Monday, September 25, 2006

Communication

I was called to go STAT to the delivery room. Unfortunately they didn't tell me what delivery room, but I found it anyway. It turned out they had brought mom to the c-section room for a "double set up", where they could do a c-section right away if needed. The baby was three minutes old when I arrived. When they brought mom back to the c-section room, they called everyone but the neonatal team.

Fortunately the baby was doing well. He was a 25 weeker but was breathing fairly well on his own. We brought him to the NICU and put him on nasal CPAP -think of it as blowing air and oxygen into the baby with a little bit of pressure - and he looked fine and dandy.

Before I left the delivery room I briefly showed the baby to mom and dad and told them I would talk to them in more detail once we got the baby settled in the NICU. I again saw them briefly when they went through the NICU on the way to mom's room, and I told them I would be out in a few minutes, once mom got settled in her room, to go over everything with them. When I got to mom's room, she was there with a friend, but no dad. "Is the dad here?" I asked. No, he had gone to the store.

I sighed a little; I guess dad didn't think it too important to hear about the baby. So I went over everything with mom: the approximately 75% chance of survival; the possibility of needing a mechanical ventilator; the need for an IV for likely 4 to 5 weeks (maybe less if he does really well;) the possibility of bleeding into the brain; the increased chance, versus if he had been born full term, of a neurological problem; and several other things, including a pitch to have her pump her breasts to feed the baby.

All in all, it was the kind of talk I wish the father had been there for, because he should hear this stuff and because I really didn't want to go over it all again. Sometimes the father comes later and wants to hear it; I try to tell them, but having done it once, I know I condense it the second time. It can get a little frustrating, especially when you make an effort to get parents there at the same time.

Sometimes I've talked to mothers at the bedside or in their room, and after I go through a long spiel they say, "Can you tell that to my husband , too? He's just outside in the waiting room." Now you tell me?

Before I left the mother of the 25 weeker I asked her if she had a name picked out yet. She said yes, he would be a junior. I waited, thinking she would tell me the name, since I didn't know dad's name, but nothing more was forthcoming. Finally I asked and she told me.

I sighed again. Some days communication is just tougher than other days.

P. S. Grand Rounds is up at Healthline.com and Pediatric Grand Rounds is up at Pediatrics Info.

6 Comments:

Anonymous Kelley said...

My husband was the same as that dad. Don't worry, it bugged me as much as you. As far as the "junior" thing, I had to chuckle. I call it my "blonde moments" (I can do that), but many times I'm thinking about so many other things, as I imagine she was, you just kind of forget what has and has not been said and you are so scatter-brained you almost think everyone else is thinking what you are thinking. I know how she felt...she had a "Doh!" moment after you asked her.

12:09 PM  
Anonymous Malaika said...

Hi, I just wanted to say how much I love your blog. It's so refreshing to have someone not sugarcoat the difficulty of being a doctor. I'm a first year med student and I had a question for you - how did you know that neonatal was right for you? I've always wanted to do pediatrics and was especially interested in neonatology but just wanted to know what you thought the best (and worst!) aspects of your job were? Thank you so much!

1:20 PM  
Anonymous jody said...

Obviously I don't know the particulars of this situation but having been on the patient side of things, your comments sound a bit harsh. It is likely that these poor parents were taken completely by surprise: that their baby was going to be born that day, that it was going to be by c-section, and very premature at 25 weeks. The whole experience was probably so rushed (especially in an emergency situation) and scary that they just couldn't take it all in. They may have had no idea of what a NICU does and may have even been in denial about the whole very scary situation. As for the mom she was probably pumped so full of drugs that she'd have trouble remembering her own name, not to mention her baby's name whom she wasn't expecting to see for a couple of more months. As for the dad, he said he was going to the store but perhaps he really went somewhere where he could break down in private because he didn't want anyone to see. Even if none of these assumptions apply to this situation they may in future and have some sympathy for the poor parents who are probably scared to death and feel like their world has just collapsed around them.

1:35 PM  
Blogger neonataldoc said...

Kelley, you're probably right. I've done similar things. Jody, don't be too hard on me. I was very nice to the parents and have a good relationship with them.

Malaika, thanks for the compliment. I thought neonatal was right for me because I liked babies and I liked intensive care. It was the right choice, because I really enjoy neonatology. The best part of my job? Working with babies every day. The worst part? The number of weekend hours required, which is time away from family and fun.

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