Just a Few Quick Things

Baby Jail

Remember how I told you that residents are underpaid for the work they do and how we are worth a lot more to the hospital than the monthly reimbursement the hospital gets from Medicare?

Well, like most things there are exceptions and I am living that exception this month as I lollygag my way through two weeks of purgatory (for an Emergency Medicine resident anyways) in a little place called Baby Jail, otherwise known as the Regional Neonatal Intensive Care Unit. To say I do nothing and am responsible for nothing would be an understatement. It’s not even as if I could take charge and a make a great contribution if I wanted to (which I don’t) because the most excellent nurses, nurse practioners, pediatric residents, neonatology fellows, and neonatologists have that place sewn up tight. They assign me a couple of babies but it’s nothing like the adult ICU where my program’s residents run the place for the attendings and nobody actually lets me manage my babies (and I don’t want to either). As far as I’m concerned, this should be an observational rotation.

I have the greatest respect for neonatologists. The ones here are excellent and I truly believe they are doing the Lord’s work, giving every baby possible a chance at life. I may be a cynic when it comes to end-of-life care for the warm dead in the adult ICU but this cynicism does not extend to the NICU where even babies born as early as 24 weeks can sometimes (sometimes, dammit) survive and blossom as children. Still, it is decidely a low-yield rotation for us. I don’t think I’m ever going to be calculating the caloric requirements and mix of proteins and fats for a preemie. If I ever get one I’m going to slap that kid on some D10 like it says on my pocket card and get him to the nearest NICU so fast that the malpractice lawyers swarming the poor OB who delivered the baby will say, “Damn, that guy is fast.”

So every day is, if not completely unpleasant, a kind of slow torture as I follow along on rounds knowing that they know that I know that they know that I’m not really interested and am counting the days until I can do something, anything, else. I am trying to get as many lumbar punctures and other procedures as I can but that’s about the only use of the rotation. I did a month of newborn nursery last year so I know how to get the Ballard score on a baby and meaning of various hip clicks and clunks.

Please, spare me the usual rah-rah pep talk about how I need to make my job relevant and make myself useful to the attendings. The consensus of every one of our residents who have done the rotation is that residents and fellows here are great people, the work is vitally important (perhaps the most important in the whole joint) but our presence is both puzzling and useless. Some of your rotations as a resident are going to be like that. You will finally get to the point where you understand that you are covering ground over which you will never tread again.


Mrs. Panda has taken the cubs to Florida for a week so I have had a little extra time to work on articles. It’s either that or just stare at the dogs and try to fathom their canine minds. I’ve got five of them and they’re sprawled despondantly around me waiting for the alpha female to return. The point is that I try to make all my posts about something and not just write a blurb here or there. I think even my critics will agree that this blog has a lot of content.

However, writing takes a lot out of me especially on a call-heavy month. But I plug away at it and appreciate you folks taking the time to read what I have to write. I realize some of you are clicking over here every day looking for some interesting commentary and if I could, I’d write a long article every day but I can’t. So I’ve started a page called Q24H where I’ll post brief comments, interesting (hopefully) observations, and maybe some ideas that I might later flesh out into posts. If any of you would like to contribute articles email them to me and I’ll consider putting them up. You could just post them in the comments section of an article but I think more people will read them if I post them on the Q24H page.

As usual, spelling, grammar, and voice are important. No rants, either and if I don’t use them I won’t use them but I will give you full credit when I do. Comments are not allowed in the Q24H section. It’s the “take it or leave it” page.


I think we have done a marvelous job of keeping the debate civil. I could use a little less condescension from Matthew but if that’s his style, well, it’s his style. But I am going to call him out on it. I will say that he is a policy wonk and therefore, because he understands the complexity of policy he believes that he knows more than he does. I am not a policy wonk but I understand economics and know full well that twenty years from now after almost two decades of Single Payer health care Matthew will still be wonking and still looking for somebody to blame because our people will still be unhealthy as all get out, he has to wait on grimy plastic chairs with everybody else, and the costs of his money-saving idea have ballooned to the point where nobody even remembers the good old days when we paid for our own health insurance and, in retrospect, it was pretty inexpensive.

9 thoughts on “Just a Few Quick Things

  1. At the end of your two weeks, I hope you realize that residents are an integral part of the team! In my institution, the ER residents do not even have the opportunity to rotate through the NICU – just Peds, Med/Peds, and the FM residents do a short rotation.

  2. Thank you for your encouragement but, with respect, the Emergency Medicine residents are not part of that team.

  3. Um….after our “lively” discussions in the last couple of days, I have to admit that I will never quite feel the same again about sitting in “plastic chairs”.

    I suppose you’re lonely now, without the wife for a week. Want me to tell you a funny story to cheer you up? Okay.

    My company frequently does wound care to an 89 year old woman’s leg cellulitis. I always get aggravated whenever I go see her and find that someone has again stolen my safety bandage scissors. (She lives in an ALF where everything not nailed down is stolen.) So I got smart and decided to HIDE some scissors. I picked a bottom drawer in her bureau, but when I slid the scissors underneath the various nether garments located in the drawer, my hand touched something….er…different than nether garments. It was a very large…uh…(how shall I put this?)…female entertainment device, with batteries and everything. I couldn’t resist turning it on–and was practically knocked down as the thing packed a wallop like being hit with a stun gun.

    All I kept thinking after that was…89??????

    And then I went to my Jeep and sterilized the hell out of my hands…

  4. i had a question – after following your blog for sometime – i see your point about the anti-trust violation and monopoly the nmrp has, etc, etc – question is – do you know if anyone’s ever tried suing the nmrp or their hospital or anything like that?

  5. I have never said that the NRMP is a monopoly or violates anti-trust laws. The NRMP does not collude with hospitals to set salaries and they in no way run hospitals or even have anything to do with them except providing a labor matching service.

    I believe a lawsuit alleging this was recently lost by the plaintiffs.

  6. actually the lawsuit wasn’t lost. the AMA lobbied congress and a few members stuck an amendment in an unrelated bill which stated the NRMP cannot be sued for anti-trust violations. So in essence the AMA played dirty pool, kind of shows you who they are really protecting doesn’t it

  7. You didn’t find a way to stop your wife from coming to Florida!!!!!! Run away, nothing to see down here.

  8. Any chance of adding the Q24H stuff to your RSS feed? Or creating a separate RSS feed?

    Good job, by the way. I may not always agree, but it definitely gets the wheels turning. I enjoy reading your blog and SDN posts.

  9. Whoa, I haven’t been here in some time (Forgive me. ‘Tis exam season and my neurons are committing suicide). Nice job you’ve done with the site. And Scalpel’s right, you do a great job writing.

    Over here in the UK we don’t have residents as such, but reading about your experiences (as well as the occasional compulsory dose of Grey’s Anatomy) gives me a great insight into your health system. (Mostly that it’s better than ours.) I’ve updated my blogroll to your new address. Keep chewing! (Sugar cane. Geddit? You’re a panda, so you chew cane, ahaha seewhatIdidthere…)

    (I’ll shut up now.)

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