You do what? My life as a Neonatologist.

My iPhone Runs My Life!

2012-08-17T10:50:00.001-07:00

I'll admit it, my iPhone runs my life! And it does a really good job of it. I don't know what I did before I had it. Calendar, Reminders, and a multitude of time conserving and life simplifying apps really make my iPhone indispensible.
I use my iPhone extensively in my life both in and outside of the NICU.
Check out the many ways that I use my iPhone here :
The Doctor's Top 10 iPhone Apps

New Year's Resolution: Better Sleep

2012-06-19T16:38:00.001-07:00

I just updated my Zeo Sleep Hygiene Project page with my results thus far for my New Year's Resolution to get better sleep.

Daily Commute on YouTube!

2012-06-06T13:11:00.000-07:00

My Partner in Daily Commute just put out a most awesome video on YouTube! Check it out!
DailyCommuteYouTubeVideo

Rough Day

2012-06-05T16:25:00.001-07:00

Pretty tough day today. Had a little one pass away due to rapidly progressing, fulminant NEC. Such a frustrating disease!

- Posted using BlogPress from my iPad

NICU Slow Down

2012-06-03T05:52:00.001-07:00

Came back to work yesterday after some time off. Things have really slowed down! It's so interesting to note the atmosphere. It's calm, there's less stress. However, you can feel an overall sense of foreboding. "How long will it stay like this?" "Is the hospital going to start cutting hours?" "I'm bored"
It never lasts, but it's interesting to watch. Every unit has its unique personality.

- Posted using BlogPress from my iPad

A Big Request

2012-06-02T09:50:00.001-07:00

I've got a huge favor to ask of my readers! If you use an iPhone, and you try Daily Commute for free. Please, Please, Please write a review. We are very excited about this app and really think that it can be a tremendously useful part of the morning routine saving time and reducing stress. However, I need Your help getting the word out and starting some buzz so please take just a few minutes and write a quick review!
Many Thanks!

- Posted using BlogPress from my iPad

What Daily Commute Did For Me Today

2012-06-02T09:26:00.001-07:00

Today I had the duty of working Saturday in the NICU. Bummer right? Well I used Daily Commute to comfortably leave the house about 15 minutes later than I normally would! I say "comfortably" because normally I would be guessing on this and feeling a little anxious about being late. However, today I had real data generated by Daily Commute so no need to sweat it. I got to work on time, and it felt like I got to sleep in!
Click Here to download Daily Commute for free from The App Store

- Posted using BlogPress from my iPad

My Latest Project: Daily Commute

2012-05-31T15:17:00.000-07:00

It's been a very long time since I've posted on the blog and I'm sorry for that. However, I felt like this would be a great forum to share something that I've been working on and am very excited about. So here is a brief story of the iPhone app Daily Commute!
I love to brainstorm on ways to be more efficient and I love to brainstorm on ways to apply the wondrous technologies that we have at our disposal. One day I was driving to work and was working on being late because I forgot about some traffic anomaly that I should have remembered from the previous day. I had the usual "I wonder if there's an app for that" moment. So I started thinking about what an app might do to get me to work on time and the idea for Daily Commute was born!
I talked to my friend Bobby Wilson who owns Valley Rocket, LLC, a company that develops iPhone apps and he liked the idea. So we got together and drew it up on the white board. The real idea was that by compiling real data about commute times, one could much more accurately predict when they need to leave for work each day. The end product uses your data to give you an exact "leave time" based on your desired arrival time and even gives you a full screen count down timer.
It's been so much fun doing this project, and the end result is exactly what I envisioned. We are currently hard at work with ideas for improvements and enhancements for future versions. So encourage anyone reading my blog who is an iPhone user and interested in making their commute routine a little more sane to check out Daily Commute. It's free to download from the app store and you can read more about it by following the link below!

