Clerkship Diaries: Week 4 in the NICU & Nursery

Week 4: NICU & Nursery


*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*

Monday 1/28

We had new interns today so the med students got to help a LOT! After pre-rounding on my three patients and presenting them at rounds, I saw two new patients (was at one’s delivery!!), did two newborn exams, gathered all their relevant info, and I wrote up two admitting H&Ps. The two new interns seem really cool and fun to work with. It’s impressive how quickly they picked up the pace of NICU/nursery given that it’s their first day. I need to be more upbeat about constantly shifting gears because that’s what this whole clerkship year is like, and now it seems like that’s what intern year is all about!

So far I think I’m adjusting well. Our new attending Anna has like an old-school medicine, calm & confident vibe that I like. During one of my patient presentations, we talked about weaning my lil baby off morphine more than we had in the past few days. One of his NICU nurses expressed her concerns in a somewhat confrontational way but Anna’s explanation was so solid and by the end of it, we were all on the same page. It was quite masterful. The whole day was so busy, there wasn’t really down time to get bored because I was always doing something. It was energizing but then around 5 PM, I started to feel really tired.

Other little moments from today: seeing a nursing student and assuming she was a nurse I could ask questions to while she assumed that I was a professional too and then we both laughed when we realized we we’re both students LOL. I accidentally set the alarm off AHH but then I learned how to turn the alarm off which was clutch. We were rushing through rounds towards the end during my presentation, but I was still able to make space for the nurses and I think they enjoyed that. Then at the end of the day, our super lovely intern who went to UCSF got news that one of her classmates was killed which was just so so sad.

Lesson learned: Everyone plays a really important role on the team, when I’m all wrapped up in my work it’s easy to think that I’m the only one who’s got stuff going on. Staying grounded and grateful that I get to be helpful and stay open to the possibility that those around me are quietly grinding too.

Kudos to Michelle, our FCM intern, for being so kind and welcoming today, for encouraging me to take ownership over my patients and having concrete ways to facilitate that. Definitely the kind of intern I wanna be (one day).




Tuesday 1/29

Watched an episode of DQMW before bed last night, and I went into FCM clinic today channeling those frontier medicine vibes because in some ways, at this clinic, we are at the frontier.

The first two patients declined the medical student. Our third patient was an extremely put together, very healthy pregnant woman. She was in stellar health and so on top of her pregnancy. The next patient was an older man with fatigue and weight loss – but not for the reason I was expecting. Our next patient was a woman with a chronic health issue but her main issue was how stressed she was about the condition. Dr Dallman was able to calm her down and help her realize that she’s doing a good job, I stuck around for a lil after and we just chatted. At the end of it, she told me that she really needed our talk. She told me I was young and beautiful and asked how young I was – then she said life was beautiful and I should enjoy it. The next patient was one I had seen two weeks ago but she’s had a tough two weeks. She’s doing a little better but it was hard to see her one step back after two steps forward.

Dr. Dallman is such a boss. We chatted for a bit about big picture, she said when it comes to her patients, she sees the forest when other doctors want to focus on trees - which I love. Then I headed down to SFGH with clinic folx to help with Food Pharmacy – a really lovely initiative that provides fresh produce from local food banks with blood pressure screens, health education, and some cooking demos. We referred patients from our clinic there, mostly African American patients with uncontrolled hypertension, and folks from a few clinics teamed up to run the event. It was really fun passing out produce!! Turnout was a little lower than expected but lots of our clinic’s patients came through which was great. Towards the end, they played some very black stand up comedy and it was just neat to share the space with folks.

I saw some of the limitations on primary care today. One of the doctors left recently and Dallman had to pick up her patients; we saw 4 new people today. 4 patients that might be Dallman’s for a long time to come or may transfer over to the new doctor who’s coming in, it’s hard to say. Of course, we can enjoy these relationships while they last but thinking that we’ll get long term relationships with most of our patients in FCM may be a bit romanticizing.

