Reflecting.

The internship, I miss it. As I started my Child Health (Peds) class this semester, I realized just how much I'd learned over the summer. Even when, at the time, I complained that it was unfortunate that we as interns were limited in what we were allowed to do. Now, I saw just how much knowledge I've gained by doing what were seemingly trivial tasks over this summer.

Those urines I dip and how to get them out of diapers, keeping track of I&O's and the importance behind it, checking on IV's every hour and keeping track of those numbers, monitoring those vitals during conscious sedation, the little tricks you use with children to get them to cooperate with you, getting blood from those central lines. They all came rushing back to me, and when my instructors lecture or showing us things in the lab, they make an absolutely perfect sense. And once again, I am humbled to be where I was this summer.

The floor I interned at receives Hematology/Oncology patients, so a lot of the children that I've taken care of are frequent fliers or regular costumers, which means they stay on the unit for a long period of time and/or frequently return for treatment. As a result, the staff get to know them and their family pretty well and vice versa. There is not a day that has gone by since I ended my internship that I don't think about those "regular costumers".

How are they responding to their treatment? Have N & M lost their hair? Is P still scared when it's time to change his port-a-cath needle? Is G still refusing his meds? Has R finished her round of chemo? How are they and their family coping? Is Y home by now? I hope her count stays up. I hope C's bone marrow transplant goes well. I hope none of them relapses....

My heart breaks for them, for what they have to go through. I used to read their charts in the lounge, then I'd watch from the window in the corner, out to the green of Central Park across the street. A playground was there, swings, slides, monkey bars, you name it, and everyday I watched as kids filter through that playground throughout all hours of the morning and afternoon, wishing the kids I had on the unit could do the same. I'd take a long sigh and get back to work, saying a little prayer as I pass each room for them to get better a little sooner.

Yet in all of this, I've found great courage. Cliche to say that, but it couldn't be more true. For two days I watched as one family broke down as their 3 year old was diagnosed with Leukemia, but in the days afterward I watched them gathered every strength they had to pull through. They took in every ounce of information the doctors tell them--treatments, procedures, side effects, risks, prognosis, asked questions, and clang to every hope. They braved procedures that they have never heard before--lumbar puncture, bone marrow aspirate, port-a-cath insertion--and one they've heard but never thought would exist in their family--chemotherapy--being done on their tiny child. They held their child's hands and soothed their child through every vitals, labs, and meds with "It's okay, it's okay. It's gonna be okay." Sometimes, I even think they said those words to assure themselves too.

Those children, they're bravery and courage personified. As angry as they might have been, as scared as they might been, as rebellious as they might have been against all of these diseases, they manage. They just do. Somehow, along the way, they find a way to cope, to accept, to fight, and a reason to live. Every so often I'd come across charts so thick with health history, full of conditions so foreign to me, I had to google as I read those charts, and every so often afterward, I've found myself dumbfounded as to how they find the strength to go through all of that for years and years. My hat is off to them.

I really do miss those kids. Baby D, unaware of the how sick he really is, moving his head happily when you play his music toys as you take his vitals. Little N, the little tod, screaming bloody murder at everything and anything done to him, but once in a while when you're just checking on him throughout the day, he'd show you what game he's playing, he'd smile and you'd forget an hour ago he was kicking all four limbs as you and your nurse restrain him down for an oral med. R, in her early teen, as sweet as she can be, letting me draw my first central line blood from her even though she's very particular about her line. S, who came in for a sickle cell crisis, was quiet as a rock, but once she talked 50 mph with her 5 year old imagination, you knew she was no longer in pain and she was going home soon.

With this experience, I look forward to my Peds clinical this semester. I love working with children, they are a source of inspiration.

Fetal demise, PIH C-section, late decels all in one night.

Last night was all kind of things mixed into one. I mean, damn, was it a full moon or something?!

Before I ramble on, you might wanna stop reading if you're squeamish.

So, it started off slow, my patient was 5 cm when I came in and stable. After a few hours with her, I ventured around the corner to where my two group mates were, and that's when I saw something odd in the basinet next to the baby warmer across from us. It was a bunched bloody blanket and I saw a surface of red flesh and I thought it as a placenta and wondering why would they wrapped a placenta and put it in the basinet?

My friends spotted the same thing and all three of us went to take a closer look, and that was when the nurses told us that earlier that evening a 24 weeks mom had come in saying she hasn't felt the baby moved in a week. Sure enough, it was a fetal demise, and she was induced to give birth to a stillborn baby.

I will never forget what I saw last night, I don't think I will ever that image of the nurse unwrapping the blanket to reveal the red glob of fetus beneath it out of my mind. Judging by the appearance of the fetus: red, floppy with no apparent bone structure (it looked like a red blob of Jell-o or a red water balloon), underdeveloped features, and peeling of the skin, they were thinking it died due to chromosomal abnormalities and that it had died a week or more before the mom came in last night. As I went back to my patient's room, I caught a glimpse to the stillborn's mother's room, where silent grief enveloped the family that had gathered there. I said a prayer for them.

My patient, in the meanwhile, was progressing slowly, only going from 5 cm to 6 cm, so the doctor order the Pitocin to speed it up. Sure enough, minutes later late decels started showing up on the monitor and it was a "Holy crap! Is that what they meant when they talked about that in class?!!" moment for me. We turned the mom to the sides, put her on O2, and turned the pit off.

