A heartbreaker . . .

If you are one of my many pregnant friends please do not read this post!!

It is sad that I have to provide a disclaimer for this post but I (like many people in the medical field) find myself telling healthcare horror stories and pre-partum anxiety is not something I want to instill in any of my besties. If you do cheat and read please remember that healthy, happy babies are born all day, everyday and they are the norm, not the exception!

We've had several babies this year be admitted on a HIE protocol (hypoxic-ischemic-encephalopathy) and they are just very sad situations. These mom's typically have a completely normal pregnancy and something just flips during their deliveries (the baby gets stuck, heart rate drops . . . each story has a slight variation) and these babies have the dreaded "just don't look good" appearance when they are born. Some immediately have seizures, some have to have chest compressions, some just don't have any respiratory drive . . . again their stories all vary a bit. We admit these babies on a cooling protocol so that we can prevent more of their brain from dying (parts of it will die due to whatever caused their birth depression). So we take this little baby that was happily kicking and hiccuping and keeping mom awake all night jsut 24 hours ago and put them on ventilators and cool their body temperature for 48 hours and just wait to see how much we were able to save of their brain. Sometimes its a lot and these babies go on to live a relatively normal life, unfortunately the ones I've seen so far this year have had variable outcomes. They require a lot of close monitoring in the first few days to keep their blood stable (constantly giving transfusions), monitoring their acid/base balance, measuring if they had a bleed into their head, if their heart is still working properly, etc. It completely rips my heart out to see these nice, normal mom's coming to see their baby who they expected to have home already in their freshly painted room filled with baby toys and shower gifts and asking everyday if we think he/she will survive. :-( Once the baby has been cooled for 48 hours we warm them back up over a 12 hour period to see how they will do. Some do nothing, some have seizures, some wake up. The big benchmark is the MRI of the brain to tell us how much the brain was injured. It's the worst waiting game for a new (already highly hormonal) mother. We have a baby that will be warmed when I am on call next so say some prayers for a good outcome!!!

Stomp!

Part of my Valentines Day gift from Roy included tickets to see Stomp, who had a scheduled stop at the Norton Center on Wednesday. I was post-call (which explains why I am up at 2am posting now) so I definitely felt as though this was the only sort of performance I could stay awake for after a 30 hour shift (loud, high energy). I have to confess I was a little nervous about whether or not I would like Stomp (2 hours of people banging on things sounded like it could go either direction to me) but I have to admit it was INCREDIBLE!! I love live performances of most kinds but it was truly impressive how in sync these performers were - I would be fired on the spot because there is now way I could have kept up!! Also the different sounds they were able to make out of seemingly useless stuff . . . sort of made me want to go home and bang on something :-). They've already left KY but if you get a chance to see it I highly recommend!

On call blues . . .

I am on call tonight - again, and am totally jealous of everyone doing ANYTHING even remotely interesting/fun. The problem with being on call is that I think of things to do (i.e. things I would rather be doing) and think "Oh I'll do that tomorrow!" So my days off turn into these exhausting days of to do marathons just so I feel like I have enough going on in the "real world" to feel human. For example, my last day off I decided I was going to bake for my Junior League secret sister (which subsequently turned into baking for everyone I know), go to spin, shop, read some spanish, have dinner with a friend, run some errands, visit my sister, study for boards, et. al. It's a completely fun disaster :-) Tomorrow I've made plans to go play polo as soon as I get off and then go to game/out with friends (the key post call is to keep moving - sitting should be outlawed). Sunday is last full day off for 2 weeks (3 if you don't call the day I take boards as an off day) - so fun must be had! Plans TBD.

Tonight I have backup (a fellow who completed a pediatric residency and is now in a fellowship to become a neonatologist) which is very comforting!! These little ones like to stop breathing, stop their hearts, stop just about everything that keeps them existing so I am happy there is more than one person keeping them alive! We have a bunch of "sick stable" babies right now (babies who are super sick but for the moment are doing okay). I have mostly babies who were born much too early, a couple who were born with holes in their diaphragm (called a congenital diaphragmatic hernia) so part of their intestines get into the space where their lungs should go so they can't breathe appropriately, a couple where part of their intestines didn't form completely, and one with pulmonary hypertension that has been keeping me in a hypertensive crisis for 3 days. I am giving blood transfusions right now and have a couple follow up labs and HOPING for a pretty quiet night. We will see . . .

I would rather be home with this little guy . . . This is Church and he is the most loving dog I have ever owned, but he completely hates not being able to get on the beds and couches. I caught this photo after I got out of the shower . . . little sneak.

Doesn't that pic just make you want to take a nap?! It does for me!

Hope everyone is having a wonderful Friday!

Inspiration for your day:

What are you reading?

