Lessons Learned from 78 Long Days in the NICU.

Abstract

Lessons Learned from 78 Long Days in the NICU Alaina Pyle I was a fourth–year medical student on an elective rotation when the meticulously planned timeline for the birth of my first child was turned completely upside down. The mild back pain I had been experiencing over the last few weeks suddenly became much worse, and despite my best efforts to “power through” the work day, it reached the point that I could no longer ignore it. Something was clearly wrong. I called my husband, also a medical student at the time, and we rushed to the nearby private hospital where my obstetrician had admitting privileges. I was in the 26th week of my pregnancy, and I was doing my best not to think of all the things I now knew could go wrong for premature infants, since I had just finished my neonatal ICU rotation a few weeks beforehand. During my time in the NICU as a pregnant medical student, my son and I had crossed the threshold of viability, and so I breathed a sigh of relief, believing that I was out of the woods. I had somehow managed to put out of my mind that you are never, ever free from the dangers of pregnancy until well after you are handed a healthy, happy baby. We arrived at the labor and delivery triage in what felt like only a few minutes, where we were settled quickly into a curtained–off hospital bed. Tests were sent, vital signs were measured, and reassurances were given in calm and kind voices. I saw my blood pressure was 145/90 and thought, “How very odd, it must be all this pain and stress, because my blood pressure is never that high!” The test results eventually came back and indicated that I had developed preeclampsia, a relatively uncommon disorder of pregnancy. I was relieved to have an explanation for my symptoms but the very real concern that I may need to deliver significantly prematurely began to set in. My plan—to work through the remainder of my pregnancy and complete all my residency interviews so I could have some time off at home with my son—disappeared. Over the next several days, I spoke with the medical school to make arrangements for my [End Page 192] scheduled rotations, and cancel my upcoming Step 2 exam, as well as the weekend trip my husband and I had planned as our “baby–moon”. I did all of this while on a magnesium drip to treat the preeclampsia, which caused dizziness and a bizarre feeling of dissociation from the people and events swirling around me. As a medical student, I had seen other women under the effects of this medication, but never really understood how significantly it could alter someone’s ability to process information. Between the waves of fuzziness in my thought process, it occurred to me that it is highly questionable that a woman could truly provide informed consent in an emergent situation, when under the influence of such a medication. This realization made me acutely aware of my limitations and grateful to have a partner by my side that I could trust to help me make decisions when I could not reliably do so. After getting over the initial terror that I could deliver prematurely at any moment, I settled into an intentionally optimistic mindset, counting on the miracles of modern medicine to protect the health of myself and my unborn child. During this waiting period, my obstetrician requested a rheumatology consult to rule out lupus as a possible cause for my symptoms. Early in my pregnancy I was found to have several positive antibodies in my blood, which I had been told at the time was definitively NOT due to lupus. The moment the rheumatologist laid eyes on me, she made her mind up that I did have lupus after all. Due to the combination of the magnesium and the preeclampsia, I was flushed and fluid overloaded, giving the appearance of a patient with classic lupus. My father found the entire situation rather comical, as an avid fan of the show House, where the diagnosis is never, ever lupus...