What's The Worst That Could Happen?

In our lives, we are privileged to have a certain number of Memorable Days - days which will stand out in our memories for the rest of our lives. (Or until we get all old and senile) And if you're lucky enough to be a resident working on call, you have the unique opportunity of having one of those Memorable Days co-incide with a Call Day, meaning it will last for a full thirty hours. Unfortunately, some of these Memorable Days stand out for the sheer horrible-ness-osity of them.

I had my first NICU call on Tuesday.

Here is some background on the NICU set-up: The team consists of three residents - one first year (me!), a second year and a third year. There is also a NICU fellow and the attending. For some reasons the rooms aren't numbered - they're labeled with names. Animal names, to be exact. So we have the Bunny, Bear, Deer, Elephant, Lion, Koala, Giraffe and Zebra rooms. The area is actually quite huge, so we wear walkie-talkie thingies (called Vocera).

Not surprisingly, I don't know all that much about taking care of babies in general - not to mention premature babies that weigh 860 grams (for comparison's sake - a loaf of bread weighs 680 grams). So I was happy to know that all those people would be there to teach me, and guide me and basically save my butt.

Except... On Monday, my 'orientation' consisted of "Here's the Vocera. Rounds start at nine." That was pretty much it. I knew a little about the four patients I was picking up from the last intern. I knew that there were a bunch of calculations I was supposed to do - not what or how, though. I winged my way through on Monday, but amid a crisis (not related to my patients) and other hullaballoo, I really didn't get any more instruction. And then I had to leave for clinic.

So, Tuesday morning felt as new to me as Monday did. And the third year had the day off, so we had to cross-cover her patients. Meaning, I had to round on eleven babies - still not really knowing the babies or the calculations or even what room was what.

The second year resident was post call, so we rounded on her patients first so she could get out by noon. Which left me to round with the attending and fellow by myself.

I think I mentioned that the attending on service is the Head of Pediatrics? Did I mention that he's from the East Coast? And, quite stereotypically, is very smart, very picky, and very not afraid to reprimand dumb interns during their presentations. And, unfortunately, he very much didn't know that it was only my second day.

It just went on and on. Me presenting, him yelling at me, me presenting while trying to not burst into tears. And, then? In the middle of all of it? My period started. Early. So I wasn't prepared. So. Add to the yelling, and fighting back tears, the worry that I was going to bleed through my scrubs and be on display to all the nurses and parents of these tiny babies. (Thankfully, I didn't bleed through - until Wednesday morning, that is.)

Rounds didn't end until 12:55, and we had a discharge planning meeting at 1:00. So, I did get lunch! And then I got to go over the disposition of all 30+ babies on the service with the social workers. Did I mention that it was my second day? I DON'T KNOW WHEN THE BABIES ARE LEAVING. Thankfully, the (very nice) fellow helped me with that.

After the meeting, I started working on a new admission. The fellow was supposed to help me, but... he disappeared. He left with a ground transport team to go pick up a sick baby at a different hospital.

Wait.

He left.

My back-up.

The person who knew the patients.

And how to manage NICU babies.

Left me alone.

The attending was still there. But... He scares me!

They did call in another fellow to help out. But she was ABSOLUTELY USELESS. She read articles. And she didn't put on her walkie-talkie. So everyone called me with the issues. Baby isn't peeing. Baby has a distended stomach. Baby's temperature is down. Baby's glucose is 35. Baby's CO2 is up to 75...

These are things that a week from now, I will know how to handle. But not on my first real day.

It was so awful.

I wasn't so successful at holding back the tears for a few hours there. I didn't know it was possible to be on the verge of tears for hours on end - and still run around writing orders and filling out paperwork. But it is.

The night fellow came in around five - so I was really only alone for three hours, but man it felt like longer.

The night fellow was a great person - very smart and on top of things and relaxed. But I am used to working with other residents - working as a team, checking in a lot with the other person. It's not quite the same with a fellow.

I did get to put in an umbilical vein catheter, which was cool. (And so easy!) But most of the night, I felt totally lost and stressed.

I finally crashed around 2 am. I couldn't stay awake any longer. I actually ended up getting over two hours of sleep. By Wednesday morning, I felt much better. Except for the diarrhea. But I won't go there.

I was doing okay getting vitals and numbers on Wednesay, feeling much more in control (it was, after all, my third day!). But then, six am came and went, and the third year resident didn't (the second year had the day off). About 6:15, I started to get worried. Around 6:20, I started panicking. What would I do if the only other resident didn't come? I paged her. No answer. I was about to call the chief resident, when the third year finally arrived. I almost burst into tears again, but this time out of relief.

Writing it all out here, it doesn't sound as bad as it all felt! I think it was all made worse by the fact that I barely got to sit down. Through the whole 30 hours, all I got to drink was one bottle of water, a Diet Pepsi and a cup of coffee. That's about ten times as much liquid as I give my baby that weighs less than two pounds. I don't weigh ten times that baby.

The whole day I felt lost and confused and just plain stupid. And there was no one there for me to complain to!

You know - it probably could have been worse. The patients were relatively stable, no one died, I did get sleep - and I even got out at noon on my post-call day. Plus, I'm off today! I just hope that I never again have a work day as bad as that! I get to do it all again on Saturday, so wish me luck.