Who says you cannot have it all? This is my crazy life as a wife, mother,healthcare professional, perpetual student, conservative yet feminist Keeper of the Crayons.
Last night, I got the call I have been dreading since my return to work. To the NICU. For a preemie.
I got to work on the baby immediately. A little boy. 3 lbs., 4 oz. Tiny, yet perfectly made. Lungs not wanting to work. I didn't ask questions, other than to make sure we weren't dealing with something that would affect his treatment. No meconium aspiration. C-section delivery. He was obviously a preemie. Gestational age? 35 weeks, 5 days. Delivered after an amniocentesis assured mature lungs, and a long struggle with preterm labor for the mom.
Chills ran up my spine.
Zachary.
Evan.
You know, I try to treat all of my patients the same. I try to treat them as I would want my loved ones to be treated if one of them were to fall ill. But I would be lying if I said anything other than that I treated this baby better than any other patient I have ever had. My touch was more gentle. My dealings with the family more compassionate. How could they not be? I saw Zach's and Evan's angel faces in his eyes. And my heart broke just a bit for the moments where I have allowed myself to forget that both of my boys are true miracles. We are so blessed. We are the lucky ones. How could I ever permit myself to forget that for even a second?
I have made a decision. My hospital is building a state-of-the-art new NICU so we no longer have to ship such high-risk cases out. They are, as we speak, assembling a core team of therapists for the role in the NICU. I didn't think I could stomach it. I thought it would rip my heart out daily. I thought this was a good reason to say no. Now I know that this level of care and understanding makes me tailor-made for the job. When working with adults, one has to be almost heartless to make it through. For this job? One has to be all heart.
...That the solution to Zach's bathtime woes would be the cheapest route. He screams and screams his way through baths. And after, when he is getting lubed up with baby lotion and diapered and clothed. He is still a bit small for his infant tub, and it is difficult to keep him secure while he is squirming in the water. So I bought this $8 mesh hammock on a wire frame at the nearest store. It goes directly into our normal tub, and it cradles and embraces his little body. o more screaming! He actually seemed to enjoy his bath, and I am wishing I would've tried this sooner!
When I was a little kid, I used to play putt-putt all of the time (errrr, miniature golf, depending on where you live). I can even remember the jingle from the commercial for our local course: "Putt-putt-putt-putt-putt-For-the-fun-of-it....." Yesterday, we were bored after going out to dinner, and headed to the neighborhood park. Well our neighbors I don't like were there, so we literally did an about-face and left, much to Evan's dismay. We couldn't figure out what to do, yet somehow we ended up at a putt-putt course. Evan had only been one time before, so he was thrilled. The outing really was about pleasing him, so in that, it was a success. But truthfully, the whole family had fun. Zach pretty much chilled in his stroller, fascinated by the bright lights overhead. John and I did what we always do when it comes to any game: fierce competition. You would have thought it was an Olympic event for which we had trained our whole lives. And Evan made friends with the teen couple one hole in front of us, despite my delicate explanation that they were on a date. (Of course John whispered in my ear about Ev "c###-blocking", and I about died with laughter, though Evan doesn't know and will never need to know what Daddy said.) But anyhow, much to John's dismay, I kept getting holes in one, and Evan made it his mission to alert the staff each time, even though I told him he didn't need to. So we ended up leaving with a handful of tickets for either discounted or free games. John got a couple of them, but he was killing me by making the Shooter McGavern move from Happy Gilmore each time. But regardless, fun was had by all, and I think we will have to do that again!
