And on a BUSY night...

Finally, a busy night with the pedometer, and I feel somewhat vindicated.

15,367 steps!

That's 7.03 miles!

My dogs are barkin'... time to put them to bed.

This is So Cool.

Pun intended.

(WARNING: highly educational and seriously UNfunny post to follow.)

In this age of technology and gadgets, it's not often that a revolutionary breakthrough utilizes basic physiology to make a miraculous difference.

Brain cooling is an amazing new (relatively speaking) technique being offered by several NICUs across the nation, and unfortunately, we've had a few babes over the last year that have needed it. Fortunately, it can work.

I was thinking about these kiddos the other day, which led me to do a little surfing in search of further information.

Brain cooling is intended for infants that have undergone hypoxic injury related to labor or delivery, with events such as abruption, ruptured uterus or cord prolapse or occlusion. This article, from Georgetown University Hospital, discusses the pathology of hypoxic-ischemic encephalopathy (HIE) and how brain cooling is used to try to avoid what was described to me as the "second wave" of brain damage that occurs following the hypoxic event.

While specific processes differ slightly, most sources agree that the cooling must be initiated within six hours of birth and bring the infant to a hypothermic state (around 91 degrees Fahrenheit!), slowing down the body's metabolic processes to avoid further chemical and inflammatory damage to the brain tissue. After 72 hours, the infant is then slowly rewarmed.

It is by no means the perfect miracle cure. This article, from the BBC, suggests that it results in significant improvement in outcomes for only one out of every six to eight babies that undergo the treatment and is unlikely to make a difference for those with the most severe brain injuries. However, that is still 12-16% of these deathly ill infants who may now have a chance for recovery.

Here is a short video documenting one such case.

What can I say?

So cool.

When Words Are Not Enough

Sometimes all it takes is one sentence to trigger a flood of memory. Kim's moving recollection about a very sick AIDS patient sent me flying into the past with this sentence: "A family desperately clinging to denial is a painful thing to witness."

*****

She was 22 weeks along, and absolutely convinced that she was out of the danger zone, that there must be something we could do, either to stop her from delivering or to save her baby. If she prayed hard enough, had enough faith... surely everything would be fine.

"I felt him kick again. He's still alive!" she exclaimed brightly. Smiling at her husband, she said, "See honey? He's right here. I can feel him kicking."

Over and over she murmured to herself, "It's going to be okay, you're going to make it. Just keep praying..."

*****

"Do a C-section. Save my baby!" she demanded, once she realized that delivery was unavoidable and the baby's heart rate was slowing. Now, she was scared and angry.

We gently explained that the baby was too early and did not have any hope of survival, whether or not we delivered him quickly. She refused to accept these facts. The tension and terror were palpable in the room, a wall of silence between us.

"It's going to be fine... he's going to make it."

*****

Her denial persisted as we moved her to a delivery room, where the inevitable birth would take place. She insisted that we call the neonatal team to be present, so that they could resuscitate the baby, make him LIVE, as she knew in her heart he could, if only she prayed hard enough. She asked for a chaplain and "anyone that believes in God" to come and pray with her.

*****

And then it came.

The moment of realization, like an invisible bubble bursting. She saw him.

"Oh," she whispered, as he was whisked into the waiting arms of the neonatologist... "He's too small." And she looked into my eyes, and then, she knew.

*****

He was too small. Only 370 grams, 13 ounces.

There is no ET tube small enough... no prayer big enough. I wanted to take her in my arms, shield her from the pain.

But at last, she was able to let go. Now she could see that it was not meant to be. Now she could hold her son, and grieve for him, and love him, as he was.

*****

Denial can be so cruel. So, too, can the onset of reality... and with it, the loss of hope.

Truth is Stranger Than Fiction. Period.

HowManyOfMe.com

There are: 8 people with my name in the U.S.A. How many have your name?

So what are the chances that I would care for a patient with the same first and last name as me?

Because I DID. About 4 years ago, I was pulled to the antepartum unit for a four-hour stint, and one of the patients in my assignment was... me! Well, same name anyway. Slightly different age, way different skin color. Huh. I wonder what the statistical probability of that happening would be.

Give Thanks

It's a day to reflect on all that we are thankful for.

I am thankful for the calling to a noble profession dedicated to helping people.
I am thankful for the opportunity to make a difference in the lives of families every time I go to work.
I am thankful for the tremendous moment of birth when the ultimate outcome is truly out of our hands, that blink of an eye in which a tiny life begins... and is both completely dependent yet must breath and suck and pump blood all on its own.
I am thankful for the technology and advances in medicine that allow us to help sick moms and babes.
I am thankful that most deliveries require no such technology.
I am thankful for the team of dedicated nurses and other staff members with whom I work, the people who make work more than bearable, the ones who fill it with laughter, smiles and enjoyment.
I am thankful for the instances when there is no laughter or joy, when life is at its rawest and most real.
I am thankful that I can return to the loving, understanding arms of my family and a warm, inviting home.

Happy Thanksgiving.

Catharsis

It's been a long weekend on L&D (busy, stressful, all-out-cuckoo?)... you would think that I might be smart enough to come home and crawl right into bed.

But no: I went looking around the internet, and accidentally (or serendipitously) came across an infant bereavement photography website. Couldn't help myself... I started paging through.

And I came across this stunning eulogy that I felt compelled to share. Please be aware, the website also contains photographs of ill and dead infants. However, this father's words were amazing and uplifting in the face of such sadness. I think that it speaks to much of the grief that those of us who work on L&D and particularly in NICU carry with us.

If anyone is in need of a good emotional release, I know it worked for me.