Friday, September 15, 2017

As If One Person Named Kellyanne Were Not Already One Too Many

the love child of Kellyanne Conway and Donald Trump

My most recent post prior to this one was about neonates.  I'm presently up to my eyeballs in my neonatal rotation. It's probably fair to say that I have newborn babies on my brain in a serious way right now. Hence, it is altogether fitting that I should share this next bit of news with my readers.

The wife of my cousin Franklin, who is the eldest son of one of my father's sisters, gave birth to her fourth child over three weeks ago. Somehow this news blurb temporarily escaped my radar. For that matter, I hadn't even been aware that Skayleen (pronounce like the triangle), the new mother, was knocked up again, though in retrospect the news shouldn't come as much of a shock. Skayleen has given birth every eleven months since she and Franklin made things permanent -- as in eternal -- in the St. George Temple just a week shy of forty-five months ago. 

In the case of this particular birth, it isn't so much the baby herself who is newsworthy. While I admit to, in my previous blog,  having waxed philosophical about the miraculous nature of childbirth, particularly when the outcome is a healthy child, it isn't the wonder associated with the miracle of birth that has motivated me to share with you the news of my family's newest member. still, I would assume that this latest addition to the family of Franklin and Skayleen is without noticeable defect, as the baby's grandmother is the rather acquisitive Aunt Elyse, who is known more for the degree to which she is motivated by any possibility of financial gain than for any other quality she possesses, and she is the possessor of one green eye and one blue one.  Aunt Elyse almost certainly would have organized and held a telethon for the benefit of the kid and herself by now had there been any sign of congenital anomaly as significant as a broken toenail. 

What is most significant about the birth of my newest first-cousin-once-removed is the rather unfortunate name with which her parents chose to afflict her. The poor kid has been named Kellyanne. To the best of the knowledge of my Uncle Michael, Franklin and Skayleen aren't especially rabid fans of Kellyanne Conway, although Skayleen told my uncle that she thinks Ms. Conway is "really smart," and hopes that some intelligence by association might coincidentally rub off on the baby.  God help us all if it does. God help the baby regardless.

I cannot fucking believe it. 

Thursday, September 14, 2017

Miracles Both Ordinary and Not So Ordinary

In my current rotation in the neonatal unit, I'm spending a considerable amount of time observing premature babies and babies with Neonatal Abstinence Syndrome as well as, for the purpose of perspective,  with newborns not presenting any particular health challenges. The birth of any baby seems nothing short of miraculous to me. When a newborn is healthy, it's a cause for wonderment.

So many things can [and too often do] go wrong between a baby's conception and birth.  When everything goes as it should, which happens, auspiciously, far more often than not, it's a cause for celebration. It's sort of an unspoken acknowledgement with every birth of a healthy child, in the face of everything that might possibly have gone wrong for this new little creation, that once again all the worst-case scenarios have failed to come to fruition and the way life should be has triumphed once again over all the more problematic possibilities. It's the sort of thing that gives a person the faith to continue with such work in the face of what, all too often, feels like sheer futility. 

Seeing the preemies in their respective states of struggle gives me empathy for my own parents, who lost preemie twins a couple of years before the births of my brother and me, and who dealt with uncertainty concerning my own outlook. A newborn girl was delivered yesterday at my precise birth size of two pounds, two ounces and fifteen and-one-half inches in length. Though the outcome cannot be guaranteed to be perfect for any baby, now is a  great time to be born in terms of all that can be done for premature babies. While the child faces increased risks for all sort of complications ranging from but not limited to breathing problems, cardiac issues, gastrointestinal problems, brain and developmental problems, and far too many potential hazards to list here, odds are that she will bypass all the potentially disabling conditions and will emerge as a healthy child. The child's prognosis is, because of this time in which she was born, if anything, brighter than mine was.

I told a neonatologist standing nearby, who served his residency here at this facility while my dad was serving an oncology residency at the same time here and is a friend of my dad, that the tiny girl I observed was the precise size I was at birth. This is the hospital where I was born. The neonatologist was actually on duty during the interval in which I was treated at the NICU here. He carefully took the baby from her incubator and handed her to me. I was as sterile as I'll ever be, as I had scrubbed and gowned but hadn't yet handled any of the babies in the unit. We don't touch any babies, much less the preemies, without being freshly and thoroughly scrubbed. As I held her, I tried to compare her weight and mass to objects I have held. The closest approximation I could reach was that she felt to me about like a dense loaf of homemade whole wheat bread. How do medical personnel go about the act of reassuring parents of a baby who weighs roughly as much as a denser-than-average loaf of bread that the child's future looks anything but bleak?

About two minutes after handing me the baby, the neonatalogist took her from me and placed her back into her incubator. He then put his arm around me and steered me, crutches and all,  down a corridor, through two set of double doors, and into the room of a patient. The neonatologist introduced me to the patient and to her husband, who was seated in a recliner next to his wife's bed. I shook their hands. The neonatologist then told the new parents that less than twenty-three years ago, when he was completing his residency at this hospital, I was born here weighing two pounds, two ounces and measuring fifteen-and-one-half inches in length -- exactly the weight and length of their own newborn daughter. He told the new parents that I would graduate from medical school in the spring at the age of twenty-three. 

The young couple's new baby may someday attend medical school as I am doing, or perhaps will not. We cannot know what direction her abilities and interests will lead her. It  was, nevertheless,  gratifying to see the countenances of the young parents  transform from worried expressions to ones that looked perhaps calmer and more filled with hope.  I was most honored to have been even small a part of it.

I don't own this video. I hope the owner doesn't object to my use of it.

