weeks #3 & 4...

goodness, where to start. the past 2 weeks have been difficult....i spent 1 week in the NICU, was on call over the weekend, and then went back to wards last week. it was a long stretch, and one that proved to be both physically and emotionally exhausting. first, i no longer have the protection of being a resident....as an attending the hard conversations and decisions fall on me, which almost makes me miss residency, almost :).

second, while i had been warned about the tragedy i would see here, there's really no way to prepare for it...in one weekend of call i had my first conversation with a family about their child being brain dead with no reasonable hope of survival. 12 hrs later i had my second. i walked into the NICU to find a baby's monitors going off with oxygen saturations of 35% (normal 100%) and heart rate of 60 (normal 140-160)....no one had responded to the monitors, and in fact the one nurse in the room was getting vitals on another baby. i have no idea how long the baby was like that, but i quickly launched into running my first code/resuscitation, which after an hour was unsuccessful and we ultimately withdrew care. all in all that weekend 1 child and 5 infants died.

the hardest part is that most of the deaths that occur here seem unnecessary....whether lack of monitoring, lack of response to monitoring or to clinical warning signs, lack of personnel, lack of resources, or misuse of the resources we have....there's so much that seems preventable. but where do you start? death is unfortunately very normal here - the number of deaths overnight are reported as casually as the number of admissions. you can imagine how difficult it must be for the medical officers and nursing staff to keep any sense of hope, and thus how challenging it is to overcome that sense of defeat/acceptance. i'm starting to realize that while our patient care is important, it's not enough. the greater need is education and empowerment of the people and the system toward change. this is not really baylor's mandate as we're here primarily for outpatient pediatric HIV care, but i hope to be a part of tackling this issue. there's a new medical director, medical school, and pediatric residency program in the works, all of which open up new possibilities for growth.

hmmm, sorry to be so debbie downer! on a happier note, there are a lot of ADORABLE kids in the hospital who do well - see pics :) most of those are kids from the surgical ward who like to run around and terrorize the medical ward, always a good time. the families here are kind and grateful, and medicine in general is just simpler....the benefit of tragedy is that it yields perspective; when everyone is focused on survival it leaves little room for more trivial details. and the best part - there are no ICD-9 codes and the term "medical-legal" is nonexistent!