Clerkship Diaries: Week 3 in Nursery & NICU

*DISCLAIMER: there is no medical advice here, my primary role is a medical student who's learning and not a writer, patient details have been changed to respect privacy*


Week 3: Nursery & NICU
Week one of two in the nursery and NICU! There’s one attending, one senior resident, two interns, and now two medical students plus lots of nurses, lactation specialists, and social workers. The peds team works closely with the OB/GYNs, we have multiple huddles during the day where members from all of these teams review patients together! For well babies, the pediatricians’ main goals are making sure baby starts feeding well, gains weight, gets their neonatal workup, and is discharged as soon as they’re healthy enough to go. For sick babies, there’s a lot more protocols to run through depending on what baby has. We see lots of premies, babies who can’t breathe on their own for lots of reasons, some babies with substance use disorders. Protocol is key to the NICU; there’s a specific way to do everything from our newborn exams to placing orders to working up labs to presenting patient cases. In the chaos of intensive care, it’s so important that we follow our algorithms to ensure that nothing gets missed. The organization makes it easier for me to learn (as someone who has spent very little time in any ICU). The NICU at SFGH is a beautiful, wide open room with a sprawling window that looks over a sweeping SF hillside neighborhood dotted with colorful houses and lots of greenery; I love watching the sun rise over the city here as the day starts. When I think of the NICU, the natural light, the nurses cradling babies, the quiet but purposeful movements of those flitting in and out come to mind.




Tuesday 1/22:
Today was so much fun. Some highlights include:

• · Waking up at 4 AM for my workout! Trying a protein shake for the first time!
• · Tina our senior resident coming to find me after I got lost in the nursery hallways sos
• · Seeing the sun rise over the Mission through the giant NICU windows
• · Being helpful to a bedside nurses by prepping saline for a resuscitation we did on an emergency C section
• · I saw a baby be BORN today! Today’s her birthday!
• · Meeting another baby and talking her dad through possibly vaccinating her, and connecting with the mom over the meaning of the baby’s name
• · Helping collect vital signs for a patient during rounds today
• · Seeing the moro reflex and having two babies suck on my pinky /SOS/
• · The noon conference today was another fun case! And didactics with Clem Donahue were great, he is SO funny and the kind of guy that has endless entertaining stories
• · One of the babies we saw had 2 super cute older sisters and it made me think of the day my sister was born
• · Getting dismissed early around 3:30 today! Esp since I was feeling some period nausea, seemed like a sign to listen to my body and take it easy at home
• · Was feeling a lil bummed that I would only get 3 days in the NICU this week but looks like I’ll get 4 since I’m going in for night shift tomorrow!!!

It felt nice finding little ways to be helpful- opening up saline and holding onto the R3’s phone and counseling parents about immunizations and finding vitals. We saw so much today – from a C-section and resus of a premie to rounds on all the babies to meeting two families and seeing newborn exams to watching an extubation and having two separate learning didactic sessions. Leaving early felt like the right thing although I have to go back in tomorrow for night call.

Today, I was reflecting on how it takes so many people to do this work. A lot of work that healthcare professionals do is to prepare for things that don’t ever happen but they always prep just in case. It’s always a good thing when procedures aren’t as complicated as we anticipate. But still there’s a part of that is a little uneasy by how MANY people it takes to do procedures and support patients. Maybe I’m being overly utilitarian and it feels wasteful. But then again, if it’s my patient, someone that I know, someone that I care about, of course I want every resource available. It’s beautiful that so many people share one mission and can function well together on one team. And these teams help SO MANY people, not just one person every day.

Lessons learned: Babies love to suck on pinkies!!
Kudos: to Tina for finding me when I got lost in the morning lol sos




Wednesday 1/23: Didactics

-Didactics were fun! we went on a walk by the water and then construction rerouted us so we had to JET back


-I got to the general around 4:15 for night call, hung out for a bit and then we went in for a DELIVERY like we were only there for 5 min it was wild just seeing the baby slip out and then it was THERE like the most normal thing


-I got some snacks for two lil boys hanging out outside the NICU waiting on their parents and new lil sib


-Had some moments that I’m just surprised at how inefficient we are - like having to ask 6 people multiple times for a few pieces of info, logging in the same info multiple times in different places (paper chart and EMR), like I just can’t believe that we still struggle with these things but it’s more of distanced curiosity than an urgent frustration; I understand why the system is as it is so I have no ill feelings (yet)


-I just love being helpful! There are little things I can do like getting paperwork or stickers or circling back for a task we tried to do earlier.


