Neonatal ICU Rotation Highlights
Before We Begin...
My last blog post was written on the evening of my wife's birthday, which was also the same night Dominica was pummeled by Hurricane Maria at Category 5 status. The many reactions and emotions I have seen from my colleagues and their families have been heartbreaking and frightening at times. I am not going to recount much more than this as I have been so engrossed in the stories and news that I have had to suppress the urge to look for wreckage photos or try to reach out to people I have had meaningful relationships with that are still on the island.
I have more peace of mind now that the fog has started to lift, RUSM students and faculty have been evacuated from the island, and relief efforts have started to help . rebuild Dominica. It also helps that I know Flavia is okay even though she stayed on-island instead of evacuating to Canada. She lost her roof to the storm, but I imagine she cannot lose her fiery and uplifting spirit, which is infectious and deserves to be shared with the recuperating island. Dominica is a resilient island, and I know that the people are strong and will rise against this horrific event. If you want a way you can give back, think about purchasing a lapel pin as the proceeds will benefit rebuilding this devastated society: Dominica Strong Lapel Pin.
Neonatal ICU Service
For one week of our pediatrics core, we have inpatient service in the NICU. This was an interesting experience as I did not give much consideration to what happens to the child after deliver as I paid more attention to the procedures involved with closing up the mother from surgery or waiting for the birth of the placenta.
I essentially neglected the transition of care of the neonate when I was on my OBGYN service.
This week was almost a reprieve from the outpatient experience I have had for the last 6 weeks, and reminded me how much I love the hospital setting. Although neonatology did have some appeal to me, I still do not think my niche is pediatrics and I am still passionate to pursue practicing obstetrics and possibly gynecology.
Expectations
Wear scrubs.
Bring plenty to study.
Do not bring a stethoscope or other tools. Each baby's bed has a stethoscope to reduce contamination.
Pre-read neonatal basics, and watch the first six OnlineMedEd videos in the pediatrics section (screen shot from OnlineMedEd.org):
If you need to make doctor's appointments, take kids to dentist or doctor's appts, or catch up on different personal errands ... this will be the week for you to schedule these things in the afternoons without needing to take off additional time from studies.
You will be expected to orally present on case on the last day after you have been involved following a baby for the week.
Overall
For some of us, this week will be one of the most relaxed and laid back weeks compared to some of the fast-paced rotations we have. Typically, you go into the NICU at 8 AM and report to the P.A. on-duty for the day after you do a 3-5 minute hand scrub. This will be the person you report to and are dismissed by everyday. The neonatologist will typically enter the ward around 10:00 AM, so you have plenty of time to see multiple patients and perform physical exams. I was lucky and had the same neonatologist every day, but there are typically 2-3 doctors on-staff and you may have a different one each day. Just remember it is the physician assistant you will be directly reporting to every morning. The day typically ends around noon where you are expected to use your afternoons to prepare for the shelf exam and read deeper into assigned neonatal subjects. I was assigned: hyperbilirubinemia, sepsis, RDS vs bronchopulmonary dysplasia, failure to pass meconium, and necrotizing enterocolitis.
I had a specific baby who I took an interest in because the baby was considered an "funny-looking (FLK)" baby. This is not a medical term by any means, but jargon used to describe the gut feeling you have when you see this baby: "There is something different about this one." My patient has some very unique features that involved the hands and feet, and a meconium plug that took 3 days to come out. This patient already was CF screened negative, and pending newborn screens and genetic analysis.
I had no idea where to start with this patient in trying to discern what illness script would help me somehow find the best diagnosis. This child was definitely a zebra in the field of horses on the hospital ward. I started with what appeared to be the more unique features, and started reading a neonatal congenital disorders book where I was able to see features that are present and related to other conditions until I got close to what my patient had. However, no textbook had the constellation of signs my patient did and they were so unique that I doubt this patient was afflicted with two different disorders. My assessment based on talking to the nurses, physician assistant, neonatologist, physical exams, and laboratory panels led me "down the rabbit hole" into some interesting rare diseases that I had not even heard described before investing in this child's wellbeing. I presented research I had found to the attending, and learned that I may never get the answer to with what genetically this baby may have been born as the outcome would not affect progression or treatment of the baby's condition.