I don't know why, but John refuses to use the Moby Wrap with Zach. He calls it our papoose, and laughs everytime I use it. This is strange to me. Zach and I both love it. We get to be close and snuggly while I have hands available for other tasks. And Zach gets the warm fuzzies he needs. It's hard to believe my baby boy is almost 2 months old. He still acts very much the newborn, and it's no wonder why. His true adjusted age is just a little past 3 weeks. So really, he still needs this. I originally bought the wrap, well, because it was cheap. I wanted a baby carrier that will be flexible as he grows, but didn't want to spend huge amounts of money until I knew for a fact that Zach would like it. The $45 for the Moby was just right. Wow! I'm so glad I picked it. Yesterday, he was having a fussy spell and nothing would fix it. After nursing him (well, really just a quick snack for him, as he fell asleep in my arms), he curled up in a ball in the wrap and drifted off to sleep, as seen above. Fussiness cured.
I was so worried about Evan's reaction to having a new baby in the house after being an only child for almost 9 years. He isn't used to having our attention divided between 2 children. We have doted on him and honestly, he is more than a little over-indulged.
I could not have been more surprised! Evan adores Zachary. He begs to hold him, will not leave or enter the room with giving his baby brother a kiss, and could spend hours showing Zach how to manipulate the world around him. What is even more touching is watching Ev read to the baby. Zach is enthralled with his big brother's voice and will stare with wide-eyed wonder as Evan shares his picture books from his younger days with the baby. In the picture above, Evan was helping to guide Zach's hands toward the toys on his overhead gym. Zach has started to reach toward things, and Evan was giving him direction. What a Proud Mommy Moment for me!
So I saw the breastfeedng medicine doc yesterday. She examined both Zach and I. Zach is tongue-tied. His frenulum is thin in the front, so they would usually just snip it in the office, but his gets thicker as it goes back, so she wasn't comfortable. She said he had a great, strong, coordinated suck and all is well there, so if was worried about it, I could follow up with an ENT doc, but she didn't think it would impact breastfeeding at all.
In her opinion, my reduced supply is due to many little things. Stress: notice I didn't have any supply issues until the spina bifida scare. Sleep deprivation: the issue got worse when he started going through his little growth spurts and I started getting less and less sleep. And when I started to take action to increase my supply, myefforts were useless because I started taking progesterone birth control pills, getting even less sleep and more stress because of work. So I have a plan.
Continue the Fenugreek. We don't seem to be having any side effects from it. It's safe, so why stop? Stop the birth control pills. For now, John will have to revert back to behaving like a pimply-faced teen nervously asking for Trojans that are behind the pharmacy counter. Continue nursing and pumping as often as I can. Add a daily bowl of outmeal to my diet. More sleep. Back to yoga. It is the only thing that has ever been able to relax my high-strung self. And daily walks. And the last part? Well, this is a little worrisome. She prescribed Reglan. Designed for reflux, it was found to have the side effect of increasing Prolactin secretion in the body, which is the hormone needed to make milk. Thus increasing supply in most all who use it. It has even been used to induce lactation in adoptive mothers. But it has some nasty neurological side effects severe enough that the FDA has made the manufacturer put a black box warning on the label. These are seen more with longer periods of use, and she is only having me use it for one month, during which they will call and check on me often. The risks also increase with a history of certain medical conditions, of which I have none. So I am gambling a bit with my brain, but the risk is calculated and most all of the side effects (if experienced, even) reverse when treatment is stopped. So that is the plan. Let's see if it works.
Remember this music? I used to love ER, as in the show. Every night in that ER was an adventure in medical rarities. We medical people love that shit. Stuff you may only see once in a career, and when it really happens, you are in awe and try to remember all of the stuff you learned in school about it. But in real life? It never happens.
Tuesday night started out uneventful. I was assigned to the ER, and was handed the ER pager by a therapist eager to get home. She told me she had only received 2 pages all day, both of which were for patients who ended up being discharged. Beautiful for her,bad for me. She jinxed me. For the first four hours of my shift, no calls at all. Then all hell broke loose.