Daily Commute

Lightening Crashes

2010-03-31T06:34:00.000-07:00

I had not met her before, though I had heard the birth story. Rapidly and unexpectedly, in the wee hours of the morning, her baby, an arguably nonviable fetus, was born. There was no time for lengthy discussion, and her baby was resuscitated. At two days of age, I am going to explain to this mother that her baby has a unilateral grade IV intraventricular hemorrhage.
I spend several minutes explaining in the simplest terms what IVH is and why premature babies are at risk for it. I methodically explain the four grades of IVH which relate to severity. I carefully outline the potential complication of post hemorrhagic hydrocephalus with grade III and grade IV hemorrhages and the possible need for a VP shunt with this complication. I then cautiously explain the association of grade III and grade IV hemorrhages with profound neurodevelopmental impairment.
This mother nods understanding throughout the discussion. Her expression is one of quiet comprehension. I wonder does she really understand or is she just pretending to follow. At this point I tell her that her baby has a grade IV hemorrhage on one side of the brain. CRACK! It's as if I've been concealing a blunt object and have now delivered a powerful blow to the face. Tears followed by sobs and the shattered appearance.
I feel villainous. How could I attack this poor defenseless person with so cruel a weapon? I spend several minutes answering questions related to prognosis and expressing my condolences before I retreat to allow her time to reflect.
A partner senses my brooding and inquires about it. I tell him what I've been doing. It's almost like a confession as I describe my conversation. He tells me that whenever he has an experience like this he reminds himself that, "if the mother doesn't cry, then you haven't made your point". I still feel terrible, but gain some comfort in knowing that if I were in that situation, I would want to get the point.

"We reserve the right to refuse service to anyone talking on a cellphone"

2010-03-26T08:32:00.000-07:00

This morning one of my partners asked for me to share my view on cellphone use in the delivery room. He was speaking specifically about the emerging phenomenon of multiple family members taking photos, notifying friends, or uploading a "birth documentary", and he knew that I could offer a lighter perspective on this practice. Before I knew it, I was barreling through a sprawling and cathartic dissertation on the growing use of cellphones. I love my cell phone, but here are some of my observations.
One of my most favorite situational cellphone use complaints is when I go to do a prenatal consult and the father, family member, or friend sits in the corner talking on the cellphone. You never hear "Oh my goodness! Is she alright?" nor do you hear "I'm sorry, I'll have to call you back" just the distracting chattering on some topic that is clearly more important than the potential complications facing the soon to be born fetus in the room. Even better is if during the discussion with the mother, a cell phone rings at high volume blurting "ITCHA BIRFDAY SO I KNOW YOU WANNA RIDE OUT" (better when the full ring is allowed to play and then answered).
While some years ago, when I was a resident and people still had home telephones I used to complain about the fact that many mothers would call with a question about their child, but when you tried to call them back, you'd get the recorded "The party that you are trying to reach has 'privacy control'. Please state your name at the beep." However, now I find it much more frequent that I get to "enjoy the music while my party is reached". So in the wee hours of the morning, As I prepare to deliver some concerning news about a baby's deteriorating condition I may get to first listen to "Shorty's like a melody in my head... nah na nah nah everyday...". Great now I'm ready to talk about potentially grave circumstances!
At this point, unexpectedly, my partner trumped me. He explained that he made one of these phone calls one night and got the voice mail box which in a rather saucy voice said, " HEY This is so n so! Leave me a message... If you're HOT... I'll call you back!"
He decided to just try calling back later!

The Pneumatocele

2010-03-24T10:31:00.000-07:00

I'm taking care of a former premie right now who has all of us a bit puzzled by her absolute refusal to part with her ventilator. Despite requiring very little support while on the ventilator, as soon as her endotracheal tube is removed she "tries to run for the bright light". She had a severe pneumonia several weeks ago with MRSA (a kind of staphylococcus which is sometimes a problem in hospitals and can be difficult to treat). With treatment and time, her lungs have improved dramatically, however, she developed a cystic cavity in the right upper lobe of her lung. We call this a pneumatocele, and it sometimes occurs with this type of pneumonia. In consultation with the pediatric pulmonologist, our current hypothesis is that while the ET tube keeps the trachea open, upon its removal, the pneumatocele impinges upon it and causes it to collapse. So the plan is to look down the trachea with a flexible scope to look for any obstruction. If there does appear to be some impingement, a surgical procedure may be necessary.

