIV. She told me she’d thought a lot about getting tested but she was afraid to. She said she didn’t know what she’d do if she turned out to be positive. I told her that was a problem, but I pointed out that she was already suffering and it might all be for nothing; there was a good chance, after all, that she’d turn out to be negative. So I guess I talked her into letting me do the test. I had her sign the consent form, and then I drew her blood. I wore gloves when I was taking it. I felt funny putting on the gloves; it was as if I were saying, “I’ve been telling you I don’t think you have it, but I’m not taking any chances.” She didn’t say anything about the gloves. I don’t know; maybe we make too much out of feeling guilty. So far, whenever I’ve worn gloves, none of the patients or their parents has said a word.

Anyway, I think I did some good for that woman. Here she had been coming to obstetricians for months, always with this dread fear, and nobody had found out anything about it. And just because I spent a little extra time with her, I was able to discover that her life was being completely disrupted by something that might be totally avoidable. I haven’t gotten the results of the blood test yet. But I’m going to see her and the baby in clinic sometime next week, and hopefully by then I’ll have the answer. I felt really good about that one.

I’ve had a couple of cases that didn’t turn out that well, though. And one of those made me feel as bad as that last case made me feel good. During rounds our attending, Joan Cameron, always tells us we should try to push breast feeding whenever we get the chance. I have mixed feelings about breast feeding. I mean, I know it’s the best thing for the baby; it’s supposed to be helpful in preventing infections and things like that, and it’s also supposed to help the bonding process between mother and infant. But it’s not the easiest thing to do. A woman really has to be committed to breast feeding, and she has to have a lot of support from the people around her. If she’s kind of wishy-washy about it, it’s just not going to work out.

Anyway, last week I was talking to this woman who asked me about breast feeding. I gave her the party line: I said yes, it’s the most important thing you could do for your baby. Then she asked if I had breast-fed my baby (I had already mentioned to her about Sarah). And I had to say that I did it for a few weeks only and then stopped because I had to start my internship. And she said something like, “You doctors are all alike! You tell us to do things you wouldn’t be caught dead doing yourself!” And she said some other things that weren’t very nice. Basically she called me a hypocrite and she immediately asked for a bottle of formula.

I knew she was right, and she hit a nerve. I mean, I would have liked to have breast-fed Sarah for longer if I’d had the chance. It makes me pretty angry. Here we are, being told by our attendings that we should advocate breast feeding, but there’s no way I would have been able to do it with my own baby. How can you breast-feed if you’re on call every third night and there’s no place in the hospital to keep your baby while you’re working? That woman was right, it was hypocritical for me to suggest she do something I couldn’t do, and it’s very hypocritical for our faculty to try to get patients to do something that’s best for their babies and not give the house staff the same opportunity. So that situation didn’t work out so well. And I’m still angry about the whole thing.

My night call is just about what I expected. I’ve only gotten sleep a couple of times on nights I’ve been on call. I’m finding something out: I really need only about two hours of sleep to function well the next day. But those two hours have to be between four and six in the morning. If I’m up between four and six, I’m just about worthless the next day. If I sleep those two hours, even if I haven’t seen the bed the rest of the night, I’m fine.

And doing night call in the NICU hasn’t made me feel any more comfortable about working with these tiny babies. If anything, I’ve become more terrified. The unit is brand new; it just opened a couple of months ago, so everything is state of the art. And these babies are so sick! We’ve had three deaths so far this month—two preemies and one full-term kid. I was on call the night the full-term kid was born. That’s something I won’t forget for a long time!

We were called to the DR because of thick mec and late decels [late decelerations: a pattern on fetal heart tracing indicating fetal distress]. The obstetricians decided to do a stat C section and they pulled out the baby, who was covered with mec. I tried to suction her mouth while she was still on the table, but I guess I didn’t get all of it out because she was in respiratory distress almost immediately. [Actually, the baby had probably already aspirated meconium prior to delivery; in this case, suctioning of the oropharynx probably didn’t provide any help in preventing what subsequently happened.] Eric Keyes was the senior on call with me, and he was on the baby as soon as she hit the warming table [the table in the DR on which the baby is placed following delivery]. He intubated her and started suctioning out her airway through the ET tube. He was getting tons of thick mec out. In the meantime, I was listening to her heart. She was really bradycardic [had a low heart rate], so Eric told me to start a line and get ready to push meds. I hadn’t ever started a UV [umbilical vein] line myself, so he talked me through it as he was suctioning out the trachea. When I finally managed to get something in, we changed places so Eric could push the first round of meds. The airway was pretty clear by that point, so I started bagging the baby [pushing oxygen through the endotracheal tube, using an ambubag to generate pressure]. The heart rate came up a little, to about 80 [the normal heart rate for a newborn is 120 to 140 beats per minute], and Eric decided that we’d better get the baby out of the DR and into the ICU right away, so we put the baby in the transport incubator and ran with her down the hall to the unit.