Throughout medical school, you always hear about the M4 life where we are able to choose our electives and there are few hard-and-fast requirements. One of those few requirements, however, is a sub-internship (or sub-I) in an ICU setting. I chose to rotate in the Neonatal ICU here at Mott so that I could become more familiar with newborn issues, particularly in premature babies.
I’m now about halfway through the rotation and there’s definitely been a learning curve. For one thing, I had forgotten how much math is involved in pediatrics pre-rounding. The patient’s I/Os suddenly became much more complicated to determine – intake should be calculated in terms of mL/kg/day whereas output is in mL/kg/hr. And, of course, all feeding volumes are increased per protocol in terms of mL/kg/day but orders have to be calculated in mL q3h. Yep. This rotation has enabled me to discover the shortcut to my phone’s calculator, so at least now I know that for the future 🙂
A few days into the rotation, I switched to nights. Sub-Is and interns all do six nights whereas the senior residents alternate between taking 24-hour call. I enjoyed nights, especially because it allowed me to learn about each of the babies on the resident side of the NICU and see the big picture, instead of immediately getting bogged down in all the minutiae (see previous paragraph…)
In the middle of last week, I switched back to days, which was a rough transition. Mostly because I was exhausted during the day at the hospital, but then would wake up a bit more by the time I got home. Then, of course, even though I would go to bed at a decent time, my brain would automatically wake me up from midnight to 4 a.m. for several nights after I transitioned back.
Overall, I’ve been enjoying my time in the NICU. It’s definitely a different experience, and probably unique amongst the ICUs in that some of the patients are absolutely acutely sick, whereas others are here because they were born extremely premature and we’re just helping to control their environment until they’re old enough to go home. The important thing to remember about babies (and children, but especially babies) is that they can be looking great with a life-threatening illness, until all of a sudden they’re not. It’s easy to get sucked into thinking everything is humming along, but a healthy suspicion of any minute change from a baby’s baseline is paramount.
In the NICU, we see babies on their birthday a lot. Luckily, I was able to leave the hospital in the early afternoon this past Sunday in order to celebrate a different kind of birthday – the 150th birthday celebration of my hometown Brighton. There was even a cake and everything! And, by everything, we even mean a collection of farm equipment, both modern and historical, all helpfully labeled.