Chest xray demonstrating a pneumatocele in the right upper lobe

The Prenatal Consult (Part VI)

2010-03-23T11:29:00.000-07:00

This is part VI of a series of posts which also currently includes part I, part II , part III, part IV, and part V.
One of the biggest challenges for all premies is getting adequate nutrition. So this is usually the next area of discussion that I address with parents during the prenatal consult. The last trimester of pregnancy is one in which a lot goes on nutritionally for babies and missing out on it puts them at quite a disadvantage.
I start by pointing out that the premature intestine, like other organs, does not function the same way as a full term intestine. It doesn't move things along very well, it doesn't absorb nutrients as well, and it is at risk to develop some complications (like NEC) that can be problematic. So in the beginning we start by infusing "IV Nutrition" (otherwise known as hyperalimentation). I always point out to mothers that this is a similar way of delivering fat, protein, carbohydrate, vitamins and minerals to what occurs in utero, however, it is inferior. We then begin feeding a small amount of breast milk by NG tube and then gradually increase this over about a week to ten days. I explain that we introduce enteral nutrition this way, and strongly encourage the use of breast milk in an effort to reduce the incidence of NEC. Once the baby is receiving all of the feedings by this route, we use a human milk fortifier to increase the calories as well as some of the vitamins and minerals that are essential for bone mineralization.
I also explain that babies don't develop the reflexes that are necessary to suck, swallow, and breath in a coordinated fashion until they reach about 34 weeks gestation. For this reason, until they are ready, they are fed by a nasogastric tube. Once the baby is able to feed once or twice a day, we gradually increase the number of feeds that the baby gets by bottle as opposed to NG tube. In order to be discharged, the baby must be capable of taking all of the feedings by mouth.
The next topic that I cover is the risk of infection and the likelihood of blood transfusion. So tune in next time.

Friday Pizza Buffet - Attack of the Urchins!

2010-03-12T18:02:00.000-08:00

When I'm working nights, my wife, daughter, and I have a friday ritual as friday night is my last night to work. We go to a local pizza buffet that we love and have a feast for lunch. We used to live near a popular location, but recently moved near a less popular location. It's really been nice. We usually have the whole place to ourselves save for a quiet few others who honor the pizza with soft spoken conversation during lunch. There's never any jockeying for position or trying to time when the cookie pizza will be fresh, hot, and not picked over. Today, our in laws were in town doing us the huge favor of fixing up our old house which we intend to rent. So we thought it would be nice if we drove across town so that they wouldn't have to drive far. My wife went back and forth over the driving across town versus the more serene environment. I didn't have the energy to have an opinion so we drove over to our old feed trough. As we pulled up, to my horror, we noted multiple buses unloading children in uniforms all wound up with the energy of some kind of disorganized trip and prepared to clamor for pizza. As we walked in, I groaned, in fact I believe a few explitives slipped out. It was total chaos! Urchins scrambling about like they were shot out of a pinball machine. Asking, "are you in line?" to the child on their left as they squirmed in front of me in just enough time to scoop up the last two pieces of pepperoni. As I sulked over my plate, head realing with overstimulation, I glanced over at my 11 month old daughter perched in her high chair happy as a clam stuffing about one out of every two chunks of pizza that my wife cut for her successfully into her mouth. She was absolutely thrilled taking in all of the activity like it was the best tv show ever. While I made a mental note to take a page from her book once in a while, I still ran from that place like there was no tomorrow. From now on, friday pizza buffet is permanently relocated!

Attention! Infection Control Barriers - Do Not Remove From Premises!

2010-03-08T17:54:00.000-08:00

So I confess. I sometimes wear my scrubs to and from work laundering them at home, especially when I'm working nights. Through the years I've attempted a change in this habit a number of times but I always seem to gravitate back to the practice at some point. This morning as I was headed home, I overheard a hospital administrator who had spotted a poor post call resident heading out to the parking deck in scrubs saying, "I don't know why they won't just change into their clothes here before leaving!" My primal "haven't slept at home in several nights" alter ego started to pipe up, but I stifled him. Still, in my head the thought "when was the last time you spent the night in the hospital? Wanted to get home to your family, to your bed badly enough to not care what you were wearing? Once you've taken a trip around that block a few times, get back to me on your thoughts here!"
Much has been made over the years about the practice of wearing home laundered scrubs to and from work. I'm not talking about wearing them to Starbucks or the grocery store. Just to and from work. While there are strong opinions on both sides, I think that it's worth noting that there is no evidence that home laundering scrubs increases the risk of spreading infection. In fact, there are published studies in the American Journal of Infection Control 2001, the American Journal of Maternal Child Nursing 2004, and the Journal of Hospital Infection 2006 all of which found no difference in the rate of infection when comparing home laundering to facility laundering of scrubs. There is so little evidence that facility laundering is superior that the CDC makes no recommendation on the subject. It seems that we may be making a mountain out of a mole hill.
Hospital laundered scrubs are not comfortable. I know, I know, this seems like a petty complaint. But when you're spending a number of nights living in these things when the opportunity for sleep could come at odd times, failing to nod off because your garb is stiff and chafing is really, really annoying! A few times through the old Maytag at home renders them much more comfortable. But still not stylish enough for Starbucks, restaurants, or the grocery store!

