Sunday, September 18, 2016

Make it through the night, little guy.

May he wake up looking less like this  . . .

and more like this, except that I don't care about the color of his hair or skin.

Tonight is my second and final on-call night of this session. I may not have another on-call weekend for quite some time.  I want to receive calls because I want to demonstrate my ability to handle them to my superiors, but I don't want life-or-death situations, not because I cannot handle them: I don't handle them -- I pass them off to my superiors immediately -- but because I don't wish life-or-death situations on anyone, and in particular, on babies and children.

I'm spending tonight at the children's hospital associated with my medical school. I'm not required to do this, but I have one little guy who is only four months old who is at a very critical stage of meningitis. Even omitting his name, I cannot go into too many details regarding his condition without committing at least one HIPAA violation. Chances are that no one who had the power to do anything about it would ever be any the wiser if I did, but those laws exist for good reasons and are not mere technicalities. I can say that the form of meningitis he is fighting is bacterial, which is more serious than viral forms of the condition. It is a type for which a vaccine has not yet been approved. Even if it were one of the vaccinatable types, he might not have received enough of the boosters yet to have developed sufficient immunity and might have contracted the illness anyway. In any event, it's a fluke and happened through no fault of his parents, who are competent care providers who maintain a clean home environment for their two precious children.

I'm here tonight for a couple of reasons. This is probably the baby's make-it-or-break-it night. I probably wouldn't get any sleep at home, and would drive the nurse's station bonkers with my frequent calls. Secondly, I'm not sure such is really the case and not that it only seems to be true, but a disproportionate number of health crises seem to happen in the late night and early morning hours. Perhaps it only seems that way to doctors who hate being awakened in the middle of REM sleep cycles, but it surely does seem to be the case. If such is to happen with this baby, there's probably not much I can do to help him directly, but I can probably get the for-real on-call pediatrician and pediatric neurologist here faster than the nurse's station can or will. There are other pediatricians on duty tonight here at the hospital, but if there is a true crisis, we want both the primary care physician and the assigned pediatric neurologist here ASAP. I have no fear whatsoever of calling them no matter what time it is. Depending upon the doctor, nurses sometimes hesitate because they may have had their heads bitten off on more than one occasion by the doctor or doctors in question over arguably unnecessary calls. The nurses will have to continue to work with these doctors. In another three-and-one-half weeks, I'll move on to my OBGYN rotation and will say adios, arrivederci, and adieu to all the doctors I'm dealing with presently. These doctors will have a say in my final grade, but unless I'm being especially obnoxious, as in phoning them approximately every fifteen minutes for light and transient causes, my grade for this rotation will not suffer.

If you're thinking that I will never survive a medical career if I feel that I must spend the night in a hospital every time I have a sick patient, you're right. I cannot behave this way throughout my career. This little baby, however, is my very first critically ill patient, and I reserve the right to treat him differently than the others. When I reach my one-hundredth critically ill patient, which may or may not happen depending upon the specialty I choose, the circumstances of my life may be such that I will not have the luxury of spending the night in a hospital even if I feel the inclination. Real life may get in the way. At this juncture, however, real life has not yet interfered to the point that I have to stay home every  night. All I have at home is a cat, who could fend for herself if she needed to, but she doesn't even need to because she has my brother there with her, and she likes him more than she likes me, anyway. Matthew can babysit the cat. I'll stay with the baby and his family.

I'm situated just outside the baby's section of the quarantined intensive care unit, in a quiet end of the hall. We have a a crib against a wall for the three-year-old sister, who fell asleep in her father's arms about fifteen minutes ago and was placed in the crib. She's sleeping blissfully, unaware of the severity of her baby brother's condition. Sleeping with her is a stuffed panda (she's old enough that it's safe) that I bought for her. Once a doctor bought a stuffed panda for me when I was in the hospital. Even though I was almost too old for such a gift, it made me feel better. When I saw the stuffed panda in the gift shop, it reminded me of the one I had been given, and it occurred to me that even though the tiny girl doesn't understand the gravity of the situation, she clearly knows that something is wrong, and she is totally out of her element, and that I should get the stuffed panda for her.

The baby's mother is praying the rosary. I have a rosary in my pocket. I don't ordinarily carry one at work, but it seemed like something I might want to use tonight. I shall take it out of my pocket and join her in praying for her tiny boy. While deep in my heart I'm not sure how much it really helps, I'm pretty sure it can't hurt, and at least it's something she (and I) can do while awaiting the outcome. My dad is here, which is good. He can say the rosary along with me in Spanish until I get it right. The mother is whispering too quietly for me to hear her.

Please join me in wishing, hoping, praying, or any combination of the three, for a stronger and healthier little boy by the time the sun returns to our part of the Earth. This once,  I shall not be sincere in reciting the "Thy will be done" line of the "Our Father." Can my will and the will of the baby's parents be done  this time? I want with all my heart for this baby to return to full health, and to be safe at home with Mami and Papi and Hermana as soon as is possible.


  1. Bless you,Alexis.
    Never underestimate or ignore the "gut feeling".Your book learning is essential but lots of medical practice is still that unexplainable sense that something is just not right. Another review of a patient often pays off as diseases are an evolving condition not just a snapshot in time.

    I still recall the last child I saw with meningitis, 20 years ago, a home visit on a Sunday evening.Straight to the paediatric unit of the teaching hospital, but I can still see her, her newly widowed mother and grandmother and their fears. She did well.You did well. I hope your little fellow does too.

    1. Thanks o much for the words of encouoragement, OzDoc.. He needed a change of meds in the wee hours, but seems to being doing better. his mother got to hold him in the quarantine area for a few minutes, and he's eating on his own (or as much as any 4-month-old can).

  2. I hope the little guy is still hanging on.

    1. Baby boy has only hit a few minor hurdles, which have been managed. If his MRI and hearing test come back clear, he should be fine. We'll just keep him here but keep him very secluded because he doesn't need germs from anyone else. His immunity is probably very low. A baby last winter who was here with the same form of meningitis went home and within a month was back with RSV. She pulled through and everything looks good. I suspect she'll struggle with immunity throughout her childhood, though. I was shadowing my preceptor when that happened, which is why I know about it. In this baby's case, it's sort of good that mom is home with the babies (dad has a pretty good job with Google)and that the family doesn't socialize much yet. Once baby boy reaches about two or two-and-one-half, they can make friends and start to socialize. Mama is a homebody and doesn't seem to get depressed just being at home with her children, and she does have me for a friend now even though I don't speak Spanish. And I'll put on clean scrubs and wash my hands any time I visit.

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