Dallman explained really well the interplay between trauma and pain and substance use; exposure to trauma can significantly worsen physical pain, and that’s a moment when people turn to substances. Without any intervention where people can develop skills to cope with these stressors in a healthy way, the cycle continues and builds on itself. Sleep also plays a role in this; when people aren’t getting sleep, their reserve capacity to cope with increased stress is completely depleted. Reserve capacities are essentially how we stay healthy, and when people are brought close to the threshold, that’s when they get really sick or even hospitalized. Lots of good learning today.

Lesson learned: look at the forest and not just the trees!
Kudos to my patient who told me I was young and beautiful and should enjoy life




Wednesday 1/30
One of my NICU babies had a rough day on Tuesday when I was away. Sad to see my patient take a step back after a few steps forward. Rounding on all my patients wasn’t too bad but I had to review all my presentations before rounds to make sure I could keep their stories straight. I asked a good question in journal club this morning. Tina kept saying how much she was gonna miss us and I was like PLS we have a few more days left!! We really have been a good team, and I don’t want to take the vibe for granted. Rounds went til 11:15 this morning. I followed Anna to watch her do her newborn exams and got to practice some maneuvers.

We had a lunch talk on teeth and there were many graphic photos which was terrifying but important. So many things I take for granted like getting braces and having good dental health (despite all my cavities ugh). Model didactics were nice, it was about homelessness which is such a heavy topic. Dr Kushel is such an expert, I learned a lot from her systemic chalk talk. Then we went back to see our BABIES. We needed to discharge a patient but couldn’t find their CHART because we still use paper charts here (!!) but the bedside nurse was so funny and eventually retrieved it so we could pull the info for our discharge note which I sent in! Helped with a few other tasks but then I got dismissed a little after 4 and oh MY it’s nice to leave the hospital while the sun is still out!! I was so happy with that extra lil sliver of time today. I had a long phone call with mom on the drive back. And then I watched a bit of TV (just like when I was little coming home from school around 5) and then got to WORK.



Lessons learned: I take my oral health for granted!
Kudos to: Joan the NICU nurse for finding our baby’s chart!




Thursday 1/31


Started off the morning rounding on my four babies. It felt good to know where to get information and updates. We had a team breakfast instead of conference today, Tina was happy to treat us to a warm breakfast and we had a really lovely chat about feedback as well as justice in medicine and our world more broadly. Rounds went well, I had some down time after with just a few tasks to complete. I got to do some reading from my peds review book which was nice. Noon conference was about child abuse, which is definitely important learning.

When we came back, I had a few more tasks to work on but things were a little slow today and there wasn’t that much to do. Morgan asked if we wanted to practice holding babies but then we went to the NICU and they were all sleeping. The charge nurse said she hopes that a baby wakes up soon so we can practice holding him - but my first thought was NO I hope he keeps sleeping, and that felt really validating that my first response is still putting patient wellness over my own learning. Anyways, not long after my sweet baby woke up and I got to go hold him and FEED him his whole bottle! Alma Martinez walked by and thought I was a new mom LOL and Tina was so impressed, she said I was a real natural. I bet those NICU nurses were like whaaaat, who is this med student coming in and doing the most basic job of something we do ALL day and getting all this credit BUT Olivia was so nice and helped me out a lot. My time with this baby was a really special moment. Ricky came by towards the end and got to hang out with him too. Mom came by soon after, she was feeling warm so I offered to get her some ice water. I know it’s hard for her to keep showing up but she does. I respect that so much.

I started an admit note for another baby, one that was born in the afternoon; then I did some tasks including getting baby’s vitals. I saw him get measured and got to do a bit of an exam, Tina came by towards the end and we examined him together and then I asked the family some questions. They were so sweet!! I got back around 4:30ish and me Tina and Morgan were just kicking it, listening to good music and chatting, making up nicknames for our babies. We had sign out at 5:30 and immediately after, I got to work on collecting d/c info. We got paged to pick up an admission from urgent care so we went back to 6M (the mems!!!). Our patient wasn’t doing too hot and her momma was holding it together well. When they were putting the IV in, I decided to stop standing awkwardly on the side and just go up to her. I offered her my hand which she held so tight as the nurse slid the needle in, and then she held onto me for a bit after. I got her a school note and momma a work note. Later, when we were talking about giving her a mask vs nasal canula, I asked if there was a difference and if not, could we let the patient pick? I figured she’d pick nasal cannula because she can eat and talk but it felt like the others didn’t feel strongly either way. That felt like a solid moment of patient advocacy. It feels really nice to have the capacity to think about these little details that actually matter a lot to patients. I hope I still have some energy to remember these things as I go further into my training.