The Adult Isolette - Order Yours Now!

2010-03-05T10:49:00.000-08:00

Ladies and gentlemen! Presenting for your ultimate luxury and comfort... my latest invention and must-have item... the Adult Isolette! Available in a variety of sizes to fit every length and general body habitus. It is constructed of durable clear plastic and its state-of-the-art double wall design with circulating air flow maintains the most stable of warm, comfy, cozy environments within its luxurious interior. It's like being in your very own comfort cocoon. And that's not all... warm air humidification is easily achieved up to 80% for that "day at the spa" feel. Air tight, hinged port holes on either side make it easy to access items outside of your isolette without affecting the temperature inside. Get yours today!
Just kidding! When I was a resident rotating in the NICU, I'd come in during the wintertime and spend the first hour or so sticking my hands into these wonderfully warm incubators to examine babies. After being outside, it seemed soooo comfortable and enticing. I would dream of having my own adult sized version that I could climb inside and go to sleep. Since that time, I have often joked about my plan of designing "The Adult Isolette". If spring doesn't come around soon, I may just start really building one!

The Prenatal Consult (Part V)

2010-03-04T11:34:00.000-08:00

This is part V of a series of posts which also currently includes part I, part II , part III, and part IV.
The next topic that I cover with parents during a prenatal consult is retinopathy of prematurity or ROP. This is another complication that relates to neurodevelopmental outcome as severe ROP can cause blindness. I start by explaining that this complication also increases in likelihood and severity with decreasing gestational age. I continue by explaining that as a fetus develops in the womb, the small and fragile blood vessels that supply the back of the eye or retina don't grow into the area completely until somewhere around 32-34 weeks gestation. As these blood vessels proliferate and grow, oxygen is toxic to the process. A baby in the womb is exposed to considerably less oxygen than a baby outside of the womb. In addition, premies often have lung disease that requires the use of supplemental oxygen. The result can be ROP.
Currently all babies born at less than 1500g or less than 30 weeks gestation receive a thorough ophthalmology exam by an ophthalmologist at around 34 weeks adjusted age. If ROP is present and severe, the baby may undergo laser treatment in an attempt to spare some of the vision.
Tune in next time for Part VI!

Caught Off Gaurd By A Profound Kinda Crazy!

2010-03-03T08:08:00.000-08:00

One day a little while back I had this encounter with a parent that I feel is worth sharing. It was the end of a rather uneventful but long day, and I was ready to check out and go home. The nurse practitioner informed me that one of our mothers was here and wanted to speak to me. I had only been seeing the baby for one day, so I was not fully up to speed on the social situation. The NNP told me that the mother who had been transferred from another hospital, and had two other children that she did not have custody of (Major red flag here!) likely due to some poor decision making in her past. She told me that the mother had spoken to her attorney who had told her that we could not do a drug screen on her breast milk. She wanted to have a discussion with me. Oh Joy! Just what I wanted to get into at the end of this long day!
So I took a deep breath and began whipping myself into a frenzy. "We have to do whatever is in your baby's best interest." "The only way to ensure that we are doing the right thing for your baby is to test your breast milk or use formula." Yep, I was steeling myself for a fight.
I approached the bedside and introduced myself to a somewhat large, wild eyed mother who spoke very dramatically as she addressed me. Standing behind her was her rail-thin mother in a tie-died shirt, denim jacket, with a bandanna around her forehead (Janis Joplin would be proud of her legacy). The mother stated that her lawyer had told her that breast milk could not be screened for drugs. Other people had told her that it could. She wanted to know who was right. It slowly occurred to me that she didn't want to argue the legality of testing her breast milk, she just wanted to know if it was technically possible.
She then launched into a very long and somewhat entertaining attack on the government agency responsible for removing her other children from her custody. Her lawyer wanted us to "keep her baby in the hospital as long as possible. Because that way they can't get their hands on him!" She went on to tell me that there was a big "black market" for babies in her home county and she had fallen victim to it. It was all a massive government conspiracy against her (she was really getting worked up and her mother was nodding and expounding and cussing). She even told me that the ethnicity of the baby's father would make this baby particularly desirable for this government run "black market". It was really pretty surreal standing there taking it all in. Somehow I managed to keep it together. You see, I'm equipped to handle crazy, I just wasn't prepared for this particular kind of crazy. It requires listening to the delusion without feeding it or openly challenging it. I ultimately reassured the mother that we would be able to screen her breast milk for the presence of illicit drugs, and that while we couldn't keep her baby in the hospital in order to "keep 'em from gettin' their hands on him", he would likely need to stay for at least a few weeks for medical reasons.
What a way to end a long and uneventful day!

