The glass is half

Perspective. Its hard thing to come by in the trenches of the NICU. Flashing lights, beeping alerts, lots of IV's and tubes running everywhere. And varying information that elicits varied response... Its hard to know if the glass is half full or half empty. Maybe its just half.



Dr Rosenberg presiding over morning NICU "rounds"



After last nights bad news about the brain bleeds, Sara and I didn't sleep too well. She was up pumping in the middle of the night, and I was fidgeting around in the bed. We awoke and stepped into the NICU just in time for the morning rounds. This is where the main doctors, the fellows, residents, nurses, and pretty much everyone go around the whole NICU. They form a circle near the particular baby they are going to be talking about;laptop computers are rolled up on stands, and notebooks are out.

The presiding "resident" doctor then explains the "case" on that particular baby, and develops his/her recommended treatment course and actions. The overseeing doctors then challenge the "resident" into why his/her thinking is such, and challenge the group to think about alternate solutions. After some insightful debate, the overseeing doctor stamps his approval on the "resident's" course of action, and they move on to the next case.

I've found the "rounds" to be the best opportunity to glean the purest information about Ashlyn & Hanna. There is no candycoating, no subjective emotional talk; It's straight up clinical diagnosis and course of action. Its fascinating.



"Resident" Stephanie working on  Hanna



Being the good student I am (my mother might disagree), I had my laptop open during the rounds and took notes. The whole group kept looking over at me as I was furiously making notes about their discussion, and laughed at the end as they asked if I had gotten it all. This is what I gleaned:

Ashlyn:

• PDA duct minor, no more treatment for now
• Gained 40 grams overnight, all fluid related
• drained 18CC's of Chlyle overnight from chest tube
• Urine was low and concerning
• Possible adrenal gland issues
• Pulling UA line today
• Trying to advance feeds with non fat enfamil as to not aggravate Chylothorax
• Start Albumin

Cary's interpretation- Fairly stable, but with a new issue; Fluid retention. Her drain increased overnight, and they are replacing more fluid than she is losing, and she's not urinating out the excess. Troubling. She is semi-bloated. Both Stephanie and Amy, the two "residents" that care for Ashlyn, say she still is an "active player" in the NICU. I take that as she is sick and struggling.



Sara's twin drawing posted on the wall in NICU

Hanna:

• Weighs 1120 grams, down 80 grams from birthweight
• On high flow oxygen, reducing from 3 to 2.5
• Murmer still apparent
• increasing feeds
• continuing Caffeine

Cary's interpretation: Continuing well, increasing feeds. No major issues. Heart murmer is PDA that is likely closing, no treatment. Doing most everything right.

On a final note, we did get some good news I suppose today from Dr Rosenberg. After "rounds", I cornered him to ask about the brain bleed news we received last night. He said "Its probably just an "artifact", and so small anyway, I wouldn't lose any sleep over it." An "artifact" is apparently a shadow or a misprint on the ultrasound machine. So after the freakout of last night, hearing about brain bleeds and thinking very bad thoughts about brain damage, he re-assured us that he is not that concerned about it. Hard to know, and we woul'nt know about any consequences from it for a matter of months/years anyway, so I'm going to try and not worry about it.

So, is the glass half full or half empty? Right now, its just half.