Adrenaline rush

Yesterday I took the test to become certified in neonatal resuscitation protocol (NRP). Today I found out that I passed (actually made a 100% on the written half). Ha ... turns out that I didn't need a test to tell me that!

Like I mentioned in a previous entry, this month I'm on call every 4th day to deliveries where something is expected to go wrong in a small way that one person can handle. I always have the full resuscitation team to call with the push of a button (which I did twice yesterday), but it's still just me in charge til they get there, and it's up to me to keep these 90-seconds old babies alive. When I arrived to work yesterday morning, I'd never had to intubate a baby before; when the babies are born with meconium (aka "baby's first poop") in their amniotic fluid and are either not breathing or are giving a very poor respiratory effort, we stick breathing tubes down their tracheas to suction out their meconium. Yes, that is very gross, and I'll even admit it as a doctor that I hate seeing babies covered with mec. Some of these kids are just NASTY at birth! In all of the deliveries that I'd gone to for the last 2 calls, the OB team had called me with enough time to get to the room, set up all my equipment, and grab a warm blanket to whisk the baby off to the warmer as soon as the OB cut the cord. All of my babies had done fine with simple suctioning, and I started to joke again about my white cloud that follows me around on call.

Yesterday I didn't have the same luck. Early in the day I arrived to one of the rooms as the baby's head was being delivered, and I didn't even have time to set up my full equipment. The OB brought the baby to the warmer where I was still hooking up the suctioning, and the baby looked horrible! Limp, blue, no cry ... I paused for 1 second, and then my training kicked in.

I quickly suctioned what I could out of the mouth and grabbed my laryngoscope. Where were the vocal cords? (Despite what TV shows like ER may depict, intubation is not always easy -- especially when your baby has a mouth full of nasty.) I thought to myself, "Ok, pull out and try again ... hurry, hurry ... steady ... there they are! Go! I'm in ... no mec below the cords. Okay, laryngoscope out and reassess. Baby not breathing ... let's bag him. Squeeze-two-three, squeeze-two-three, squeeze-two-three ... Keep it up. C'mon, baby, gimme a cry ... still bagging with no response. Okay, let's do it -- hit the Resus button and call the team. Where are they?? Has it really only been 30 seconds? Wait, what is this? A cry? C'mon, baby ... YES!! Good cry!!! You're pinking up!!"

By the time the team made it upstairs, the baby looked great. I felt a little silly to have them there for a pink, screaming baby, but it was better to have them there and have fixed the problem before their arrival than to have waited too long to call them. My heart was pounding the entire time especially since I was the only one in the room who was in charge of this baby. God really brought everything I studied into my mind at this point!

Later in the night (or actually early this morning), I got called to one of the delivery rooms for what must have been at least the 15th delivery I attended in 24 hours. I announced "Pedi!" as I always do when I entered the room and asked for the story. Initially I was told that mom just had an infection ... no other problems. Okay, that's cool; I'm trained to do that alone. I asked if there was mec(onium) and answered that there was not. As I rushed to set up my equipment, I heard someone at the mom's bedside call out, "She's moderate mec." Oh really now? Hmm, I can handle 2 things alone, but I better check and make sure the 3rd element of the so-called "triple threat" wasn't there. "How is the baby's heartrate?" "Actually, since you asked, he's been decelling with every contraction." CRAP. Infection + meconium (a sign of potential fetal distress) + abnormal fetal heart tones = triple threat = resus team = why the heck did they call just the intern??? They should have known better. I radioed my senior resident on call on the walkie we carry to confirm that I shouldn't be there alone, and I was instructed to push the Resus button NOW.

In the meantime (of course), the baby was delivered. It was COVERED in grossness and not breathing. Being the only pediatric provider in the room at this time, I grabbed my equipment and prepped for intubation. This one was harder; I was scared and had a hard time visualizing what I was supposed to see, but I KNEW it had to be done. Praise God, I got the intubation on the first try. Unfortunately this baby did have meconium below the cords and didn't respond at all at first to my efforts. By this time, the team had arrived and took over resuscitation. It was a good thing they were there because this kid needed way more support than I could provide or even than the senior could have provided alone. He ended up doing fine, but it was SCARY!

My whole point is that my life feels like one big test sometimes. I don't study anymore to make a good grade. I study because my patients depend on my knowledge; sometimes they even stake their lives on it. I'm glad I passed when it counts.

I'm not sure what it is ...