The Prenatal Consult (Part IV)

2010-03-02T06:31:00.000-08:00

This is part IV of a series of posts which also currently includes part I, part II , and part III.
The first topic that I cover in my head to toe discussion of possible complications is Intraventricular Hemorrhage (IVH). I start by reminding them of our discussion of developmental outcomes. I then state that one of the potential complications related to developmental outcome is IVH. Simply stated, IVH is bleeding in a particular area of the brain. At the center of the brain are several fluid filled chambers known as the ventricles. As a fetus develops in the womb, there is a network of very fragile capillary blood vessels called the germinal matrix which is located at the center of the two lateral ventricles. This network of blood vessels becomes hardier and less fragile as the fetus develops, and ultimately goes away by about 34 weeks gestation. The earlier during gestation that a baby is delivered, the higher the chances for IVH. It is also associated with some other factors such as the presence of infection and overall stability of the baby. We screen all babies less than ~ 32 weeks gestation with a head ultrasound at about a week to ten days of age.
When IVH occurs, it is graded in severity as grade I-IV. Grade I is limited to the germinal matrix, while grade II involves extension of blood into the ventricle. Grade III bleeding extends into the ventricle and causes dilation of this fluid filled space. Grade IV extends into the brain tissue itself. Grade III and IV hemorrhages may progress to a condition known as post-hemorhhagic hydrocephalus in which the flow of fluid in the ventricles is obstructed and they become markedly enlarged. Such a condition may require surgical intervention. In terms of prognosis, grade III and IV hemorrhages are associated with worse neurodevelopmental outcomes while grade I and II hemorrhages are not necessarily. The strongest preditor is the need for surgical treatment of post-hemorrhagic hydrocephalus. I always point out to parents, however, that a head ultrasound is not an IQ test. An abnormal one does not mean for sure that a child will be affected developmentally and a normal one doesn't mean that a child will have no neurodevelopmental problems.
At this point, I pause for questions before moving onto the topic of Retinopathy of Prematurity, a topic that I will post about later.

2010-02-24T16:06:00.001-08:00

I have the week off. So right now I'm watching my 10 month old eat chicken n dumplings, Gerber graduate puffs, and girl scout cookies all with her hands. She's a holy mess. That's what my wife gets for leaving me in charge while she teaches a Body Step class!

Advice For Doctors In Training - Part Two : College Students

2010-02-24T04:55:00.000-08:00

View Part One
I've recently had a lot of enthusiastic interest from people at varying levels of training! Some very good specific questions as well as requests for generalized advice. I'm always happy to answer specific questions and I encourage my readers to keep them coming! I've also decided to release a series of posts with my specific thoughts about things that may benefit future doctors at different times during their training. I'll post a new one periodically.
Part Two is geared towards college students that are interested in neonatology. Again, I'll break it down into five points:

Study HARD! You may recognize this as a repeat from Part One. Studying for me was always the number one deciding factor for academic success. I put it at the top of this list for a different reason. For most people interested in a career in medicine, the biggest hurdle will be getting accepted to medical school. The ratio of number applying to number accepted is much different than for colleges. You may ask "what about the difficulty of medical school?" Well, the fact is that once you are accepted to medical school, they've made a pretty sizable investment in you and will work hard to help you succeed.
Get involved in some extra-curricular activities. I was always told "college is the last time that you will live in close proximity to so many people of similar age with similar interests ever again." This is very true. Join a club, fraternity, sorority, etc. However, if your main activities involve a fraternity or sorority, make sure that you pursue a position involving responsibility and get involved intimately with all philanthropic efforts. Volunteer work also looks great on a medical school application.
Regardless of your major, take a course in developmental biology. As a neonatologist, it is great to have a strong background in embryology which starts with a good undergraduate developmental biology course ( I still have the textbook from mine).
Take an MCAT Review course prior to taking the test. The parts of this strongly basic sciences based test that you have a strong background in will probably not be affected so much by this, but your weaker areas will really get a boost from a review course prior to taking the test. Most Universities offer a course for a small fee, or you can take more "private" course for a little more. I took the University course myself.
Have fun! Back to point 2, this is likely the last time that you'll have the opportunity to live amongst so many people of similar age and interests. So take some time to enjoy it! Just don't enjoy it so much that you neglect the other points!

