Periodically I like to reflect on the journey I took to become the physician (and mother) I am today. Here is an excerpt from my time as a third year medical student working in the neonatal intensive care unit. I can still feel, smell and hear the sensations described in this piece, and it reminds me of the passion and wonder of my early training years.
2006: The NICU
For weeks I’ve been dreading this part of my pediatrics rotation – the Neonatal Intensive Care Unit. Two weeks of psychological trauma and sleep deprivation, according to those who went before me. Therefore I was understandably quite nervous on the morning I walked into the bright, loud, extremely full NICU. I chose to take the first call shift, on the first day, because I wanted to dive right in and get the gist of things quickly. So on Monday, with butterflies flapping up a monsoon in my belly, I donned my scrubs and took the call pager for the next 32 hours. No regrets.
The NICU is a whole new world full of new sounds, smells, sights, tastes and touch. Some of the babies are so tiny it’s hard to imagine that they are really there at all – one 24 weeker weighed only 530 grams at birth (imagine that, it’s barely over one pound!). We have a baby that was born at 23 weeks – that’s below the usual threshold for survival (24 weeks, when the lungs start producing surfactant, a soapy substance that keeps your alveoli – air sacs – open). We also have big babies born to diabetic moms, a baby born addicted to methadone and in withdrawal, some babies who were just too small at birth and need nutrition, triplets, and more. Just the sight of the 24 weeker whose feet are the size of my thumb (and I have small hands!) and in whose body courses blood the equivalent volume of maybe ¼ can of soda, is something that takes getting used to.
Babies smell differently, as we all know, but they smell even more foreign when they’ve just been born and are lying under my hands as I wipe them down and suction goop from their mouths. I can’t describe the smell – but not unpleasant by any means. Taste is a sense I didn’t expect to experience in this rotation, but my lips have an icky rubbing alcohol taste to them thanks to all the handwashing I do every day – I guess somehow after I wash some of the stuff gets on my face (after seeing the baby, of course).
And sound – the NICU assaults my ears like no other place in the hospital so far. There was only one moment of relative quiet today, at around 7:45 a.m., when the monitors for once were silent and the babies weren’t crying, and the nurses weren’t all talking. Otherwise – imagine one large room full of over 32 crying babies, add in about 30 monitors all clanging and beeping away with alarms that generally mean nothing, then on top of all that add in the regular noises of a hospital ward with families and nurses and doctors all conversing. Then, periodically, throw in some strange clanging followed by a hollow intercom voice warning of a code red (fire) somewhere in the hospital, and phones ringing, beepers going off and overall one big hullabaloo. Next – imagine you’re a little tiny premature baby in an incubator, trying desperately hard to feed and grow and overcome your obstacles, and every moment of your day is full of an assault of noise. So when I come home to the peace of my apartment, I try hard not to complain to myself about the headache – because I remember that I’ve left my patients, my babies, back in a room that never quiets, a land that never sleeps.
Finally, touching these little infants, these barely former fetuses (my Dad’s great expression that he uses about me all the time but that seems to fit these babies to a “T”) stirs in me something very human, very primitive, very womanly and motherly – call it maternal instinct. My attending said to me today as we were watching a delivery of a premie, that he could hear my biological clock ticking. I denied it, but inside I knew how true that was. The skin of a baby, of a premie, is so fragile and shiny and thin sometimes that you almost fear to touch it because it seems like it should just melt under your fingers. I am continually amazed that the infant stethoscope I am using on these teeny chests doesn’t rip a gash in their frail skin. But then, the older babies (still premature but not extreme) are so soft and downy, warm and cozy that sometimes I just want to scoop them up out of their incubators like the nurses do, and comfort them in my arms. Today my attending called Marc and I to come observe him doing a circumcision in the normal nursery (where the regular not-at-risk babies go), and he asked me to keep the little boy (2 days old) calm and happy throughout the procedure. A daunting task – some strange man is looming over you with some strange metal apparatus, about to cut part of your penis, and some strange woman is trying to keep you from crying – is that going to work?? A trick they use in neonates is to give them some sugar solution before procedures, which gets their endorphins going and helps them feel less pain (theoretically). So I gave the baby sucrose, then when it didn’t quite do the trick, I stuck my gloved finger in his mouth and let him latch on and suck. The baby showed absolutely zero distress throughout the circumcision (performed with a local anesthetic) and actually fell asleep sucking on my finger while the physician was in the midst of cutting. What a bizarre feeling, to have a tiny little baby sucking on your finger with incredible force. I have to admit, it stirred up some strange unknown feelings inside, deeply physical sensations that only a baby sucking must be able to do to a woman. But not unwelcome.
The NICU is a beautiful place – seriously. I am loving my time there, completely unexpectedly. The vulnerability of these little ones is astounding, and the teamwork involved in ensuring their survival rivals the multidisciplinary approach of the Saint Mary’s geriatrics ward. The medicine of the place is complex physiology at it’s best and worst for a med student like me who needs to search her brain for the deep seated subconscious memories of first year. Then there is the acuity of it all – and I love acuity. I thrive on action, getting my hands into the thick of things, resuscitation. That is why I love emergency medicine – and in the NICU I get a small flavour of this. This evening before I left at 7:30 pm, I was rounding on some of my patients when my attending and I saw one of the nurses bagging a baby who had pulled out his own endotracheal tube (what we use for intubation, to help the baby keep his airway open). We immediately stepped in, and it was so natural to me as I took over bagging the baby (giving breaths with a bag and mask). He was so calm, my staff, and so was I because for me this is what medicine is all about. As the baby started breathing on his own and just required oxygen by nose, inside I felt magic. Watching his parents walking to the bus stop ahead of me upon leaving the hospital, hand in hand with sunshine in her hair and a smile on her face, I felt what it is I am here in medicine for. We saved this baby’s life in a few short moments of breathing for him and cleaning his airway of vomit – and in those few seconds we gave hope back to a frightened couple who thought their baby was on the brink. That is medicine at it’s best, saving a life, inspiring hope. As the Talmud says “one who saves a life is as if he/she saved a world entire”; by allowing a baby to live, you give it a chance to grow and one day have children of it’s own perhaps, and a whole new world around that little soul.
Yes, the NICU is a place of fear, but through it runs a river of magic.