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Therapeutic Moments

I always look forward to being on call in the nursery. We take care of the newborns in the well-baby level 1 nursery, and also the little ones who need some extra care in the level 2 nursery. The level 1 babies usually spend most of the time with their moms. They enjoy eating and sleeping and keeping us guessing at whether they’ll turn yellow or not. Most of the level 2 babies were born early and are chilling out with us until they’ve mastered the art of temperature regulation, and are eating and gaining weight well.

Back on OB rotation in October, I had learned via a blurb on the news that the most common shared birthday in the United States is October 5. For kicks, we brought out those trusty old pregnancy wheels and calculated 9 months back to find the magical day of mass conception. New Year’s Eve. Well, maybe last New Year’s wasn’t all that exciting because I think we might have had only 1 or 2 babies born on the October 5 when I was on OB. Oh well. 

However, sometime around last Valentine’s Day was apparently a much more successful romantic splurge, because during the week before Thanksgiving, the nursery experienced a population explosion. The first time I was on nursery call, we had deliveries just about every hour during the day—-and only slightly less often during the night. It was non-stop action, and though by the end of my call, I pretty much had the hang of things, I still felt like I was running around like the proverbial decapitated chicken. Still, in between C-sections, I did manage to steal a few moments to sneak away and feed a baby.

After the bustle of the day, after all of the rounding and number crunching and order writing (and then finding someone who’s actually a doctor to co-sign the order), it is always nice to finally get a chance to sit down and have some quiet time. But this quiet time is so much sweeter when you are tucked away in the corner of the level 2 nursery, holding a preemie NICU graduate and coaxing her through her mammoth 30cc midnight snack.

You can walk around making decisions all day long: “decrease TPN to 80,” “d/c phototherapy,” “increase IV fluids,” “stat CBC and blood cultures,” “wean to open crib,” “feed for weight.” But it’s only words. This, the actual blood draw, the actual medication change, the act of talking to the parents, the act of holding and feeding, this is the healing.

I have to admit that maybe, so far, “medicine” isn’t exactly what I thought it would be like. My vision had always included more acts of healing, whereas the reality I’ve experienced so far seems to be making decisions and leaving them for other people to actually enact. This saddens me. I understand that decision making is important, and that we have so many patients who each need multiple levels of care, that we have to delegate. But at times, it feels like we are just making decisions about their care rather than actually caring for them. Of course, the medical community is rich with talented and caring people, such as the nurses, therapists, social workers, and teachers who work with doctors and patients in order to provide all aspects of care. I have to admit that sometimes I’m envious of them, that they get to interact with the actual people while it seems that I am mostly interacting with pieces of paper.

One of the great things about the regular pediatric ward is that there are cots in all of the rooms so that patients’ parents can stay with them, and for the most part, parents of my patients did tend to stay with their children. What better caretaker is there for a sick child than his or her own parent. There also tended to be fewer patients per nurse on regular wards. Long story short, all of the children were well cared for by numerous people, as it should be. But aside from directing and coordinating all of this care, it seemed like we general peds doctors/residents/students really weren’t needed for much else. It was great getting to interact with the kids during prerounding in the morning, and then sometimes at brief moments to check up on them during the day, but for the most part, it seemed like there really wasn’t all that much I could really do for them.

But in the level 2 nursery, there were no cots for parents, and the nursery seemed to clear out into an almost barren place at night. And with little feed-for-weighters snacking every 2 or 3 hours, the nurses were always happy to have some help. So, I finally got my patient contact, my little chance to heal, my chance to be more than just a decision-making mind, but actually a pair of healing hands.

And really, I wasn’t even very good at feeding babies. I talked to them too much, and I distracted them from the suck-swallow task at hand. The nurses chided me that I was causing the babies to burn more calories than they were actually consuming. But I learned. Now I know to sit quietly and let them concentrate on suck-swallow so they get plumped up and ready to go home where they belong. And the experience is therapeutic for both of us.

December 7, 2005 | Permalink

Comments

Kristen -- Your post made me teary-eyed. Never stop caring about being a healer.
Danielle

Posted by: Danielle | Dec 7, 2005 8:01:09 AM

I am a fourth year veterinary medical student preparing to to a laboratory anima medicine/Comparative Medicine Post-Doc Program at MIT next year.
It's interesting to hear your views on wanting to do more with and for you patients as fas as interaction. This is what I love about Veterinary Medicine; as students, residents, interns, and vets we handle EVERYTHING dealing with out cases from the initial PE, to surgery, to medical tx, discharge and client education. Guess it would kinda suck if we delegated it all to our vet techs (nurses). Very touching story.
-Markeya

Posted by: Markeya | Dec 7, 2005 1:45:28 PM

Hi Kristen,
I can identify with you all too well. I am from the Caribbean however, so we get to have great patient doctor interaction, from the youngest patients to the oldest. I finished my Paediatrics rotation about 6 weeks ago and today had the great pleasure of seeing one of our most premature babies return to clinic for follow-up. He is definitely a fighter and although it was a long, difficult and tiresome time for him and his parents and the medical staff, it was all worth it. So you keep doing your best and know that every little bit counts and although you don't think that you have the level of interaction you desire,sometimes just a smile or a word of encouragement makes a great difference in your patients' and their families' lives.

Marisha.

Posted by: Marisha | Dec 7, 2005 5:56:08 PM

Hi Kristin. I'm an extern (6th year med student, that's the last year here) studying in Thailand. I totally identify with you about those life-in-the-nursery parts. It's definitely tough out there having to deal with anxious moms who don't have a clue what was wrong with their babies and making decisions concerning those cute but oh-so-vulnerable creatures. The only thing that kept me going on was their adorable little faces. I always went to the Full Term room (where all the babies are much more healthy and cuddly) to feed them (despite of the nurses' odd looks) and play with them before having to come back to being on call in the NICU, waiting for exciting moments to happen...again and again and again...all night long!

I agree with you that doctors are supposed to be more than just someone making decisions on pieces of paper. I came into medicine in the first place because I believed in the spirit of the medical profession. I really did think that I could be like one of those doctors I saw on the first few seasons of ER. But once I got in deep enough I knew that things were not what I thought it would be. Sometimes I'd like to spend more time with my patients but it's just too exhausting. The last year of med school is drowning me out of consciousness. I don't really feel like I've grown up so much after six years in med school. It's just like I was still a little baby needing 12 hrs of sleep each day. I just can't get enough of it! And guess what, I'll be graduating in 2 months! What kind of doctor would I turn out to be?!!?

Posted by: Peera | Dec 8, 2005 8:21:19 AM

Kristen -

You described exactly why I went into nursing!

I know right now it seems as though all you are doing is directing care; it's important and it is what doctors are expected to do.

But that urge to care is wonderful because when you are out of medical school and into your own practice, you are going to be one of those great "hands on" doctors that patients adore.

And nurses love!! : )


Posted by: Kim | Dec 8, 2005 1:42:40 PM

Could you share some tips on how to help babies master that art of temperature regulation? There's this one tip shared by a friend that involves having a temperature regulation system at home. Other than that, are there any more that you can share?

Posted by: Selene McGraw | Sep 9, 2011 4:29:29 PM

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