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).