Advice For Doctors In Training - Part One : Medical Students

2010-02-19T12:46:00.000-08:00

I've recently had a lot of enthusiastic interest from people at varying levels of training! Some very good specific questions as well as requests for generalized advice. I'm always happy to answer specific questions and I encourage my readers to keep them coming! I've also decided to release a series of posts with my specific thoughts about things that may benefit future doctors at different times during their training. I'll post a new one periodically.
In going a bit out of order, I'll start with advice for medical students. Some is general and some will pertain to those interested in neonatology. I'll break it down into a list of five points :

Study HARD! As you're truly an adult now, your brain is reaching full maturity. This is both exciting and depressing! You'll likely never be able to learn things quite the same way again - the long hours of memorization, the study groups, the constant experimentation with different techniques. It can be grueling, but no one ever died from over studying!
Develop or maintain a hobby that has nothing to do with science or medicine. It should require attention, focus, and practice. It should not provoke frustration (i.e. if you get upset and throw your clubs when you don't play golf well, then this is not a good hobby for you to use for this purpose). I took up fly fishing during medical school and learned some basic fly tying skills. I could take a break from studying and practice casting or I could tie a few flies.
If you're interested in neonatology, then find out who the neonatologists in your medical school are and see if you can arrange to meet one or two of them. This sounds daunting, but most of these folks are happy to share a few minutes to talk to an interested medical student even if they are very busy.
During the non-clinical years, consider looking at particular areas of focus as they apply to a neonate. For example, as you study immunology and how the immune system is structured in the human lung, you might read about the evolution of Bronchopumonary Dysplasia in a premature neonate including the complement cascade, inflammatory cytokines, B-cells, T-cells, etc. Just be sure not to get too hung up on the specifics as your goal is to understand these components, not necessarily the subject of BPD.
Keep yourself open to other areas of medicine that you may be interested in. I started medical school with the idea of being a surgeon. I changed to pediatrics after my third year of medical school. I started residency with the idea of being a general pediatrician. I decided to do a fellowship in neonatology about half way through my second year. It's a lot easier to find yourself in a career that you're happy with if you truly remain open minded about different possibilities.

I hope that this series is helpful. Again, I invite specific questions and input. Look for advice for college students, coming soon! Thanks for reading.

Starting the 24 hour day with a "Bang"!

2010-02-16T14:08:00.000-08:00

Something that I didn't mention in my "nuts and bolts" post is that when I do a week of nights in the hospital, I actually get one night out of the seven off (Tuesday night). So I work Saturday, Sunday, and Monday night, then off Tuesday night, then work Wednesday, Thursday, and Friday nights. The fact is that it's just too difficult to do seven straight nights in the hospital.
What that means is that on Tuesday, the person that is covering deliveries etc. for the week works a 24 hour shift. This week, that lucky person is me! I've actually just gotten back to the land of the living from last week's night call! But I came to work feeling pretty refreshed.
The day started right away with the delivery of a baby at 23 weeks gestation who weighed about 1.5 pounds. The scenario has disaster written all over it, but not today. My team was focused and functioned like clock work. Assessing the baby, providing me with prompt and ample feedback, helping to administer just the right amount of respiratory support. All the members of the team doing their part, doing it well, and enjoying it.
This baby has a very long road ahead. No one will deny that. But for someone so small, it has been a pretty good start.

