Some of you might remember the many subdued, nuanced posts I made in 2013 about how my NICU sub-internship made me want to quit medicine, quit life, become a hobo who hops trains for a living and never have to calculate a TFL or realize I forgot to write down a UOP or adjust 42 meds for the brand-new weight of +5 grams ever again so help me god.
But more likely none of you remember these NICU sub-I posts because, in looking back to link to them, I realize I must have deleted them all in a fit of self-awareness.
Regardless, it was in 2013 – and lucky for you I lack that same sense of self-aware professionalism 2 years later- so LET ME GIVE YOU A RECAP:
- My first day, I was given a “feeder and grower” baby who was supposed to be my simple exercise in NICU mathematics (calculating intake per kilo, counting apneas / bradys / destats, etc.)
- My first day, said baby had an eye exam and promptly decided to stop breathing, stop pumping blood, and just generally feign death. Which is apparently a thing that NICU babies like to do.
- My first day I was essentially somewhat convinced, for at least the duration of the code blue, that I had murdered the baby.
- Probably by failing to properly calculate the fluids/kg/hr.
- My second day, I had to present the above to a new attending (who apparently didn’t hear about the code on sign-out? What?) while the mother was in the room (What?)
- It was my first NICU patient presentation.
- It went poorly.
- The senior resident noticed and took me quietly by the hand afterwards to ask me what the hell I was thinking in trying to give a narrative account of what happened as opposed to just going by systems.
- You could tell he was disappointed because he literally walked with me for about 20 minutes just trying to find a place quiet enough to loudly voice his disapproval. That made it so much worse.
- It’s a little like when a delivery note describes a baby as “stunned”. I was ‘stunned’. I was out of my element. There was no placenta. There was only an angry senior resident speaking words I did not understand.
- I cried.
- a lot.
The rotation had a few ups on its way to a largely permanently downhill slide, but largely the only redeeming factor it had for me was that goddamnit, I did it. I left that rotation with a well-earned sense of THIS MAY HAVE SUCKED, BUT WHEN I AM ON NICU AS AN INTERN I WILL BE THE BEST NICU INTERN EVER.
The worst thing about my NICU sub-I, as a 4th year med student, was that you couldn’t overcome inadequate knowledge with superhuman effort: I tried showing up to pre-round 2 hours earlier, and I learned the hard way that it just meant that all of my calculations would be 2 hours behind everyone else’s.
When you think about it, that’s just supremely unfair.
(“Uh, sorry, med student? you said the urine output was 3.2? It was actually 2.9. Try doing your math again” “Oh, but I calculated from 5am-5am…” “Well, don’t do that. It’s 7-7am. Because reasons.”)
But again with the optimism: Most peds interns have no NICU experience when they start- but I had a full month! A bloody, torturous, terrible month as a sub-intern! I know what TPN is and what the abbreviations mean! I know that “trialing CPAP” means trialing off CPAP. I know that grunting is auto-PEEP, and I know how to ask insightful questions when the RT explains HFOV, which will never make any damned sense to anyone, sorry.
(it works by magic.)
I started NICU again on Monday: but this time, instead of being the scared sub-I who cries when the intern berates me for reporting 4 bradycardias in 24 hours instead of 5 (“I’m sorry, this makes a difference in your management HOW?”) (<– is a thing I should have said) I will instead BE THAT INTERN.
Also I don’t have a senior resident.
Also this may be the worst month of my life.