We got called away soon after because my sweet NICU baby (the one I held today and have been following all week) was having more withdrawal symptoms which had everyone super spooked. It's tough because I'm uneasy upping his morphine without a game plan but I get that everyone on his care really just wants what's best for him. Later, we got called into a delivery and I got to “catch the baby” - I warmed and dried and stimmed her on her mom's belly but she was just fine and did just great! Definitely an action packed evening with lots of things happening at the same time. Towards the end of the night, I was definitely hungry and tired and a lil more sensitive so I was picking up some not great energy from someone I had interacted with BUT I decided that I'm not going to let those last few moments detract from what was a REALLY good day.

Lesson learned: There’s always more to the story, especially when it comes to judging new moms who seem like they aren't doing "enough" for their babes, there's always more to the story.
Kudos to sweet NICU baby for letting me part of his care and for our sweet feeding moment




Friday 2/1
Wait it’s February already? Four weeks of rotations have gone by?? Does time fly or what!!

I remember someone telling me that great medical students aren’t unusual but when two solid med students on the same team work well together, that stands out. I really felt that this week. Ricky and I became valuable members of the team, and everyone trusted us to take on lots of responsibility. During rounds the last few days, the interns have joked that they don’t really need to be there since we’ve taken on so many patients! Michelle, one of the interns, told me that I really knew my patients and that means a lot.

I remember thinking during rounds that I’m getting really efficient at pulling numbers. I was able to communicate with nurses and other team members with a new confidence about our patients. Today I felt competent. And it made me wonder if that’s a sign that I’m ready for the next rotation. Of course I love feeling like I have a handle on things, but the learning curve is always sharpest when I’m outside my comfort zone. I am going to miss nursery/NICU so much, for the patients and clinical learning and our amazing team that brought me in and trusted me and listened to me and made me feel valuable but I can leave knowing that I got so much from my two weeks here.

At the end of the day, Tina treated us to BOBA and they went around sharing advice. There was so much of it! But nuggets that I remember well are - don’t take on too many patients bc it’s better to have fewer that you know really well than to take on too many that you can’t keep up with well. They encouraged us to keep making presentations and to use that as a way to zoom in on things we really care about especially when we’re in a rotation that doesn’t speak that much to us. Use SAFE reporting. It was great to hear how they take care of themselves outside of clinical work.

Reflecting on the rotation at the end with Anna was nice, I almost didn’t go so I’m glad Ricky remembered to bring it up. Anna was surprised that we were so early in our rotations which was another really sweet moment! But I realized that I enjoyed the well babies more than the sick ones. Maybe I have a short attention span or don’t have a ton of patience but there was so stimulating about meeting a new family, seeing them through a pivotal moment and then having them go home in 2-3 days without major complications. The turn around of getting new patients every few days was exciting, each patient with their own family and social and medical history. The brief moments we shared with these families didn’t feel inadequate to me. In contrast, I loved my own nicu baby that I followed but... tinkering with a little bit of this and waiting to see the response, having to monitor him 24/7 and there being sooo many little details to keep up with that no one person could? It's a lot. And I think long-term, I’d find it more fulfilling to have a large volume of short-term patients than a small volume of long-term patients.

Also I used an in person translator today and it was AMAZING!

Lesson learned: Always check in with the team before popping by to say hi to patients; I was going to see how my patient from last night was doing but she'd taken a turn for the worse so I'm so glad I checked in with her current team to get the update. I didn't end up seeing her again but I hope she's doing better <3


Kudos to TINA our R3 for boba today, for setting the most incredible tone for our team these last two weeks, for being a boss queen who speaks up when something needs to be said, for navigating interpersonal tension on our teams with utmost grace, for answering all of my questions and for making me feel like a valuable part of the team <3