What Should Have Been

Last overnight call for the next two months! Wow. I never thought I'd see the day. It was a good call, too. Steady enough to be interesting and slow enough to sneak in a siesta at 3 am.

Patients admitted last night:

1. Rule out sepsis--pretty standard protocol, cute little seven day old with fever and rash. Babies can't tell you where it hurts so you have to go on a treasure hunt looking for bacteria, end up usually not finding it and figuring that it's viral anyway but treating with antibiotics in the meantime until your cultures come back negative.

2. Acute Life Threatening Event (ALTE)--another peanut. 16 day old former 35 wk premie with super awful reflux and super anxious parents. Also with failure to thrive; he hasn't even regained his birth weight and his little skin sags all over him like it knows it's supposed to be covering a bigger body.

3. Intususseption--two and a half year old with really bad intermittend abdominal pain caused by the telecoping of one part of bowel into another, treated with an air enema, causing him to fart the rest of the night when he wasn't being a terrible two, "NO!" And then this morning, "I want to go home! I'll be okay."

4. Seizures and half a brain missing--sort of amazing that you can actually survive. She literally is missing at least a third of her brain. Called proencephaly and caused by an in utero stroke of one of the major blood vessels that supply the brain. Family recently immigrated from Iran via Pakistan and very concerned about her increased seizure activity. That was the majority of my night-time calls: "She's having a seizure. She's having another seizure." She has seizures all night.

5. Stridor--9 year old guy who was born at 23 weeks (that's the cut-off for survival usually, he was also a triplet, one of the triplet's died at birth and the other is living and normal developmentally; he weighed about a pound at birth). He has been breathing through a tracheostomy since birth and he just got it out last week. Came in with some difficulty clearing secretions.

And tomorrow I'll get my Anabell back. She comes back because the home where she went didn't feed her the right thing and she got an infection. I visited her before I came home; she is just at cute as ever. Chubby little cheeks.

One of the patients on the other teams is about to die any day. We're all sort of on alert. He is a year and a half and has been brain dead since he had 30 minutes of no oxygen to his brain when he was two years old. Parents have decided to not recuscitate him when he stops breathing. All night his nurse was staring at him to see if he kept breathing. This morning the attending was going over what to do when someone dies on your service. I guess you listen to the heart for a minute to make sure it really has stopped beating, then you listen to the lungs and do a quick pulse check then call the nurse for all the paperwork and details. Gosh. The things you never thought you'd have to learn. This little guy's life has been pretty awful, though. Every asks me if it's hard when kids die. It's hard when it's senseless or they are healthy. It's always hard. I guess sometimes you just see that it's the right thing in the end. It's hardest when there is no thinking that it is right.

There is another baby on another team that is the boy described above only a year earlier in his course. He is two months old. The victum of severe and ongoing child abuse with multiple rib fractures, skull fractures, bleed, retinal hemohorrages, etc. inflicted by his parents at multiple points when they were high on methamphetamine. He is brain dead also and parents are always at the bedside. They want to withdraw care. Which is probably the most humane thing to do at this point. Still hard to think of what could have been...what should have been.