Jezebel

The nurses named the baby "Jezebel." I hope her mom, even with her limited English will give her a name today. Yesterday, the mom, brought to the hospital by an ambulance, was too sick to name her. Growth restricted by her mother's hypertension, "Jezebel" only weighs 5 pounds even though she is full term. Her mother had been on medications for the high blood pressure but felt these medications were not working so she did not go back to the clinic for more. I am hoping in three days with my limited Spanish and the translator, I can help her understand.

Mom has many reasons to stay healthy. A single mother with two other children to feed, clothe, and get to school every day (one is elementary age, the other middle school), Jezebel's mom was working cleaning houses until she got sick with feet and hands too swollen to work and a terrible headache. I am just happy someone called the ambulance before a stroke or a seizure occurred. I also feel pretty good about the fact that Jezebel's blood gases and Apgar scores at birth were good. Now, I only have to worry about how to convince mom that her blood pressure is a problem even when she is not pregnant. How do I know? I appears she has the early signs of kidney disease probably secondary to her long standing, untreated high blood pressure.

I am remembering I live in that great land where we pay for care if you are in renal failure and need dialysis but we don't cover patients who are not pregnant with hypertension that could cause renal failure. At least not yet. I hope, as a country we are at least getting there.

SUBspecialist

subspecialist - def. In medicine, someone who makes more money by doing less work.

The babies

While most of my stories end with the birth of the baby, when I was in private practice, I always enjoyed seeing my patients' children grow. Because of this, I cannot resist visits to the neonatal intensive care unit (NICU) to see the babies. Occasionally one will celebrate a 1st birthday there. Usually the stint is much shorter. After graduating to intermediate care and "rooming in" with the parents over night to allow the parents to adjust to the machines such as the apnea and bradycardia monitor which checks heart rate and breathing, these kids will go home.

This morning, however, I am thinking about Megan. This is not her real name but she is a real baby. Born in early January, she weighed slightly more than a pound. She is now almost six pounds and her mother is now 18. Megan's mother rarely visits I am told. Megan is very fussy and the non-pediatrician that I am, I thought this was due to inattention. I ask to hold Megan and I noticed she gets quiet for a few seconds but then she is fussy again. The respiratory therapist explained the fussiness is due to air hunger. That is right, even with oxygen on, Megan struggles to breath. She is off the ventalator in an effort to get her stable enough to move to intermediate care.

For those of you out there who have had the opportunity to sit with someone afflicted with emphysema, air hunger is what makes these adults so restless. Every nerve connected to respiration is firing, pushing the muscle cells that control respiration to work harder and faster. When this doesn't work, more catecholamines are released, making other nerves and muscles twitch.

Perhaps you arrived at the conclusion of this story before I did. How is a mother who was 17 when this baby was born going to deal with these health problems in her daughter? This mother did not seek medical care when she was pregnant and she did not follow medical advice when she was in premature labor. Yes, social services is involved. And yes, there are days that my prayer is one of thanks that I do not have that job.