Earlier this week I saw snow in Texas for the first time since 1989. I was not in Houston a couple of Christmases ago when it snowed, so I hadn't seen snow since it snowed in December 1989 in Houston. I'm now leaving for work at the fabulous hour of 6:30 (no more 4:45 trips to the hospital for me til I'm a 2nd year!), but it's still dark when I get to work. As I pulled out of the garage one morning earlier this week, some weird white stuff started hitting my car. I called my husband at home (yes, at home!) and warned him to be careful since the roads were iced over and this weird sleet/snow was coming down pretty hard. As I drove for a few more minutes, it lightened up a bit and began to swirl around, and I realized that we had honest-to-goodness snow in Dallas. It was amazing!! I'm such a nerd for getting so excited about snow.

I'm in the Newborn Nursery this month, so I'm taking care of relatively healthy babies by day and then going to deliveries with problems every 4th day and night. It's kind of scary -- some of these babies aren't breathing when they are born, and I'm the only pediatrician in the room! I can call for back-up if I need it, but it will still take the senior resident on call at least 60 seconds to get there, so I really need to know what I'm doing.

In other exciting news, my beloved is home!!!! I didn't believe it until he finally didn't get on a plane Monday morning. It is so weird to come home and know he'll get home several hours after me. It's really hard being on call every 4th night now that he's here and knowing that I'm the one away, but it's so great to see him the following night and not have to wait several days after a rough call night to get a hug from him. He has to go to training on the East Coast for 4 nights next week and will have to go back to California for 2 nights this Spring, but he'll be in Dallas for the majority of the next 3 months. I can't wait to see what marriage is truly supposed to be like!!

I miss ...

I miss my girlfriends. I must admit that I have often been called a loner; I don't "need" people. I like people a lot, but I'm one of those people who tends to forge a few very deep, meaningful relationships instead of many surface ones. Most of the people who truly know the real me are people with whom I rarely speak, but when we do speak, it's like no time has elapsed since we were last together. There are many days when I feel like Colonel Brandon from Sense and Sensibility ..."the sort of [wo]man every speaks well of but nobody remembers to talk to." I get along very well with 99% of the people with whom I come into contact, but there are very few times that I actually bond with someone on a very deep level. Part of that comes from my extreme dislike of the telephone. There are two people in the world with whom I can carry on a telephone conversation lasting more than 3-5 minutes: Scott and my mom. Even my sister, who is one of my very best friends, and I rarely speak on the phone for more than just a few minutes at a time; it's just not my thing unless I know you well and am super comfortable. I don't think to "call up" friends; I'm much more of the "let's go grab dinner and catch up" type. I need the face-to-face contact! The problem is that my close friends are now scattered across the country: Houston, San Antonio, North Carolina, Wichita Falls ... the list is short but important.

I miss these girls. I miss coming to them and laughing, crying, or just gabbing for hours. I miss knowing they'd accept me as I am without judgement but would still nudge me towards the right direction. I miss laughing at old jokes. I miss talking about how we had no idea where our lives were headed but couldn't wait to find out. I miss not discussing politics with one of my best friends whose political views are totally opposite mine because we'd agreed to disagree and then moved on and stayed so close. I got an email from one of my bridesmaids this week, and I welled up with tears when I read it because I felt the ache again of not having that female companionship that I took for granted back in Houston. I know that God provides all we need and will provide me with women of quality in His timing, but in the middle of intern year when I don't have the time to forge friendships since I practically live at the hospital, I just miss that. I miss having girlfriends to grab coffee with after work. I miss coming to the hospital and seeing people I'd had dinner with two nights earlier. I miss going to church on Sundays and seeing women where I knew details of what was going on in their lives; I am so rarely able to make it to church (once a month if I'm lucky) that it's difficult to feel authentically involved with the women there to the same degree which I am used to. The girls at work are great, but I haven't bonded with any of them to the same degree that I did with my med school friends.

I know there is a purpose for all of this, and I know that it is making me a stronger person. I just don't want to forget what it's like to have close relationships with women who live in the same town I do.

A new year

I could bore everyone with a reflective post on all the changes that happened in my life in 2006, but instead I'll leave yall with a list of interesting events from my life over the last two weeks:

• I chopped off 8 inches of hair.
• I was told I can finally get a puppy whenever we move into our house!
• We had our build meeting for our house cancelled for the second time in a month -- twenty minutes before the meeting was scheduled to begin. We then had one of the head builders find out what happened and personally reschedule our meeting to be with him that afternoon. Our house should break ground sometime within the next couple of weeks!
• I stayed up 34 hours straight thanks to my inability to sleep on a hard plastic mattress and my evil pager that went off every 20-30 minutes for the little time I had to lie down.
• I crossed the halfway point of internship. Baby, it's all downhill from here. I also realized that I've learned more in the last 6 months than I ever knew possible.
• I fell in love with my job all over again. I may hate the long hours, I may get frustrated by inane rules and paperwork, I may be driven slowly crazy by parents, but I sure love these kids.
• I discovered that chocolate chip waffles made at home with someone you love can be one of the best dinners ever.

I had a great 2006. 2007 is only looking up.