Sunday, May 21, 2006

Worry

I worry sometimes. I worry whether the jaundiced baby's mother will bring her back for a jaundice level check the next day. I worry whether I should have just kept the baby here. I worry about the 24 weeker who's been on a ventilator for 10 weeks now and is still on fairly high settings. Will we be able to get him off the ventilator, or will he need a tracheostomy and long term ventilation? And will his 19 year old mom be able to handle it? I worry about the small baby we just discharged who is feeding okay but not great. Will he eat well enough? Will his mom make an appointment with the pediatrician in 4 days for a weight check like we asked? I worry about one of my partners, who still makes some statements about fluids that suggest he doesn't understand some pretty basic principles of fluid management , even though he's been a practicing neonatologist for many years. But most of all, I worry when I've done everything I can for a baby and he's still doing poorly.

Actually, I don't worry as much as I used to. Earlier in my career, if a baby was not doing well, I would wonder what I might have done wrong. Now, after more experience, I realize that if a baby is not doing well after I've done everything I can think of, it's more likely because he's very sick and nobody can make him better, and not because I've screwed up. Now, I don't worry as much as I used to, but I still think and wonder about things.

I think about the mother whose delivery I just went to, who's 23 years old and just had her fifth baby, and who weighs 370 pounds. I wonder how long she'll live, and when she'll start having knee and back pain, and how big her kids will be when they're 23 years old. I think about the 6 year old patient of a pediatrician friend of mine, who weighs 160 pounds already. I think about the 17 year old who just delivered her first baby. Will she have five babies by the time whe's 23 years old? And then I think about the 18 year old who just had her third baby.

Sometimes I worry I think too much....

12 Comments:

Blogger Flea said...

Worried about post-discharge follow-up? Do the patient and yourself a favor and speak the G**d*** flea prior to discharge!!!. You'll be doing the flea a favor too.

The phone is your friend. Use it!

best,

Flea

7:54 PM  
Blogger Janae said...

I agree with Flea. It's easy to use the phone. At the hospital where I had my babies, they always scheduled the first appointment with our pediatrician before discharge.

9:39 PM  
Blogger SmartBlkWoman said...

It breaks my heart to hear about women my age having their 3rd, 4th or 5th baby. Many of these women have probably have 2 or 3 more pregnancies than they have kids due to several abortions in between the pregnancies that they actually choose to continue.

I'm a young single mother myself and I my pregnancy was unplanned. I can't even fathom having more than one "accidental" pregnancy. Once is an accident, twice is a pattern.

I think with many of these women after they have a baby the people around them just give up on them and in turn the women give up on themselves. When I was leaving the hospital after the birth of my daughter the nurse that was pushing me in my wheel chair said she would see me back again next year. And she thought she was being funny.

Another time I had a women my age with 2 kids and one abortion under her belt tell me that I would be pregnant again in 2 years after I said I didn't plan on having any more kids soon. It was as if she thought pregnancy was just something that happens to a woman throughtout her life and that because she didn't know how to control her fertility that other women couldn't either.

11:40 PM  
Anonymous Midwife said...

I'd be worried if you didn't worry...

12:52 AM  
Blogger Megan said...

Unfortunately (or fortunately, depending on how you look at it) worry is part of the job. Sometimes I curse how much I worry about my patients, but the more I worry, think, whatever..probably the better off it is for my patients.

However, I wonder if it is really that good for ME. =)

4:14 PM  
Blogger Fat Doctor said...

You are such a good writer.

We all worry, some of us excessively.

It's a curse. I inherited it from my grandmother.

5:18 PM  
Blogger neonataldoc said...

Thanks everyone, and Fat Doctor, it's good to see you back in the saddle!

Flea and Janae, I wish I could call the pediatricians so easily. But about half of my patients don't know who their pediatrician is going to be, and many of the remainder go to a pediatric clinic that is so chaotic that it doesn't seem to matter if we call them. They wouldn't do anything if a baby didn't show up who was supposed to anyway. There is one pediatrician in private practice who is great, who I know will follow up on a problem. It's pure pleasure working with her, but she's the exception in my neck of the woods.

SBW, I too see nurses joke about single moms coming back next year, and it drives me crazy.

5:38 PM  
Blogger Janae said...

This is my mom (the fixer)coming out, but is there some way you could compile a short list of maybe 10 practices that includes the insurances they accept? Or a list of 20 without the insurances they accept? Then, give it to the parents. Tell them you'd like to have a follow up appt set up before the discharge. It's more work on your part, but I think it's doable.

Why not establish some kind of protocol with the peds in the clinic? There has to be some head honcho that you can take to about it. If Flea can talk to the head of a local ED, I don't see why you can't talk to the head ped in clinic.

10:38 PM  
Anonymous doula said...

I think worrying makes you human. But I also think that people have a responsibility to take care of themselves. You can't make sure everyone does everything exactly how they should (even if you can shepherd them through the transition from hosptial to home). Some of it is up to them as to whether or not they're going to do what's best for them and their children. Sometimes they will. Sometimes they won't. As a doula, I'm continually amazed by the number of people who simply don't want to know....about anything. Somehow they seem to think that ignorance gets them off the hook. Even with the education I do, I can't force someone into making good decisions if they just don't care...frustrating, but unfortunately true.

10:57 PM  
Blogger NeoNurseChic said...

I do agree with the above in that there's a point where people MUST take responsibility for their own actions and their own health care. That being said, I still ride the fence about the fact that in our world, our patients can't make that choice or take that responsibility. It's their parents who must do this. Because of that fact alone, I worry more about what happens to babies than I ever have before about any adult patient. In my short career already I've seen some go home and then heard of their death - often because of some senseless reason. It's heartbreaking. Those babies never had a choice. Who will worry about them if we don't? We can't just leave it up to the parents....or can we? How much responsibility do we really have once they leave us?

Our unit also makes follow up appts. If they are going to continue with our hospital's peds clinic, then we schedule the appt. As well as follow up for eyes and also home care. We have this whole gigantic referral page we can fill out - with triple carbon copy. I was informed recently that I had to have a mother of twins sign that she understood she was to make the appt with her own chosen pediatrician and that she was bringing her babies there on a certain date/time. I think that's fair. She wanted her own peds doc, so she set it up. She already has another child, and I had no question that she would do it.

But does everyone?

We can only do our best to inform as much as possible. If they choose to take the baby home without a properly fitting car seat, they must sign a waiver. It sounds cruel to say "so long," but people do have their free will I suppose.... What saddens me is that the babies do NOT have their free will yet.

That's most definitely why I worry more about them than anything...

Great post, as usual. :)

Take care!
Carrie :)

2:03 AM  
Blogger Barbados Butterfly said...

It's when you start worrying that you think too much that it's time to find something to do to distract you from all that thinking. Like, say, lining up all the tins in the pantry so that the all labels face the front.

:)

Cheers,
Barb.

5:56 AM  
Anonymous Anonymous said...

What's the worry? As I read through these posts it seems less like genuine concern and more like aggravation. I could be miss reading the media though. There just seems to be a real lack of charity (the milk of human kindness variety, not the indigent patient care variety). You have very absolute opinions for someone who is so young and seem to me to have a bit of the Divining Doctor mentality. Again I could be wrong. People are not always born in the best circumstances (and certainly those who are are nt necessarily better for it). These children despite whatever popular culture would dictate are a blessing. It seems horrible that someone in your field would not recognize that. Why bother? Go into pathology or radiology. Good hours, great pay, little patient interaction (and thus no worries).

5:56 PM  

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