We worked on her all night. We called the neonatal fellow at home, and he came in to help. She had severe respiratory distress and PFC [persistence of the fetal circulation]. We were having trouble ventilating her and getting her blood circulating. We put her on a ventilator and had it turned up to very high settings. [To ventilate a child with mec aspiration, it’s often necessary to use a great deal of pressure with which to push oxygen into the lungs. Meconium causes the lungs to become very stiff, and the pressure is necessary to get them to expand.]
At about four in the morning, she crumped. Eric decided she had a pneumothorax [a collapsed lung, caused, most likely, by the high ventilator pressure that was being used to force air into the baby’s lungs], so he put a chest tube in and she immediately looked better. But she was still hypoxic all night, and at about five in the morning Eric and the neonatal fellow decided to start her on tolazoline, which is supposed to help PFC. It didn’t do her much good. She crumped again at about eight, just when the day crew started showing up. It was another pneumothorax. I didn’t stay any longer than that. I had to get out to the well-baby nursery and start doing my physsies. The baby died a little later that morning.
It was terrible. She had been completely normal. If she hadn’t gotten all fouled up with meconium, she probably would have been a normal child.
That baby’s mother was put on the gyn ward, so I didn’t get a chance to talk to her. They did that so it would be easier for her; it would have been very hard if they’d put her on the regular postpartum ward and she had to be surrounded by all the new mothers with their healthy babies. I don’t know what I would have said to her if I had gone to talk with her. Nothing seems right.
I heard that Angela died a little over a week ago. She spent her last couple of weeks in the ICU at Mount Scopus, comatose. I never thought there’d be so many deaths in a pediatric internship!
Anyway, I’ve got to go to sleep. I’m getting tired and I’m on call again tomorrow, so I’ve got to get a good night’s sleep. I’ve got another week to go in the nursery, then I have two weeks in the OPD and then vacation. I hope I make it until then.
Sunday, January 26, 1986
There are so many crack users around. There are six babies who’ve stayed in the nursery the entire month. The mother of each of these babies is a crackhead and the babies have been taken out of their custody by the BCW. They’re all waiting for foster placements, but it’s hard to find homes for these kids because there’s a good chance they’re infected with HIV. All of them spent their first few weeks of life withdrawing from drugs. It’s sad. For a lot of these children, their lives are already over before they even had a chance to start.
The ICU has been pretty quiet over the past week. There was an outbreak of naf-resistant staph [a type of bacteria that is insensitive to nafcillin, the antibiotic that is most effective in treating staph], so they had to close two whole rooms [closing the rooms and cleaning them is the only effective way to prevent sick newborns from getting infected with the bacteria]. That cut the census by about half, so taking call in there wasn’t so bad. I even got a few hours’ sleep the last two nights I’ve been on. So all in all, it’s been a pretty good month.
We’re going out to New Jersey to visit my father this afternoon. Sarah was nine months old yesterday, so my father’s going to have a little party for her. We haven’t seen him in over a month; he’s starting to feel like we’re trying to avoid him. He still doesn’t understand what it’s like to be an intern. He thinks I’ve got a lot of free time and that we’re just doing other things rather than coming out to see him.
Well, I’m going to stop now. Tomorrow I’ll be back in the Jonas Bronck ICU. Seven months down, five more to go.
Oh, one more thing. That woman who thought her baby’s strawberry hemangioma was a sign of AIDS showed up at clinic this week. I called the lab to get the results of her HIV testing, and guess what? She tested negative! When I told her, she hugged me and kissed me. That’s the first time this whole year when I really thought I had done somebody some good. And it happened only because I took the time to sit and listen to what she had to say. It had nothing to do with medicine.
Mark
JANUARY 1986
Thursday, December 26, 1985
I was on call Tuesday for the first time this month, and it wasn’t too bad. It should have been great: It was Christmas Eve, the ward was quiet, and I had only one admission. I should have gotten six hours of sleep at least, right? Wrong! It was one of those cases where if anything can go wrong, it will go wrong. It was a two-and-a-half-year-old sickler with pneumonia. She was called up from the ER at about eleven-thirty, so I figured great, I’ll go down, bring her up to the floor, do the workup, start her on some antibiotics, and be in bed by one. Of course, that’s not even close to what happened. First, I got down there and found that no one had been able to get an IV into her. Everyone had tried and everyone had failed. So they figured what the hell, let old Mark take the kid up to the ward and have a crack at it. How nice of them! But it turned out okay, because you know what? I got it in on the first stick. That’s right, the very first stick! I’ll tell you, I’m becoming the King of Scut. It just shows you that if you take a plain, ordinary, moronic intern and make him do the same things over and over again until he loses his mind, you can teach him to do almost anything. I think that now that I’ve mastered IVs, I might take up neurosurgery in my spare time.