{"id":115,"date":"2005-09-01T19:34:16","date_gmt":"2005-09-02T02:34:16","guid":{"rendered":"http:\/\/jillcook.com\/blog\/?p=115"},"modified":"2005-09-01T19:41:23","modified_gmt":"2005-09-02T02:41:23","slug":"115","status":"publish","type":"post","link":"https:\/\/jillcook.com\/blog\/2005\/09\/01\/115\/","title":{"rendered":"The things I see"},"content":{"rendered":"

I see the strangest and most interesting things at work.  I also see the happiest and saddest things.<\/p>\n

Tuesday morning I was at the birth of a very tiny little baby.  He was only 25 weeks gestation (full term would be 40 weeks) and his story is heartwrenching.  His 18-year-old mom had at one point made the decision that she was not going to carry this baby anymore and went in to have an abortion.  However, something changed her mind once the procedure was set in motion, and she ended up not going through with it.  However, her membranes had already been ruptured and she had lost a lot of the amniotic fluid.  This was not a great thing for the little one inside, and sure enough mom and baby both ended up getting an infection because the protection of the membranes was no longer intact.  This necessitated induction of delivery since it was going to be much less healthy for the baby inside than out here, where we can give him medicines and help him get better.  So mom had the baby at 25 weeks.  Now she’s going home (to far to commute to visit) and is planning to come back and rent an apartment closer to here so she can visit her baby.  Her baby who will be hospitalized for months because of his age.  Her baby who will endure the hardships of prematurity and all that it brings – infections, lung disease, feeding difficulties, risk of blindness, bleeding in the brain…  and very likely a less than ideal outcome as far as disabilities go.  I wonder what this girl had planned for her life and how things will work out for her now – so different than what she expected I’m sure.<\/p>\n

On Wednesday we anticipated the arrival of a new baby with a sacrococcygeal teratoma.  Whoa, big word!  It’s basically a really big growth near the tailbone.  It makes it nearly impossible to have a vaginal delivery (it would be like trying to get 2 heads out – and just 1 is work enough, ask any mother!).  Usually they are benign growths, but 10% can be mailgnant so it’s important to have the surgeons go in and remove all of it.  So I was there in the operating room when this little guy was born, and I watched as he was stabilized and then put into a sterile plastic bag to protect the growth from rupture\/infection until he could be transferred to the operating room.  Don’t worry, the plastic only covered from his feet up to his chest, his head was open and free to breathe. \ud83d\ude42  It was pretty amazing to be able to see this kind of birth defect in person – one of those "I hope it never happens to anyone again, but if it has<\/em> to, then I would appreciate the opportunity to see and learn from it" kind of things.  It’s considered the most common tumor of newborns with an incidence of 1 in every ~40,000 births (which still doesn’t make it that<\/em> common).  My attending said that maybe there are one or two born here every year, so it’s not often that one gets a chance to see it.  I’ve seen lots of textbook pictures of these tumors, but this was my first "in person" experience and it will definitely stay with me.  The tumor was at least 1\/3 of the baby’s weight!  Anyway, here’s a drawing of what one looks like:<\/p>\n<\/p>\n<\/p>\n<\/p>\n

\"\"<\/p>\n

This morning there was another baby born with an abnormality – he had some blockage of the urinary tract and his bladder was really distended.  While he was still in utero, a surgeon put a little tube in so the bladder could drain (into the amniotic fluid – where it would go anyway, people, so don’t be grossed out by that!).  It looks like he might have "prune belly syndrome" where the abdominal muscles don’t form well and the urinary tract may have malformations.  He was a twin, and his brother is totally fine.  Actually, he was totally fine too.  Breathing well, heart beating fine, good muscle tone – all the good stuff.<\/p>\n

And finally, this afternoon a little boy was born (all these boys, oh my) by C-section because his mom was getting sick from being pregnant.  She had HELLP syndrome (h<\/u><\/strong>emolysis, e<\/u><\/strong>levated l<\/u><\/strong>iver enzymes, and l<\/u><\/strong>ow p<\/u><\/strong>latelets), which is something moms can get for unknown reasons and it can be fatal – the treatment is delivery of the baby as soon as possible.  Luckily, this guy was almost 35 weeks, so he was barely premature.  He came out a little dazed and confused since his mom had gotten general anesthesia and it affected him as well.  But soon he was kicking and breathing well.  And his dad was just so happy and excited.  He teared up and held the little guy’s fingers and was positively giddy.  It makes me smile just thinking about it. \ud83d\ude42<\/p>\n

There are lots more happy stories too – but of course not all of those stick around in my head as much as some of the "interesting cases" do.  Kind of like on the evening news – we hear lots about the crazy and bad things that happen, but not too much that warms the heart.  I’m trying to make sure I remember the good experiences with as much clarity as the not-so-good.  It helps to remember that more than 90% of babies don’t need any help from us doctors when they are born.  That’s a big number.  And it’s just fine with me. \ud83d\ude42<\/p><\/p>\n","protected":false},"excerpt":{"rendered":"

I see the strangest and most interesting things at work.  I also see the happiest and saddest things. Tuesday morning I was at the birth of a very tiny little baby.  He was only 25 weeks gestation (full term would … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-115","post","type-post","status-publish","format-standard","hentry","category-medschool"],"_links":{"self":[{"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/posts\/115","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/comments?post=115"}],"version-history":[{"count":0,"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/posts\/115\/revisions"}],"wp:attachment":[{"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/media?parent=115"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/categories?post=115"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jillcook.com\/blog\/wp-json\/wp\/v2\/tags?post=115"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}