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.

Q24H

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.

Comments

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.