ANTOINETTE: Gonna Be Alright?

Rise up this mornin’,
Smiled with the risin’ sun,
Three little birds
Pitch by my doorstep
Singin’ sweet songs
Of melodies pure and true,
Sayin’, “This is my message to you:”
Singin’: “Don’t worry about a thing, worry about a thing, oh!
Every little thing gonna be alright. Don’t worry!”

Some mornings, I need a little Bob Marley to get me going. Today was one of those mornings. I was tired and cranky and about to start a 13-hour nursery shift while on my pediatrics rotation. Then I saw Baby D, swaddled in hospital blankets and lying in his neonatal ICU (NICU) crib. I grinned widely to myself.

Mommy D had been my patient at the end of July when I was on the Labor & Delivery OB service. She was 25 years old, just a year younger than me, and she was pregnant with Baby #4. Of her 3 kids, she only had custody of one; she wasn’t even sure if she was going to keep Baby D.

Mommy D was addicted to crack cocaine.

It could have been the reason why her water ruptured prematurely at 30.2 weeks. And as a result Baby D was struggling in utero with almost no amniotic fluid to cushion him. On ultrasound, he wasn’t breathing or moving much. We tried to prolong Baby D’s delivery as long as possible, to give his lungs a chance to mature, but he was eventually welcomed into the world, albeit 2 months early.

Fast forward one month. Mommy D has not visited or called about Baby D in the NICU since she was discharged from the hospital. Baby D has periventricular leukomalacia and some calcifications of the brain (maybe due to a maternal TORCH infection). He may also have microcephaly and long-term neuro deficits. Essentially, Mommy D’s addiction has caused holes in Baby D’s brain. It was like one of those Saturday morning public service announcements – this is your brain on drugs – but in the flesh, in the form of this infant in my arms.

DFACS has been called and Baby D will probably be discharged to foster care once he’s stable and eating on his own. As I rocked him for almost an hour, holding him tight to my chest and humming a song, I couldn’t keep the tears back. What a sweet, sweet baby. With so many cards stacked against him already.

I’m going to listen to Whitney and my mentor on this one: Crack is whack. It ruins lives. It strips people of their futures. It kills hope.

So often, I’m plagued by the question: Is every little thing gonna be alright? I’d like to think so. But I know the truth is: not always.

So, I’ll make sure to hug Baby D extra tight tomorrow, even if it does cause tears to roll down my face.

TONY: Just Her Time…

I’ve been trying to remember every piece of this for the last month but time, as it often does, has managed to wipe many of the details away.  I suppose the best way to bring you back with me would be to tell you about the images that I still see when I close my eyes and think of my second day on surgery:  I can hear the cacophony of the bells, whistles, horns, and sirens of each monitor in the ICU room; I can see the heart monitor and watch as the normal rhythm changes suddenly to a pattern of tombstones racing across the screen; I can feel every muscle in my body tiring as I start my sixth round of chest compressions; I can pull my sneaker off of the floor and wonder why I was stuck to the ground for a moment, then realize that the linoleum is covered with blood;  I can hear fluid sloshing around in her lungs and underneath her skin as I pound on her chest; I can see the look of defeat in the eyes of everyone in the room when resuscitation efforts are called off; and I can still sense the stillness in the air of the room in the moments before it all started.

This patient came into the ER the night before for a problem that required immediate surgical intervention.  The surgery was long and reasonably complicated, but the patient was stable when she came out.  She ended up passing away approximately 12 hours after she returned from the operating room.  Within those twelve hours, her blood pressure readings were dangerously low.  Clinically, however, she did not appear as if her BP could possibly be as low as the machines were indicating, so hours were spent replacing cuffs, inserting new lines, and insisting that the blood pressure that we continued to read on the monitors was incorrect.  As it turned out, the blood pressure was being read correctly the entire time.  Every resident and attending racked their brains that afternoon, knowing that something just wasn’t right, but not prepared to second guess their treatment.  After all was said and done, three residents and I sat in the silent room, the patient’s cold body lying on the bed before us, wondering aloud if anything could have been done differently.  Everyone agreed, or perhaps was forced by defeat to agree, that every other path of management would have lead to the same outcome.

I know that this woman was eulogized by somebody, somewhere later that week.  If I know eulogies, much was made of the tragedy of this young woman’s death, but the universal consolation was that it was simply ‘her time’.  Some being greater than us had decided that her life on this earth was over.  Simple, really.  But as you enter the medical field, those consolations start to feel more and more empty.  Was it simply this woman’s time?  Or did your action, or lack of action, your judgment call, your mistake force the hands of the clock?

Welcome to the real part of medical school, kids.