Since I started residency I have read 16 non-medical books on iBooks and Roy must have tired of me burning down the battery in my cell because one of my Christmas gifts was the Nook Color (which I am in LOVE with - I switched some magazine subscriptions to it first and it is perfect!). Last night while I was waiting on some labs to come back I grabbed my Nook and started shopping for some juicy fiction and came across this book by Mary Kay Andrews. Anyone read it? Most of my book recommendations this year have come from Brooke K. (Hedge Fund Wives, Lauren Conrad series), Jay (the Ken Follett books and some financial stuff), and Lauren (Madeleine Wickham and Emily Giffin) but if anyone else has something good to recommend I am open!! So far Savannah Blues is interesting . . . I'll let you know how it turns out!!

Also thanks for the prayers for my call night! My first night alone in the NICU went great (I told my fellow interns the babies must have know they were in survival mode because they all behaved :-). I am on call again on Thursday so it's a GOLDEN WEEKEND!! Yay my favorite! One of my kiddos isn't doing great, he/she was born with part of her skull missing (called aplasia cutis congenita), so now you can pray for him/her :-(.

Just a little mention .. . did you see Dr. McGehee, DVM had her garden featured in Martha Stewart Living this month? She lives in the Lexington area! Nice to have a little local shout out! Hope you are having a Happy Monday!!

Pinterest love

Oh I am in LOVE with Pinterest!!! Recently Ms. Melanie Mauer posted about pinterest.com - a fun new way to keep idea boards online! I think they are PERFECT for people who are big planners - especially for weddings and parties and really just about anything!! Please check the site out, I CAN'T STOP PINNING!!! P.S. I am on call alone in the NICU tomorrow . . . say a little prayer!

Baby Blankets

Last night we had dinner with my aunt and uncle and sweet Lilly in Gtown (shout out for the "thrice" baked potatoes!) and got to talking about baby blankets. Lilly's baby blanket is a hand crocheted blanket that my aunt used because Lilly would pull the blankets over head and she figured she probably wouldn't suffocate if it had holes in it :-). My blanket was made by a friend of my moms and it never left my side for at least 10 years. My husband teases that it has been replaced by a hideous old sleeping bag that I wrap up in when I am home :-). I was thinking of this conversation this morning when I pulled Churchill's blanket out of the dryer:

Church is the puppy and I have no idea why but he will pull up certain parts of the blanket and suck on it . . . very strange. It's a good thing he's not like humans who get attached to one specific blanket because about every 6 months or so we have to reinvest in new "blankies" for him. Hope everyone is having a happy Saturday!!

A Night in the NICU

Oh the NICU . . . we have such a love/hate relationship :-). I love the NICU because it is a place where miracles can happen (because lets be honest, there is nothing miraculous about curing an ear infection) and because you will see diseases there that you just will not see anywhere else. The hate comes from the AWFUL social situations - drug abusing moms, crackhead dads, abusive families etc. where sadly, social services often deems the families suitable to care for these fragile little people.

Well last night was my first 30 hour shift this month and I want to share the good, the bad, and the ugly from my first night back in the NICU. I'll keep the information trim so I don't violate patient confidentiality :-).

The good:

- one of my babies was born with a serious heart problem called a "hypoplastic heart" where part of the heart is underdeveloped and doesn't pump blood well. These babies have to have at least three surgeries to fix the problem and the likelihood that they will live through just the first phase is ~30% depending on the severity and other anomalies!! I've had several babies in the past with this problem and sadly most of my last have either passed away or had an injury to their brain. Well my latest kiddo with this condition is doing GREAT and is going home this weekend to grow and play and get ready for the next phase of his/her treatments. :-) Discharges are happy days.

The less than good:

- We recently had a new baby who was born with both male and female private parts (called ambiguous genitalia) which is really tough for the families first - luckily we looked at the babies chromosomes before he/she was born and found out the babies sex (it helps the families identify with their "little girl" vs. "little boy"). This kiddo will be worked up for things that cause this condition and that will help determine how this baby will do. If its just an anatomy issue then supposedly its a fairly easy fix (at least according to the surgeons).

The ugly:

- we had a baby whose mom tried to self abort at home but the baby lived and now has a lot of issues :-( I won't go into the how's and why's but it is just one of the MANY sad stories.

One of my most memorable babies was a full term baby who was born to lovely parents who tried for several years to get pregnant and had a completely normal pregnancy. However she had a rough delivery and the baby essentially suffocated at birth (called birth asphyxia). He/she was put on a ventilator just so mom could get up to say goodbye :-(. I think about this baby every time I walk in the nursery where the baby was.

I'll leave you a recent quote as told to a resident:

Resident: "Tell me about the dad, what do we know about his family?"

Mom of patient: "Oh it was just one of those meet and greets."

So much of medicine just can't be made up. . .