After 11 PM, our staffing cuts down and the ER therapist covers other areas also. At 10:35, 5 minutes after getting report, I was called to a crashing patient's bedside. The therapist who had her during evening hours doesn't do critical care, and the patient was in a severe respiratory acidosis. She started her on BiPAP (non-invasive ventilation that is used non-aggressively for sleep apnea and more aggressively for this). After an hour, the patient was mine, and I start the first minutes of the 11PM leg of my shift fielding a call from her nurse, who had her pulmonologist on the phone, demanding to know why her acidosis had not improved on the machine. He wanted immediate intubation, but I managed to hold him off while he let me (experienced in critical care) get more aggressive with the equipment. Beautiful. And it worked.
But in the throes of all of that, I get a page: respiratory distress in the ER. I respond immediately to the little girl in pretty bad distress, get her settled on a continuous neb, and off I go to answer the call I get for respiratory arrest in another ER bed. An intubation, and 2-hour fiasco while I try to ventilate an obese woman with a physician who simply refused to give adequate sedation, making my job a nightmare. Then it is off to another unit in the hospital for a patient who aspirated a chocolate milkshake that was supplied by family members who did not understand that nothing by mouth means just that: nothing. I suctioned his lungs free of the chocolate goop, and off I go to a cardiopulmonary arrest in the ER, which resulted in me bagging a patient while running to the cath lab to fix a blockage in a 34 year old man. As soon as I get him hooked up to a ventilator and my hands are freed, I get called for another crashing patient. While responding to this one, I get 2 calls. An employee at a local factory wrecked a forklift while drunk. I had to do a breathalyzer, which is a legal process and I hate doing them. But as soon as I get there, the ER calls me for a cric kit. Seriously? Never in my career have I been party to an emergency cricothyroidotomy. A true life-saving measure for someone whose airway is closed, but we avoid it at all costs. And we have all kinds of airway tricks up our sleeve to help us do so. So why does the ER need a cric kit, and if there is that bad of an airway emergency, why was I just then getting called? Severe allergic reaction, and a resident tried to look at that throat with a scope. Bad move. Really bad move. Because anytime there is that much swelling, ramming a scope down there is just going to cause the airway to close up. Lovely.
So I think my shift is ending. It it 5:45 AM. I finally sit down to chart everything I have done in 8 hours from my scribbled notes in my pocket (Incidentally, the paper is damp with my sweat: The huge exam lights we use for codes get damned hot, plus I have been running fo 8 hours.) I am also trying to stuff my face with the sandwich a kind coworker got for me when it became apparent that I would not be getting a lunch break. I take the first bite and make the first entry into the charting software when I hear the dreaded pager. Another code, full arrest, meet the patient in the cath lab, where EMS is taking him. I was relieved when I heard he was already intubated. That means I just set up a vent and go on about my day. I am having dreams about finishing my sandwich, of getting my charting done so I can leave on time, when I hear the dreaded words that lead me to the most Holy Shit Moment of my career.
"We need an OB kit NOW!!!!!". Ha. right. OB kit? Whatever. I sarcastically ask the ER doc if we are now in the business of delivering babies in the ER when OB is right down the hall. (Think of Gone With the Wind: "I don't know nuthin' 'bout buthin' no babies!) Yes, we are. And before I can even think, we are running. I am simply following. But wait! We are running to the waiting room. Why are we leaving the hospital?
Oh. Oh holy CRAP! We are delivering a baby in the ER parking lot. In the back of a Chevy Equinox. Seriously. And I am the only one there with experience in neonatal resuscitation. And the baby is blue. And all I have is a bulb syringe that was taped to the OB kit. Before I know it, I am barking orders. And I am running through the halls of the hospital with a blue baby girl in one arm and an oxygen tank in the other while the nurse runs alongside me, holding the blow-by near her face. Before we can even get to the NICU, she is pink. I did my job well. She doesn't even go to the nursery, but straight to her mother's arms. And I go straight to my department to hand off that damned pager and go home.
So there you have it. I love cool Rockstar moments in my work. But I don't like having them all occur in one night. That was not cool. I don't think I will be watching ER reruns ever again. And I am still wondering if that night was a dream. Did I really do all of that? Did I really resuscitate a baby at a parking-lot delivery?
