Nights misery

On nights again. It's amazing how one can be so bored at work when there is so much to do. I guess it just gets repetitive after a while. I miss having patients you can actually talk to. Must keep reminding myself that the little creatures in boxes are actual people. Desperately desperately need some sleep. (am awake now as life goes on - still have exams to study for, laundry to do, holidays to plan, must keep fit etc so can't afford to sleep all day). sorry this is so uninspired.

epilogue

the parents of baby Z (the baby in my last post) handed in a hand-written letter yesterday evening. "Dear Sirs," it began, "thank you for your excellent care of Z. We have spoken to our parents... and they agree that we should set his soul free and let him die peacefully so we may see him again in the next life.....we have agreed that the date to do this should be March 10th."

And so Z's ventilator was switched off, and he was placed in his mother's arms - for the first time. He died within minutes.

Beautiful Freak

Thursday is Academic Day on the Unit, which means we don't do any work until lunchtime (and consequently work like mad afterwards and can't leave until nearly seven... but i'll save that rant for next time). Cotside teaching today was on a tiny, hairy little thing, a baby born at 30 weeks' gestation (i.e. 10 weeks early), unable to breath on his own and with multiple deformities. Having sent all the parents out of the room, we crowded round the incubator. "Now, who's going to help me criticise this baby?" said Dr. J, ending this question in his usual alligator grin. "Look at the feet. The heels are very prominent... they had 5 goes at intubating this baby - he has a micro-oropharynx. His ears are low-set and his fingers overlap - classic clinodactyly. On the xray, he has gracile ribs." Dr. J pauses to remove the nappy. "Now that is a very posterior anus...hang on, it's not an anus!" He gets really excited at this point. "Write in the notes, will you, Ali* (he says to one of the other SHOs) the baby has an imperforate anus and a sacral pit. Those are spinal structures you can see through that hole. What do you think," he turns to the other consultants, "surgical opinion?" They all bristle with excitement. One gushes about the size of the ventricular septal defect he'd found on echocardiography and marvels that it was not picked up by antenatal ultrasound scanning.

The baby is likely to have Edwards syndrome (genetic tests are pending), and will most likely die once he is taken off the ventilator. Meanwhile we try to explain all this to his parents while he serves as an unwitting specimen for postgraduate teaching. But one has to learn somehow. What freaks me out is the consultants. Neonatal medicine attracts a certain kind of personality. It requires an obsessive amount of attention to detail and a deft hand with fiddly procedures. Your patients never talk back, and (usually) possess near-miraculous powers of recovery. However, they come with (usually very distraught) parents and you also have to work with Midwives (another group of bizarre individuals) and Obstetricians. The work never stops because babies are born at all hours and fluctuate almost from minute to minute. So its an admirable job they do. But it gets a bit sad when they start getting excited about anuses being in the wrong place (or, indeed, absent).

the two faces of stoke newington

[once again so much has happened that I haven't had time to blog it, so here's a select list: survived 5 x 13 hr shifts in NICU, was going to blog an anonymised patient list but am too tired at the moment; took a short break in Edinburgh, submitted some pictures to a stock library, can now memorise about 30 minutes worth of Pilates - done purely out of a book and...]

Went rock climbing with my sister - at a castle (yes, literally) in Stoke Newington, discovering a whole new side of Hackney in the process - one where New-Agey (mostly white) couples come to nest, and which contains an entire herd of miniature tame deer in a landscaped park, gastropubs galore and a holistic hair salon. This is perhaps best described in the magazineN16. It truly is (or pretends to be!) a world apart from that of the Hackney Gazette - the latter's top headline today being a case in point: "A PARTYGOER ATTACKED in the street after a night out died of his injuries yesterday..." And all within a half hour's walk from my flat!