The future

I stand very quietly watching the tiny form wiggle his toes, the whole foot not much larger than my thumb. "No name yet," the nurse informs me as she adjusts the ventalator. She is reading my mind, "We are coming down on the ventolator settings. He is doing better."

I always go up to the NICU or neonatal intensive care unit to see the babies I have delivered. Many make it through to the step down unit, grow to be 5 or more pounds and go home. As with this baby, I always wonder what kind of home that will be.

I know this baby's mother better than most. She was in the hospital 5 weeks before he was born. Her drug screen was positive and after a few days of "drying out" she ask me to terminate the pregnancy. When I told her this was not only against hospital policy but at her stage in gestation, it was illegal as well, she refused all subsequent care and left against medical advice.

She returned via ambulance, again in a drug induced stupor, and I delivered this two pound baby boy on the stretcher just inside the doors to labor and delivery. At delivery I thought he was dead but the NICU team was there and revived him. Now we are here. He is two days old and getting stronger.

From the mother's previous hospitalization I know there are two other children. One in the custody of her mother, the other her sister. The patient asked to have her tubes tied and if it were up to me that would already be done. I have no illusions of rehabiliation. Sterilization is at least part of the solution. I am just wondering about this baby, with feet the size of my thumb. Who will care for him? What does his future hold?

How many more like him are in this city, state, country? Where does it stop? I fear we will run out of resources sooner than we will run out of babies with feet smaller than my thumb.

My office

With my change in positions several people have ask, "Where is your office?"

The short answer and probably the most truthful is, "I don't have one."

Oh, I have an eight by eleven foot call room complete with bed, desk, and chair. I have grow so tired of this space in the last 6 months that I now only go there to sleep. I share a conference room, complete with two computers, monitors for all the beds in labor and delivery, and cable TV with any other obstetrician who happens to have a patient in labor. There is a common workspace I use in labor and delivery, again with monitors and computers to scan what is happening in each room or access medical records. Similar accommodations exist for my use in the emergency department.

Yet, it dawned on me one morning last week, as I slogged around a park south of my home, that my office is there also. On my non-call days, when I am not chained to the hospital by my contract which states I will be physically present to care for any obstetrical or gynecologic emergency, I head for this park. It has a one mile dirt trail, beautiful oak and pecan trees, a creek bed, and several grassy areas. Set back from the roadway, the sounds are birds, squirrels, and the rustle of the leaves.

The peace of this place passes any understanding. I can feel very beaten down when I arrive but I leave refreshed, physically spent, and believing I can make it at least one more day. And, lest you doubt, it is my office, my beeper is strapped to my side and my cell phone is in my pocket. Some days I spend more than one of the five miles I attempt to traverse talking with a young doctor about how to care for a patient. My counterpart, the person who is now captive in the hospital, will have to be the physical presence when one is needed. I am fine with talking for a few minutes as I sweat and struggle to make it around the trail again or as I simply sit and admire what a fine piece of work the interior designer of this space has done.

The flu

I once heard from a patient, "You know you have the flu when your hair hurts." Well my hair hurts today, not because I have the flu but it certainly seems as if everyone else does.

I received my flu shot for the common seasonal flu over a month ago. Now city officials say all the current flu circulating is the swine variety. This is a problem since there is no vaccine. The hospital asked for 7,000 doses. They received less than 700. Pregnant employees in the emergency room and women's and children's services were the first to be vaccinated. Other pregnant employees will be next.

Flu is a dangerous disease in pregnancy. It can lead to pneumonia and hypoxia, a fancy word for too little oxygen. As you can imagine, too little oxygen is not good for mother or baby. We have had several mothers and mothers to be in the intensive care unit. So far we have not had a maternal death but we have come very close - twice.

I try not to think about getting the flu and I must admit, I am more afraid for my sons than for myself. The young seem to be very vulnerable to this virus. One patient who was in the ICU for two weeks is the same age as my oldest. He is not pregnant but he has an underlying medical condition. I will not hestitate to give him an antiviral should he or anyone in our household comes down with the swine flu.