Wednesday, September 6, 2017

APGARS, Unusual Surgeries, and Unfortunate Reactions to Vaccines

My rotation in the neonatal unit began on Friday. The attending physician adjusted my weeks in this rotation to begin on Fridays and end on the following Thursdays so that I could start the new rotation right away. I scrubbed in for an INCREDIBLY interesting surgical procedure performed on a child only a few hours old. I really wish I could describe it more, but I do not wish to have have a new parent google his child's condition only to find his own child's surgery described in detail in my blog.  

I didn't assist beyond helping to position the baby. He was under general anesthesia and as such, didn't need to be restrained or anything of the sort, but even an unconscious body doesn't necessarily remain exactly as positioned. It wouldn't have been appropriate for me to incise or to suture in this procedure because a newborn should not be under general anesthesia for ten seconds longer than is absolutely necessary, and students don't incise or suture as proficiently or as efficiently as real surgeons do. We, the rookies, must perfect our technique on larger humans before we advance to the newbies.

For the record, despite requiring surgery at such an insanely young age, the odds are that this baby will be fine. The condition necessitating the surgery was all that was wrong as far as anyone could tell. If nothing tragic happens during the procedure, the prognosis is typically quite good. I certainly hope everything turns out great for this little guy.

I've dealt with healthy babies to abstinence syndrome babies to babies with conditions requiring almost immediate surgery. I'm rapidly moving toward proficiency in APGAR scoring. APGAR scores are the rating scales applied to newborns (except possibly to some of the Duggars, who may not have anyone qualified to accurately rate them on hand when they were born) at one minute after birth, then again at five minutes. as you might have guessed, APGAR is an acronym, in this case standing for "Appearance, Pulse, Grimace, Activity, and Respiration." What you might not have guessed is that the term APGAR actually was the surname of Dr. Virginia Apgar, the New York  anesthesiologist who developed the scale, originally to be used as a method of quantifying the effects of anesthesia on infants. Ranking from one to ten by assigning from zero to two points for each criterion, a typical score for a thriving baby might be 8-9.  (My brother's score  was 9.10, which was at the time of his birth tied for the highest APGAR for any baby under seven pounds at the hospital where we were born. The record probably still holds, not that anyone other than my mother would be keeping track, as the odds of a kid under seven pounds knocking out consecutive tens is practically nonexistent.)

My weekly maximum hours were reached earlier in the week. I told the resident in charge of tracking our hours that I don't object to exceeding limits but that I won't falsify time sheets. It would be my luck that, were I to falsify times that I worked,  something significant, resulting in noting all personnel present,  would end up happening during one of my shifts, thereby calling attention to the false documentation on my time sheet. The residents are cut a certain amount of slack in exceeding students' duty hours. It is understood that some shifts need to be covered and that available personnel to cover shifts can be limited. The on-the-record reason for our presence is so that we may be adequately trained, but the practical purpose is sometimes for coverage of shifts. The scope of our duties is limited by our inexperience, but we can provide long stints of patient-monitoring when needed.

Because the attending physicians' and residents' primary concern is the well-being of their patients, as it should be. educating us is a secondary responsibility for them. It's one they signed up for when they accepted positions at a teaching hospital, but still they're wearing at least two hats most of the time that they work. My current attending physician and resident, as well as the ones I most recently worked with at the end of my gastroenterology rotation (This is going to make me sound like more of an airhead than I actually am, but I drew a complete blank when I attempted to recall what was my most recent rotation before the present one; I had to look back into my notes in order to remember what it was. This is like honest-to-God early-onset Alzheimers. So much for avoiding neurology at all costs because neurological conditions freak me out) have been awesome about trying hard to ensure that the med students' hours of duty were scheduled for times that would be most beneficial and would provide the best learning experiences. Many supervising residents tell students to show up at whatever times that make it easiest for the actual MDs. I've been most fortunate throughout most of my clerkship experience to have supervising residents who were considerate in that regard.

Flu shots were given today. Medical students need to take advantage of them in the absence of any compelling medical reasons to avoid them. I would have liked to ask to delay mine for a couple of months until my orthopedic situation has improved, but having a thoroughly messed up leg didn't legitimately disqualify me from receiving an injection in my upper arm. I now wish I had wimped out. I'm not actually ill, but my arm is swollen and painful to the extent that it's beyond the normal post-injection soreness and is considered a genuine reaction to the vaccine. My body doesn't handle injections all that well in general. Intramuscular shots in particular give me problems because my muscles are small. Often  the needles used are more suitable for arms larger than mine. If I'm being treated for an accident or injury with an injection, and if the serum has to be drawn or the syringe filled specifically for me, the nurse or whoever is filling it will most often look at my arm, then decide to use a syringe with a smaller needle. When vaccinations are being given in mass, whoever is giving the shot only rarely will bother. In the future I will be more insistent that such is indeed done. If I'm to be de facto forced into immunization, it will be with a needle that is the appropriate size for my puny body.

My upper arm is discolored and swollen. It feels worse than it looks. The discomfort is such that using my crutches is quite painful, but I don't yet have the option of walking without crutches. The current vaccine isn't a live virus, so actual flu symptoms following the vaccine are extremely unlikely though still possible. I'd rather be dealing with a sore arm than with even the most minor version of the flu, though, so all things considered, I'm probably lucky that my reaction is in the form of a sore arm. 

I've already put in seventy-one hours for the week, and I haven't had a day off since something like August 24. Because of my hours and because of my shot reaction, I've been kicked out of the hospital for the rest of this week (with my week ending on Thursday). Under more ordinary circumstances I might be hurt or insulted by the exclusion, but in my present situation I'm considering myself lucky. I've already dragged body up the stairs of the condo, so it's just a matter of putting my laptop on the floor, after which I will be ready for a deep state of unconsciousness and REM sleep.

Good night, all.