Over the Firth

Breakfast (brioche with marmalade and a cup of tea) on the train, with sea view as we go over the bridge - a world away from the view of someone's armpit one gets when commuting in London.

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Just completed a 1/2 set of nights (they are split 4 and 3, with a week of days in between). Was a bit bemused when the nurses said "that was a busy one"; we only had 3 babies in intensive care and only one ventilated (am used to up to 9 ventilated, and nasty nurses who won't help with the blood gases on principle). But I suppose that is trivialising things a bit; the one sick baby had grade 2-3 HIE, and the only thing he had going for him was he didn't need inotopic support. His oedema, high urine output, plummeting sodium and rocketing potassium, occasional metabolic acidosis and coagulopathy made for a rather challenging maths session at 4 o'clock in the morning. I had more than one "better call the registar" moment, followed by a sinking realisation: "oh, that would be me". I didn't really want to wake the sleeping on-call consultant (a paediatrician rather than a neonatologist) but at 5am I gave up and called her. (having changed the baby's fluids to what I thought would approximate what he needed) She wasn't much help - merely agreed with what I'd done, leaving me to get told off on the morning ward round by the neonatal consultant. "Did you calculate the sodium excretion?" he demanded to know. "And why wasn't the baby weighed?" he asked the nurses, looking decidedly unimpressed. Nurses often don't weigh critically ill babies (because they don't tolerate handling), and the weight obtained is often inaccurate due to all the tubes and lines that can't be disconnected. And I've learned (from previous bitter experience) to avoid contradicting neonatal nurses unless I'm absolutely sure I'm right. I suppose you can't win. I just hope the baby's alright.