It's funny because in class, my instructor taught us a song to help us remember what to do when decels happen, and that exactly what was done last night. I'm still getting used to the feeling when things I've studied in the textbook happen in front of my eyes, it's like "HEEEEYYY!!!", the dots connected, light bulb goes on, whatever.

Mother and baby were okay after that, and nearing the end of my shift, my instructor came around telling us that she was going to sneak us into a C-section in a few minutes after they got the mother settled down and ready to go. The mom was 32 weeks along with PIH and overweight, which is not a good combination for the surgeons and the anesthesiologists.

They started and not long after that the patient started moaning and you can see everyone was alarmed, but the anesthesia team reassured that she was just feeling uncomfortable from the tugging and retracting they surgeons were doing to try to locate the uterus. As they cut through more layers of fat, the patient started groaning and it got louder and louder.

My friends and I looked at each other wide eyed, thinking "What in the world?!!", then we saw the surgical tech and my instructors rolling their eyes and giving each other "What the hell are they doing?!!!" It was bizarre to see someone with their abdomen open and blood flowing out and hearing them making noises that indicate that she is obviously in PAIN!

All this time, the surgeons continued to try to get to the baby as fast as they could, and the anesthesia team announced to the room whatever everything they cannot do because she was so large and hypertensive with low platelets therefore the pending complications, and I was just screaming in my head "DO SOMETHING, SHE IS IN PAIN!!!!"

They finally got the baby out after a series of groaning from the mom, who was still groaning as they sew the uterus. The baby needed intubation and some helped to breath, but the NICU team finally go the baby to cry, so that was good. We left right after that and didn't see the rest of that procedure.

I had no idea why the anesthesia didn't seem to work completely and why the team couldn't get it right. I knew the mother posts a series of complications but it doesn't mean you would just let her feel the pain of her surgery. Uncomfortable? Okay. Pressure? Okay. Pain? Oh hell no! That's not right, but unfortunately, it happens.

So that was my night on the OB floor yesterday. It was a night to remember for sure.

The one with the poo.

Okay, I get it. I get why parents can be obsessed with their baby's poops.

I spent today's clinical at the newborn nursery, and having changed many poopy diapers, all I want to tell my friends now is the many kind of poops I saw. I mean, did you know that a cutie patootie baby can generate a poop of gross epic proportion?! And it that color?! And in that form?!! And that often?! Who would've thunk it?!

I also believe my kidlet invented a new game called "Oops, I did it again!", in which I change the dirty diaper, turn around for a second to dump it in the trash, only to find upon return that the kidlet has pooped--again--and peed--again. Anyway, today was a good one--a really good one--aside from how many times my baby pooped.

Oh, one more thing, counting newborn's heart rate is another story. It sounds easy when they say "You count for 6 seconds then times 1o", not so easy when heart rate goes 123456789101112131415 in 6 seconds.... I think I lost track and had to redo it several times before getting it right. Oh, and I gave erythromycin eye ointment and vitamin K shot. Yay!

And by now I am also tone deaf to newborn cries....

"Oh, there is another one....."

On the morning of 27th, I received a phone call from my mom. It was night time where she lives (we originated from an South East Asian country) and she sounded tired yet happy, the reason being that she and Dad had just become proud grandparents to twin baby girls. My SIL gave birth--4 weeks early--after long hours of labor.

But that is not the whole story.

The whole is that all along we were expecting a single baby girl, ultrasound technician and OB/GYN himself confirmed a single baby girl, that is until a baby girl did come out but OB/GYN noticed that SIL's tummy was still round and swell. So he prodded around and lo and behold, there is another one, say hello to baby #2, y'all!

Bah! What the hell?! How could they missed twins during 8 months of prenatal care??!! I realized that they opted with the old school ultrasound, none of that fancy schmancy level 4 one, but still! There are two heartbeats, is it really possible not to hear two?! Or was it just pure carelessness?

I think it was the latter.

SIL's OB/GYN was the doctor who birthed my two brothers and I, so my mom was quite loyal and defended him when I criticized bitched on his (and the ultrasound technician's) skill, or lack of thereof. The OB/GYN blamed said ultrasound technician for the mishap and excused it with the twins' on top of each other position instead of side by side, hence the appearance of one baby on the screen. As for the heartbeat, he made an excuse of they were beating at the same time so he could not differentiate, plus he was going on the confirmed ultrasound of one baby. Mom seemed to accept it and let it go, but I beg to differ. I (and a few friends and a nurse I've talked about this to) still can't wrapped it around our mind that they missed it.

Fortunately, the babies are healthy. Baby #1 weighed in at 2. 3 kg (4 lbs. 7 oz.) and baby #2 was 2. 248 kg (4 lbs. 648 oz.). Baby #2 had some breathing difficulty shortly after birth, but she's pulled out of it and is going to be fine. My grandparents who live here are elated at the news, seeing their faces when I told them the news were something I would never forget, though it broke my heart a little that they won't be able to see their great granddaughters in the near future. They haven't been officially named, though Mom just said they are thisclose to putting the names down on the birth certificates--the last I heard they are Arabella and Aurelia. I, as the proud aunt, approve of the names.

Now I have to shop double for the baby stuffs. Le sigh. I'm turning into one of those aunts who spoil the kidlets rotten....

In other news, aka nursing school wise, final is a mere two weeks away. Comprehensive final, 'nuff said. I can foresee a lot of long hours and late nights studying and very little to none going out of the house in the next two weeks, very bleak and gloomy future I say. Oy....