Why I hate people.

At 7pm tonight, I got a page from the post-partum nursing station.

"We've got a patient here; baby is 48 hours old, has a bilirubin of 185. GBS-, term baby, normal delivery, no risk factors. We were going to send them home, but Mum is really worried that the bilirubin is going up."

Me: Ok, I'll go talk to them.
Nurse: Um...they want to know what the plan is...
Me: Ok. I'll send them home tonight, but ask them to come back for a repeat blood test in the morning, just to make sure.
Nurse: So...you agree that they should go home?

That should have been my first red flag.

I discussed the case with my staff pediatrician. He agreed - the baby did not need treatment, but should return tomorrow for a repeat blood test.

I walked into the patient's room, pleasant and smiling, ready to tell them the good news.

Me; "Good news! Your baby is well. She doesn't need treatment. You can go home tonight!"

All hell broke loose.

In the room I had 2 sets of grandparents, a crazed post-partum mother and a small (apparently inconsequential) baby. All of them, except the baby, started yelling at me.

"We can't leave. It's 7 o'clock at night and we live in Scarborough!"
"This baby is sick, you said we had to come back tomorrow anyways, how can you make us leave?"
"What do you mean the baby is well? She is turning yellow!"

Ah, I thought. These people are worried about their baby. I will give them reassurance.

Me: Your baby is actually ok. It is very normal for babies to have some level of jaundice in the first days of life. Her level is not dangerous.

"How can that be true? She is turning yellow!"
"My daughter had jaundice too! I know what this is! She's sick"
"Even if she's fine, what if she's not fine tomorrow, you can't tell us to leave!"
"It'll take us 2 hours to pack up all our stuff and we didn't bring a car seat!"
" We were told we could stay until 11 am tomorrow!"

Ah, I thought. These people don't understand jaundice. I was about to start explaining when...

Grandfather: "It's snowing out. You want us to take this sick baby out in the snow, then put her in the car when you don't know what could happen to us on the road?"
Grandma 1: "I just want you to hear what I'm saying, we want to stay till tomorrow because it's going to be very annoying for us to go all the way home tonight and come all the way back tomorrow".
Grandma 2: "The baby has jaundice, the numbers have gone up. You said it yourself. You said the baby is sick."

Ah, I thought. These people are ignorant fucktards, and I would be doing the baby a favor if I gave her to a pack of wolves to be raised.

I kept trying to explain, but everything I said was ignored. Finally, I said, "This baby does not need treatment tonight. She is well. Her numbers are not in the dangerous range and so she is safe to go home."

Grandma 2: "I don't believe you. I want a second opinion and another doctor. A real doctor."

At this point I excused myself from the room. I took a deep breath.

When I came back in to tell them they could have what they want, I didn't expect gratitude. And my expectations were way too high:

"You know, you are the reason people complain about the human face of healthcare."
"It's not personal, we respect you as a doctor, but you have to know that we're right..."

This is the edited version. The actual event took about 2 hours. On the plus side, I made 8 dollars.

Lord.
Just 11 hours of this shit to go. (I wrote shift, but I believe my typo speaks the truth).

NPR

Neonatal resuscitation follows the same principles as adult resuscitation, right? Like, babies should be, like, breathing and stuff. They should totally have, like, heart beats. And oxygen. Oxygen is totes essential.

This was my approach to NRP (and not NPR, as I've been calling it). I thought that newborns were much like tiny tiny adults, and that you could simply open their mouths, grab their wrists for a pulse and treat them like grownups.

Wrong.

Scenario:
Baby is blue. What do you do?
Me: Um, intubate them and start CPAP.
NRP: Wrong. You popped the tiny lungs and now the baby is dead.
Me: !
Me: Um, ok. Just apply the mask and give CPAP.
NRP: Wrong. There was baby-poop in the baby's throat and now it's dead.
Me: !!
Me: Well, what if I just open the airway with this head position and bag and mask the baby until help arrives.
NRP: Wrong. You have the baby's head in the wrong position. And it is...
Me: Dead. Slippery little suckers, aren't they.
NRP: !!!

The correct choice? Don't answer your pager.

Clearly, everything I do to this baby is lethal or torturous or both. Might as well hide in the call room watching "Say Yes to the Dress" marathons and practicing my penmanship. Letters from inmates are all the rage these days.

Disclaimer: My NRP exam is tomorrow. I am only studying. I have not killed any babies yet. I do not intend to.

The babies may have other plans.
I'll keep you posted.

Happy Baby Posture

Remember medical school? Remember when all you wanted was to be around soft, squishy, wiggly babies all the time? Remember when you thought that nothing could be more delightful than baby-time, all the time?

Turns out you were right. I'm doing pediatrics right now, and baby-time is the BEST!

I start every morning with a round of the NICU, picking up babies that fit into my palm, poking their tummies, tickling their feet. Sometimes I cuddle them and get to feed them. Sometimes I stroke their soft spots until they calm.

Then, I go to clinic. All day, people bring their tiny adorable children to me. I sometimes get to watch them play (developmental clinic), sometimes get to help them eat (nutrition clinic) and sometimes get to wiggle their feet (well-baby checks).

So why am I 100% happy I'm going to be a family doctor, instead of a pediatrician?

Because sometimes your pager goes off at 1am for a "Code Pink".

Sometimes the baby is born early, at 33 weeks. And you have to run this tiny sack of skin down the hall and place it on a warming table. You have to bag & mask while your boss gets the tubes ready. You have to hold it still as a tube is forced down it's throat, then watch blood bubble up. You have to squeeze a chest the size of a toy, squeeze it with both hands until you feel it crunch flat. Keep squeezing at a rate of 100bpm. And then send the baby to Sick Kids, not knowing if what you've done caused harm or helped.

Sometimes there's a Code OB - emergency C sections for fetal distress. For these, you're doing the procedures in the OR and you can hear the Obstetricians behind you saying things like, "She's crashing!" and "Why are her O2 sats dropping?". And meanwhile, the baby is white as paper due to a lack of circulation.

Sure, not all pediatrics is so dramatic. But sometimes kids get sick cos of parental neglect. Sometimes they get sick cos they got into Gran's medicine. Sometimes they just get sick. And sick kids are the saddest thing in the world.

So, I am truly thrilled to be a Family Doctor. The kids I see have coughs, colds and rashes. They will pee on me while I try and find their testicles (harder than it sounds). They will puke on my lap and poop on my examining table. But 99% of them will go home with Mum, returning in 6 months for their annual shots.

And those are the babies I want to see. I'll send the rest on to the Pediatricians, and wish them all luck.