Residency 2.5: NICU

My first day on call, we had an admission come in that made my heart sink. A C-section gone horribly wrong resulted in the baby being without oxygen for several minutes, depriving his brain and other organs of life. He arrived to us unresponsive, intubated, bleeding from everywhere. His kidneys were in failure, and all the retained water made him so swollen you couldn't open his eyes. His parents sat in agony at his bedside, fearing the worst and hoping for the best. An EEG and MRI suggested significant brain damage, but it was impossible to predict what he would do. How do you balance telling parents the grim truth without shattering every hope of recovery? Wondering whether he would ever be able to breathe on his own and what was best for her son, his mom whispered to him through tears, "You have to show me what to do, buddy." Within the next 24 hours, he began making purposeful movements, regained his gag reflex, and started to work to breathe over the ventilator. A few days later, he was off the vent and learning how to eat. His kidneys healed and the swelling subsided, revealing a very cute baby. He will still struggle, and will almost certainly have significant developmental delays. Even learning to sit will be a challenge, but at least he will struggle while surrounded by parents, grandparents, and a big sister who love him so much.

I saw other babies who didn't make it. It's never fun to work a weekend that makes the staff say, "Normally we don't have that many die at the same time." But stories like the one above made weekends like that a little less painful. Nonetheless, I'm glad to be done for a while with the NICU, and move on the slightly bigger, slightly healthier kids.

Rex Christi

Today we celebrate the feast day of Christ the King--a King that yes, has conquered death and rules over all, but also a King Who humbled Himself, Who let Himself be beaten down, rejected, denied, betrayed, mocked...for me. And I get upset when I am shot down at work, when I get lonely, when I am not chosen first, when I don't get put on a pedestal for being the best. It seems as good a time as any to break out the Litany of Humility again. Again. Lord, help me remember that blessed are those who are poor, hungry, sorrowful, and persecuted, and that it's okay if I am those things as well.

Litany of Humility

O Jesus, meek and humble of heart, Hear me.

From the desire of being esteemed, Deliver me, O Jesus.
From the desire of being loved, Deliver me, O Jesus.
From the desire of being extolled, Deliver me, O Jesus.
From he desire of being honored, Deliver me, O Jesus.
From the desire of being praised, Deliver me, O Jesus. 
From the desire of being preferred to other, Deliver me, O Jesus. 
From the desire of being consulted, Deliver me, O Jesus.
From the desire of being approved, Deliver me, O Jesus.

From the fear of being humiliated, Deliver me, O Jesus. 
From the fear of being despised, Deliver me, O Jesus. 
From the fear of suffering rebukes, Deliver me, O Jesus. 
From the fear of being calumniated (slandered), Deliver me, O Jesus. 
From the fear of being forgotten, Deliver me, O Jesus. 
From the fear of being ridiculed, Deliver me, O Jesus. 
From the fear of being wronged, Deliver me, O Jesus. 
From the fear of being suspected, Deliver me, O Jesus.  

That others may be loved more than I,
Jesus, grant me the grace to desire it..
That others may be esteemed more than I,
Jesus, grant me the grace to desire it.
That, in the opinion of the world,
others may increase and I may decrease,
Jesus, grant me the grace to desire it.
That others may be chosen and I set aside,
Jesus, grant me the grace to desire it.
That others may be praised and I go unnoticed,
Jesus, grant me the grace to desire it.
That others may be preferred to me in everything,
Jesus, grant me the grace to desire it.
That others may become holier than I,
provided that I may become as holy as I should,
Jesus, grant me the grace to desire it.

Lord, grant us the desire to become Holy through humility.

The Hard Stuff

When I first started this whole doctor thing, people would say, "It must be so hard to be around sick and dying kids." Yeah, I guess, I would reply, and brush it off, because I hadn't seen the really sick, and I hadn't seen the dying. Pretty much everyone got better and went home, and I thought, this isn't so hard after all. Children are resilient, and medicine has advanced so much. We're in the business of curing kids!

Then came the first death, and the second, and then Heme/Onc, and the NICU. And now every time another "Death Notice" email comes through my Inbox, I cringe, because now I know their names. I remember their faces and their voices, their rooms, their parents, their pajamas and their favorite gatorade flavors. And it's awful. I keep trying to think of a "but" statement, like "but it's worth it" or "but I'm grateful to be a part of it" except that today, getting another email, and remembering yet another face, I don't have a silver lining. It's just hard.

Grateful

for seeing babies get better and get to go home
for days off and cinnamon rolls
for a warm bed
for music that lifts my heart to God
for family that ALWAYS keeps me company on my drive home
for a Broncos comeback win
for my health
for God's constant forgiveness
for patients that change my life
for hugs that last a full 7 seconds
for library books
for new super warm gloves
for you!

Residency 2.4: Behavior and Development

Sorry I'm a bit late in posting last month's recap. It was a lovely month in terms of hours--clinic work and such, with a few float in shifts. We had a wide variety of clinics and things to observe--psych visits for ADHD, anxiety, depression; behavioral counseling for toilet training and temper tantrums; playing with kids at a daycare; evaluations for reading delay and IQ tests--all sorts of different things. One of my most entertaining afternoons came in the hearing clinic, where I got to see all sorts of different strategies for testings very young and/or nonverbal children for hearing loss. I also learned a few tricks for when the patient is faking it--not faking that they heard the beeps, faking that they DON'T. Who would have thought I would ever see an 8 year old faking hearing loss? Seriously!

The over-arching sentiment for the month was relief that my family somehow turned out so normal. I saw so many parents at their wit's end from kids who were messed up, and also kids who were debilitated by dysfunctional parents. Maybe I should have had my parents do a B&D rotation when I was in high school, so they could have seen how good they had it!

At any rate, I'm back to inpatient--this month I'm in the Mercy NICU, and got off to a bit of a rough start (don't get me started on my first call shift), but it's getting better.

Also, Happy November! Where is the time going?????