Monday, April 23, 2007

The Circle Game

Earworms - those songs or fragments that just get caught in your head and stick until you can play them all the way through or replace them.

I couldn't remember the name and couldn't seem to get the lyrics straight. No time to google. I was too busy. Sometimes being on admissions means a dull night. Sometimes it means admitting a preemie to the NICU and following through. Sometimes you just feel like you're running around in circles -- hence the earworm.

"Can you get this kid over to newborn? He's 4 hours old - slow transition. They said he could come over after they get report."

"No problem. I'll call and see when it's convenient.... 20 minutes? I'll just make sure his documentation is together and grab a set of vitals."

The folks in the newborn nursery were glad to see he'd already been bathed and most of his admission paperwork completed. Back to the NICU, I started feeding one of my patients and the phone rang.

"It's the Birthing Center - high risk delivery in 4. Oh, you're busy. I'm free, I can cover this for you."

15 minutes later: "Sharon wants you to know she's bringing the baby back. Just for observation."

"OK. This one is finished eating. I'll be right over."

Sometimes even term babies are sick at birth. Rarely they're born with an infection or congenital heart disease Much more commonly they are simply slow transitioning to extrauterine life. Usually they just need a little time to clear the amniotic fluid, but it's not always easy to tell the difference in the first moments of life.

If a baby doesn't appear to be adjusting well, we do what we can to help them transition in the birthing room. Most of the time, all that is needed is to dry the baby and perhaps stimulate him. If necessary, we provide oxygen and suction secretions.

A very small fraction will actually require resuscitation - those babies usually are admitted to the NICU, but some will recover in time to stay with mom in the birthing center.

If a baby is breathing, but obviously working hard at it, or continues to require oxygen beyond the first minutes of life, he'll get to come back with us to the NICU for continued observation. If he doesn't transition very quickly there, we will almost certainly do some lab tests(blood count, arterial blood gas), get a chest x-ray, and possibly start more aggressive treatment if that's indicated. Many of these babies will complete the transition within an hour or two and we'll be able to return them to their moms either in the birthing center or by way of the well-baby nursery.

That's how my shift went. Over and over. As I was cleaning the bed for the third time in less than 4 hours, one of my co-workers remarked, "I think I'd pick another bed. That one's unlucky."

"Unlucky?" I responded, "Nope. Just busy. I think I'll stick with this one."

Running in circles isn't always a bad thing.

And the seasons they go round and round
And the painted ponies go up and down
Were captive on the carousel of time
We can't return we can only look behind
From where we came
And go round and round and round
In the circle game

Joni Mitchell -- The Circle Game

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