This month I'm back in the Neonatal Intensive Care Unit (NICU) for my last call month of the year! The NICU has a certain charm of its own. I started off in the NICU for my first month as an intern, and really enjoyed working with the little babies who are mostly too small to scream out loud.

Nurses in the NICU are one of a kind. For the most part, they are absolutely incredible. It takes a certain intensity to work in the NICU, and these gals sure know their stuff. They make sure that the residents don't let anything fall through the cracks. And unless there is an admission in the middle of the night or a baby is totally crashing, you are pretty much guaranteed a full night of sleep on your call night because the nurses take care of everything and don't page you about every inconsequential event (unlike the floor nurses).

NICU nurses also have quite the tradition of baking. It is a rare day when the workroom desktops aren't covered with homemade breads, cookies, and cakes. And if the nurses drop the ball on midnight treats, the parents are sure to have filled in the gaps with their large baskets of chocolates, trays of cheesecakes, and decorated cupcakes, provided with hearts of gratefulness for our care of their precious babies.

Of course, it's not all fun and games. My least favorite phrase to hear when I am checking in with the nurses before morning rounds is, "Oh, I've been waiting for you! I saved a diaper for you to look at!!" When you hear that, you know you're in for a pretty disgusting sight of something very abnormal that you won't be able to get out of your head for the rest of the day.

I really enjoy interacting with parents in the NICU. Unfortunately, many of these little peanuts come from social disasters. It is the young, single teenage mother who smokes and has had no prenatal care who is most like to end up with a premature baby in poor health.

However, I also find that parents of NICU babies are some of the most grateful. It is incredibly satisfying to provide a reassuring word to these parents, letting them know that their baby who now weighs as much as a box of butter will someday be a healthy, normal child who talks and runs and does everything a parent would want a child to do. Last week, a very cute Hispanic mother who spoke little English was literally in tears when we told her that her baby boy was not, in fact, going to die, as she imagined. The funny things was, this little guy was considered one of our most stable babies. She had simply misconstrued talk of transferring him to another medical facility closer to her home as a sign that we were out of treatment options for him at Mayo and had given up all hope.


There are many, many, many ethical issues in the NICU that can really be difficult to deal with. Right now, we happen to have about four babies with various rare genetic disorders and abnormalities that may or may not be compatible life and certainly have poor prognoses for any meaningful kind of function. In these situations, it is very important to be completely honest and realistic from the beginning, so the parents can make decisions based on real expectations rather than wishful hopes. With these patients, in particular, we have to be very careful to take a step back and evaluate whether the tests we are performing are for our own academic interest or for the care of the baby and futuere decision-making of the parents.

Today has been a difficult day...A sweet little boy was born two weeks ago with Dandy Walker malformation, a brain abnormality that results in a blockage of cerebrospinal fluid so that it cannot drain properly from the ventricles in the brain. Among other abnormalities, this baby was born with a head of alien-like proportions. A normal term baby's head circumference might measure around 35 cm at birth. This baby at 34 weeks gestational age had an initial head circumference of 44 cm. At two weeks of life, his head circumference was 52 cm. Initial brain scans showed that he had hardly any brain matter and was filled with fluid. In fact, you could hold a flashlight to his skull, and his entire head would illuminate. Not a good thing.

The parents are a young, sweet couple...first-time parents. They made the difficult decision early on (around the fourth day of life) to withdraw support. However, they wanted to continue all life-preserving measures for ten more days, until March 17th at 4pm. Their wedding anniversary. Sounds a little morbid, I know, but it was quite obvious that this particular date and time was very special for this couple, and so everyone decided to support them in that decision.

At one point last week, one of the nurses called in the hospital's ethics committee to evaluate the case--a pretty big deal. In her opinion, it was wrongful to prolong this baby's life for the parents' gratification. I was on the parents' side, understanding that it was a difficult decision for them to make in the first place, so why not allow them to transition to palliative care on their own terms? Well, to make a long story short, the ethics committee found that there was nothing wrong with keeping the baby alive until the specified time, and this afternoon at 4pm, the breathing tube was removed.

Over the next few days, there will be more decisions to be made regarding continuity of care for these other critical babies. There will be babies who code (stop breathing/beating their heart) multiple times in one morning. There will also, however, be babies who are able to start breastfeeding for the first time after months of being fed through a nasogastric tube. There will be babies who are able to make it through an entire night without supplemental oxygen. And there will be some babies who are able to go home with their parents.