The "Daily Grind"

2010-02-12T17:53:00.000-08:00

I've recently had a lot of interest from readers through e-mails and comments about the "nuts and bolts" of daily life. Do I have my dry cleaning delivered to the hospital? When was the last time that I saw my wife and daughter? etc.
Well the simple answer is that my life style is actually pretty good. Most weeks, I work about a 50 hour week 8am to 6pm monday through friday. We have a neonatologist in the hospital 24 hours a day, 7 days a week. So about every six weeks, I do a week of nights. During this week, I come in at 5:30 pm and leave around 8 am the next morning. This is a 90 hour work week, and can be quite grueling as it plays the worst kind of havoc with one's sleep cycles. The bright side is that the other 5 weeks, you don't have to worry about working nights! I work about every sixth weekend as well. I get a generous amount of time off which really makes family life work quite nicely! My wife is a group fitness instructor and takes care of our 10 month old daughter full time, taking her to the nursery at the gym during her classes which she teaches on average one to two per day during the week. She also teaches an occassional weekend class, and when I'm not working this makes for a nice Daddy / Daughter day out!
Overall, there are jobs with much better hours, and sure I miss out on a few things here and there, but I really can't complain and I really don't think I'd change anything about "the daily grind". Oh, wait maybe a few less nights!

4 am Twin Debacle

2010-02-08T17:22:00.000-08:00

It's fairly rare that twin pregnancies go as far as 37 completed weeks of gestation. It's also rare that the twins are in an orientation inside the womb in which the OB is comfortable attempting to deliver the twins vaginally. This morning at around 4 am, both scenarios presented themselves.
In our hospital, all twin deliveries are attended by the NICU resuscitation team including the neonatologist. At 4:15, my delivery phone went off indicating that we were to attend the delivery of 37 week twins in the OR. My thought was that it would be a Cesarean Section, be quick, and at 37 weeks, the twins would be fine, and I would be back in the call room in 20 or 30 minutes. I entered the OR to find that they were set up for a vaginal delivery (Twins are always delivered in the OR in case they have to convert to a C-Section). The first twin came out kicking and screaming at 4:35, got supplemental oxygen briefly, had APGAR scores of 7 and 8 and was ready for the newborn nursery shortly.
The mother then proceeded to push for ~ 2 hours in an attempt to deliver the larger second twin. All the while, we waited with baited breath. Surely the next contraction will be productive. At quarter til 7, the OB offered the mother three choices. One : continue to push, though no progress was really being made. Two : attempt a vacuum extraction ( a vacuum device is placed on the baby's head and he is gently pulled down). Three have a C-Section for the second twin. She decided to try the vacuum extraction. It didn't work. At 10 til 7 she opted for the C-Section. At 7:10, the second, much larger twin was born by C-Section. He required a little more oxygen and stimulation than his brother and had some bruising and molding of the head, but was otherwise healthy and also able to go to the newborn nursery. Being that it was 7:30, and my alarm had been going off in the call room for half an hour, there was no point in trying to go back to sleep.
All's well that ends well, but I really wish that I had asked that I be excused at around 5 and had them call me back when delivery of the second twin was imminent, two hours of sleep that I'll never get back!

The "NICU Rumor Mill"

2010-02-05T06:14:00.001-08:00

There's a childhood game called "Rumors" where a person has a written message whispered to them and then they relay that message to another person with a whisper. The message is then communicated as many times as there are people in the group. You then compare the final communication to the actual message that was written down. It can be amazing how the story changes.
A version of this game takes place in every work environment. Add the general anxiety of the NICU environment, and you really can get some interesting results. The typical scenario is that the attending physician is notified of a possible admission to the NICU. Information about the same possible admission is also communicated through a variety of channels and in a variety of different versions to nurses and other staff in the NICU. The busier the NICU is, the more distorted the varying versions may become.
For example, I was in charge of attending deliveries and admitting babies to the NICU one day. As I sat in my office, my phone rang and I was told by our secretary that a physician wanted to speak with me. I answered the call, and a pediatric nephrologist (kidney doctor) that I know told me that his new partner's wife would be having triplets that afternoon, and he wanted me to be aware. Because they would be premature, they would be admitted to the NICU. I thanked him for the information. As I thought about relaying the information to the charge nurse, the phone rang again. It was the secretary phoning to give me a "heads up" that we would be admitting triplets that afternoon. I thanked her for the information. I decided that it would be wise to inform those that would take part in the admissions of who the father of the babies was prior to the delivery. As I walked into the unit, the nurse practitioner attending deliveries for the day excitedly relayed to me that we were getting triplets, and that one of them "has a renal issue (kidney problem)". I said, "yes I know all about it. Want to know what the renal issue is?" Nods all around. "Their father is a nephrologist!" Two hours later, three beautiful healthy babies were delivered and admitted to the NICU due to mild prematurity.