-Night shift is nice because things slow down a lil and we focus on THE most urgent things and there’s time to get to know your teammates, Holly the R3 was super cool and made such an effort to let me be part of the team!


-Dr Carpenter did some great teaching about newborn physical exam and ventilation settings, he also asked a lot of questions that I didn’t know the answers to but he was so nice that I didn’t feel bad


-Holly kept dropping hints for me to leave early and I think she was a lil annoyed that I didn’t take them but I wanted to do a night shift right for once!! I’ll definitely take her hints on the next one!!


Lessons learned: Take the hint and go home girllll
Kudos to Holly for taking me along with her the whole shift and making me feel like part of the team!




Thursday 1/24
My home visit today was really lovely. The mom was so welcoming and so good with her baby. It was my fault for assuming the visit would be quicker than it was; towards the end, I had to pee and had a headache. There were definitely moments that I was just wishing it would be over. But then I paused and reminded myself that this a special moment, a kind woman invited me into her home for a vulnerable moment with her baby and her nurse, a moment that I might never get again, and that I needed to be more present. Towards the end, the mom asked me some questions about med school and it really brought me into the conversation. I was adding a few comments here and there, some supportive smiles, it was all really formulaic from my end which felt bad, but I think they appreciated it. I hoped they couldn’t tell how tired I was. I’m really grateful I could muster up some energy. Looking back on today, I had energy when I was given tasks that felt helpful. When I was watching someone else or observing something I couldn’t directly help with, that’s when my energy dipped. Overall though, I really like the idea of home visits. It feels like old-school medicine, and it’s so lovely to see people in their contexts.


Lesson learned: Even when I’m really tired, pause and refresh. Go back to my neutral energy.
Kudos to the mom for inviting me to her home visit!!




Friday 1/25
Morning conference was great, a case presented by our attending this week, Adam. Alma teased me in front of the fourth years who were visiting for a second look weekend SOS but I know she does it out of love so I don’t mind. The first thing that came to mind when Adam presented his case on a critically ill infant was congenital heart defect – and I’m glad I spoke up because that’s where the case was headed! I almost didn’t say anything! I got to catch up a little bit with Manny who’s a super cool fourth year doing peds here next year. When we were leaving conference, Debbie Madhok (one of my favorite mentors and role models) saw me in the hallway and gave TWO hugs – two! Rounds went well, I presented my patients in what felt like a pretty organized fashion. Adam quizzed me on something that I didn’t know the answer to but then he explained it to me. It didn’t feel like pimping, more like gentle teaching and highlighting key points. And then the whole team LEFT for a delivery so Adam and I hung out for a bit before finishing off rounds when everyone got back.

I saw Toff today and told him that I’m loving life but like also struggling to gauge how well I’m doing in the grand scheme of things. He asked me if I was learning – and I am, lots, so I think I’m okay. It’s always so good to see him and get his perspective. Noon conference was a contraception talk - super solid. When we went back, there wasn’t much for me to do. I worked on some heart diagrams Adam had taught us in morning conference and then helped Tina with her tasks, filled out some half sheets and made some trips to the NICU to ask questions. We definitely had moments today where I was reminded that patients don’t stick to our schedule in the hospital. I’m so used to the rest of the healthcare team adjusting to the medical team’s schedule that when we go in to see patients that tell us to come back another time, it’s an important reminder about who’s really at the center of our purpose here. Later, I got to introduce myself to one of my babies’ mom and she was lovely!! We got some Friday afternoon ice cream and then we had some teaching and then I had some feedback time with Adam and then Tina dismissed me and I took the hint!

I’m sad that we only get attendings for one week because I really liked mine!! I wasn’t all that intimidated by Adam and maybe I should have been. He welcomed questions and was always eager to teach these beautiful lessons. When the whole team left for a C section today and just the two of us were left, he took me around the nursery and we practiced physical exams and listened to lots of tiny lungs in different stages of respiratory distress. I think I just learned really well from his methodical approach. He made sure to give us feedback at the end of the day when he could have left us early; we went on a little walk and he offered me some really excellent suggestions for how to improve. Also when we had those applicants join us for rounds, Adam apologized because watching someone else’s rounds is like “watching a bad movie in a foreign language” loll so he was really funny too.


Kudos: to Adam for being such a great first attending to work with
Lessons learned: I'm not going to hurt the baby by performing a physical exam so don't let it overpower me!!