Anyway, I'm sure I'll think back to this FLK baby one day and wonder how they are doing similar to how I already think back to some of the children from my cases with Child Protective Services. One thing I can say for sure is that it was awesome to see parents who were fully invested in their child's wellbeing and outcome more than I have seen in the outpatient setting, and likely due to the sensitive nature of the NICU setting.
What Do You Do With All That 'Free Time'?
As a Medical Student House Husband, as my wife so eloquently put it recently, my 'free time' is always spent being productive since I am usually optimistic about how much I can accomplish in a day. I already use Cramfighter to schedule out shelf preparation during the six week period so I continued to do my schedule during my off afternoons. I would also use the time to read one of the assigned topics and watch a video on YouTube so I could feel confident if I was "pimped" with questions by the P.A. the next day.
After I was finished studying at home, it would normally be around 3:00 PM and I would start to work on house chores. Our house has not been this clean since psychiatry rotation! I picked one room to do some more deep cleaning each day, and helped my wife with some of the chores she normally completes. Whenever I have free time, I feel that it is important to do my part as a partner to my wife since we both have obligations to take care of our household needs. For example, I do not like doing laundry and my wife does not like dishes. So, I typically do dishes and she does our laundry. Since I was home more than usual this week while she would be at work, I would also help where I could with doing laundry and putting them up. By the time my wife came home with our youngest (I would pick up our oldest from school since it is next to our home), we would all be ready to sit down to a cooked meal and talk about our days. This has genuinely been one of the best weeks for me to invest time into my family and still feel like I have been able to study for my shelf exam.
I made time for catching up on clinical student government responsibilities. Being senator has let me feel more connected with the tracks over the U.S. from my March IMF cohort, compared to my counterparts in clinical rotations and I am thankful for this because of the connections I have been able to maintain with colleagues and RUSM faculty. With the school changes going on due to the hurricane, I think this is a time to make sure and connect with each other because the fear and anxiety for the island's condition is a great reason for us to come together. I know not everyone shares the same pride for RUSM that I do, but this is a time where we all should be united in pushing forward to succeed. Dominica gave us so much strength in preparing us for our clinical education, and I think we owe it to the island to represent our school proudly and gracefully.
I also had more time for my friends that I feel have been to busy lately with their own medical journeys. One of my closest friends is studying for a STEP exam, and I have been doing five questions each day with them over the phone. I think going over questions with someone else has helped both of us with developing our paradigms geared more toward differential diagnosis that is more clinically relevant. I am also more confident that I truly do know more than I give myself credit for from the basic sciences, and I think it is the clinical practice that has helped to solidify basic science concepts in a more meaningful way. Whenever I have gone back to some of the STEP 1 resources now or try one of the practice questions, I notice that I am amused by the questions because they seem much less intimidating than 7 months ago when I took STEP 1.
I have also been running into my closest amigas, the truly amazing Sarah Brown, since she has been at the hospital for her IM and Surgery rotations whereas I have been primarily outpatient. It has been awesome having breakfast or lunch with Sarah, and hearing her describe her experiences because it makes me look forward to both IM and surgery. Although the schedules seem intimidating and will have me strengthening my ability to work long hours, I look forward to the experiences in both areas because they are fundamentals in medicine and will help me be prepared for the next step in my education journey. Sarah, keep being awesome and I can't wait until we are able to reflect back on these med school days from PB's boat on a lake in any state but Oklahoma 😜... What's in Oklahoma anyway?
Alrighty, so I am going to enjoy the weekend with my family (although my wife has a paper to write for her second graduate degree)... so I will get some quality time with my boys and I can't think of a better way to spend a weekend. I will continue my outpatient pediatrics rotation next week, and am slated to take my shelf exam in two weeks. Thank you for reading, feel free to share or leave comments, and send questions to me anytime!
The Gallery of Sarah Brown: When Your Med School Bestie Has Her Own Faces Album on Your MacBook - Please click on a photo to see more details of the trials and tribulations of the not-so-invisible Sarah and her sidekick Sham.
