Chapter 17
The social worker took this patient transition as a great moment to escape, and Clarissa used her exit to walk to the opposite side of the room and the final patient in the pod.
She started talking as she walked, making Schuller chase her, and was aided by Pharmacy herding everyone in that direction.
Using a generous dollop of hand sanitizer, she carefully propped up the gorgeous curly-haired baby. He wasn’t intubated, was fully neurologically intact, and other than the PICC line in his left arm, he appeared almost normal.
Unless you paid attention to his lightly draped abdominal binder keeping his intestines (among other organs) from falling further out of his body. Or the NG tube in his nose. Or the slight green cast to his skin from TPN-associated liver irritation.
Gastroschesis was when babies were born with their intestines outside of their belly, usually through the belly button. Seven out of ten babies were surgically repaired immediately after birth. Cortland was in the unlucky group who had a large enough defect that couldn’t be closed easily.
“He is! And how is his mood?” Schuller asked, surprised the baby was watching her with wide eyes.
“Fabulous. This month is all about maximizing his growth and stability. Peds surgery is doing the next procedure under general and prefer he be four months old,” Clarissa said.
Her anesthesia rotation had taught her ped surgery rarely performed elective procedures using general anesthesia unless they were at least four months old and weighed over ten pounds.
It counted as elective, one supposed, if he had survived this long without a GI system. Cortland wasn’t allowed to eat, and the NG tube was continuously suctioning any swallowed saliva or mucous since it had nowhere to go.
“Oh, he is so cute. Nutritional status?” Schuller inquired, smiling at Cortland.
“Continues total parenteral nutrition and has been stable. We’ve spaced his labs to twice a week. Liver function remains in the safe range.” Nutrition and pharmacy both nodded in agreement with Clarissa’s presentation.
“What does he do for fun?” Schuller wanted to know.
A softball of a question on Cortland.
“His best friend is Mr. Glowworm.” Clarissa set him back down and tapped the musical toy next to him. “He likes the Go to Sleep song and Twinkle Twinkle Little Star. Frère Jacques is the devil.”
Schuller started glancing around the room like she was searching for more random questions to ask, but salvation arrived as a new player entered the game.
“Dr. Schuller, can you sign a few care coordination documents for me?” The NICU charge nurse, Chioma, had come to their rescue. She’d run the dayshift for twelve years and didn’t appreciate rounds running overly long. Social work must have dropped off the papers with her as an excuse to intervene.
The firm set of her mouth and the jerk of her head toward Clarissa also communicated her desire for Clarissa to move rounds along.
“Everyone, let’s go to Level 2.” She trotted them over to the nearby level 2/Limbo pod and gathered the residents and med students to her. “This isn’t working. We need to have a new strategy.”
“Why does anyone care if the baby is cute? Mine only has one lung and half a heart!” Linga complained. “Cute isn’t science.”
Her irritation might have hit the issue on the head. Most of Schuller’s questions had a bent outside of a systems-based approach. In fact, there was a vague pattern to the information Schuller sought.
“Actually, there are statistical ways to measure attractiveness and factors eliciting emotions,” Clarissa said as her team stared at her blankly. “I was an art minor, and we’re going to use them to speed up rounds.”
“How?” the other medical student, Jon, the only guy in the group, asked.
“Write these down about each of your patients. Eye color. Hair color. Hair texture. Clothing type and color. Likes and dislikes. Hobbies,” Clarissa instructed. With the exception of Linga, the rest of the group started updating their notes.
“They don’t have hobbies. The intubated ones aren’t very conscious to have likes or dislikes,” she pointed out.
Jon said, “I can’t come up with hobbies either.”
“If you’re stumped, pick from this list, baths, burping, pacifiers, picture of their parents, siblings or dogs.
Don’t like dirty diapers, being cold, spitting up, temp checks.
Likes being held, clean diapers, chewing on blankets, rattles, warmed breast milk, kangaroo time.
” Clarissa slowed down to let them catch up.
“It’s not rocket science. Have one of those as a response if she asks.
If you want a specific one, ask their main bedside nurse. ”
“I think this is a waste of time,” Linga said. “These babies are really sick, and the color of their onsie or if they like to be held isn’t very important.”
“Not having an answer for the neo is a waste of our time. Do you want rounds to last till three p.m.?” Clarissa reminded her and continued, “Start each presentation like this. ‘In Bed 16, we have Unique Smith, an ex 25-weeker, now 34-weeks, working on po feedings. She transitioned to open crib two days ago and is maintaining her temp safely in this adorable pink romper with butterflies on it.’ If neo asks about any cuteness, big beautiful brown eyes, gorgeous lashes, curly hair, lovely smile, whatever.”
“I still don’t get why she cares,” Linga grumbled.
“Because she wants us to think past the medicine. It shows you pay attention beyond just the numbers.” Clarissa went on to remind her, “Every neo has their quirks. Dr. Edwards loves retellings of big past procedures. Dr. Haydarian focuses on withdrawal of care discussions. We’ve got to adapt. Clear?”
Her explanation made Linga nod, and the other two residents appeared simply grateful she’d taken charge.
Schuller reappeared, and Clarissa stepped up to start the first presentation. Hopefully, they’d finish on time, because she had a birthday party waiting for her.