Phan was midway through the excessively long one sentence patient summary about Manifest Destiny Loveland when Schuller interrupted her.
“Would you say this baby is cute?”
There was an equally excessively long moment of silence, because Manifest Destiny was a cyclops.
Not a joke. She had a serious midline defect that led to a single non-working eye, nasal proboscis, and multiple associated organ system deficits. It was a great debate among the staff regarding why Dr. Edwards had intubated her—and how—since she had a tiny mouth and had since been trached by ENT. She had no respiratory drive of her own and was permanently ventilator dependent. Among other issues, imaging showed she lacked large sections of her brain and required pharmaceutical replacement for her endocrine system.
Also her GI system, her heart, and her lung…
“Is she cute?” Linga repeated, scanning her notes like she’d have recorded that between the neuro consult that showed she was minimally responsive to pain and the pulm consult about her lung.
Lung. Single.
“Yes, while midline defects are quite rare, are you using your skills on a holistic evaluation?” Schuller pressed in her strange way to justify her question about cuteness.
Social work had the best expression trying not to crack up. Pharmacy and nutrition snorted a few times, and Clarissa pointed at her own flowered scrub cap and hair.
“Of course. She has lovely hair. Her parents adore her. So cute,” Linga got the hint and launched into the rest of her presentation without further ado.
As the problem list continued, one of the medical students, Bridgette, whispered to Clarissa, “Is there really a holistic evaluation?”
“Not for her,” Clarissa wrote down in response.
The 23 and 24-weekers, if they survived the first few weeks, had an endpoint, a theoretical discharge date where social work and the family would figure out what was needed, outpatient and beyond. Manifest Destiny had no chance of leaving the hospital, and more than once, other neonatologists had implied they didn’t agree with this massive use of resources on a patient with no realistic future.
But Dr. Edwards had saved her, and the family wouldn’t withdraw care. She was full code, and unless her partially working heart failed, they’d keep bringing her back.
A horrible future. A horrible plan.
The fact that Clarissa was resenting the choices made a month ago and was viewing the care of sick babies as an obstacle to sleep was a sign of her exhaustion. There were no quiet NICU calls, and the lack of sleep was making her more and more cynical.
Even Schuller must have been tired by the end of the presentation, because she didn’t have more to add or make any additional interesting additions.
CHAPTER 17
The social worker took this patient transition as a great moment to escape, and Clarissa used her exit to walk to the opposite side of the room and the final patient in the pod. She started talking as she walked, making Schuller chase her, and was aided by Pharmacy herding everyone in that direction.
“This is Cortland Sabrowiski, ex 34-weeker, now three and a half months old. Maintained on TPN due to failure of multiple different closure attempts of his gastroschesis. Oh, and he is so very, very cute.”
Using a generous dollop of hand sanitizer, she carefully propped up the gorgeous curly-haired baby. He wasn’t intubated, was fully neurologically intact, and other than the PICC line in his left arm, he appeared almost normal.
Unless you paid attention to his lightly draped abdominal binder keeping his intestines (among other organs) from falling further out of his body. Or the NG tube in his nose. Or the slight green cast to his skin from TPN-associated liver irritation.
Gastroschesis was when babies were born with their intestines outside of their belly, usually through the belly button. Seven out of ten babies were surgically repaired immediately after birth. Cortland was in the unlucky group who had a large enough defect that couldn’t be closed easily.
“He is! And how is his mood?” Schuller asked, surprised the baby was watching her with wide eyes.
“Fabulous. This month is all about maximizing his growth and stability. Peds surgery is doing the next procedure under general and prefer he be four months old,” Clarissa said. Her anesthesia rotation had taught her ped surgery rarely performed elective procedures using general anesthesia unless they were at least four months old and weighed over ten pounds.
It counted as elective, one supposed, if he had survived this long without a GI system. Cortland wasn’t allowed to eat, and the NG tube was continuously suctioning any swallowed saliva or mucous since it had nowhere to go.
“Oh, he is so cute. Nutritional status?” Schuller inquired, smiling at Cortland.
“Continues total parenteral nutrition and has been stable. We’ve spaced his labs to twice a week. Liver function remains in the safe range.” Nutrition and pharmacy both nodded in agreement with Clarissa’s presentation.
“What does he do for fun?” Schuller wanted to know.
A softball of a question on Cortland.
