A good week

I've been on my own all week covering the oncology floor, and I've really loved it. Maybe not the floor necessarily, though most of the patients are really able to communicate with me and the nurses are all very helpful, but I enjoyed being on my own completely (except for running around trying to find an RD to sign all of my notes...). But I would have to say my favorite experience this week was Wednesday went I spent a day with a doctor in the NICU. I absolutely loved it. This doctor said basically his whole job was nutrition, trying to get these babies to grow. I feel that I like this segment of the ICU as compared to adult ICU for a couple reasons. #1 Though the patients can't communicate with you (similarly to other ICUs), their parents are always around to talk to and encourage. I love not only providing medical aid, but also the direct encouragement to families and patients so that they know that a medical professional is looking out for them. #2 Though about 98% of the patients are getting some sort of nutrition support, compared to adult ICUs where the patients used to be able to feed themselves but now are in a terrible medical condition, the little babies have never been able to eat on their own. I suppose it's more the beginning of life need for nutrition support than end of life/advanced disease/etc. need for it that I enjoy. However, a sad story, we did have one preemie baby with ESRD (I suppose that term still applies... that's what a PA said, but who knows). At first, they gave him a relatively high calorie formula to help him grow (he was probably about 1 kg or so), but his BUN and Cr were extremely elevated. So they cut back a little bit with a less dense formula, but his growth started to plateau. So they increased it again... BUN up... etc. They can do acute peritoneal dialysis on babies only when they get to 2 kg, and they can transplant kidneys when babies are 10 kg. The baby just has to make it there first. Also, the parents have to decide if they want their child to be undergoing dialysis for an indefinable time period, which would obviously not be a pleasant experience. So, a tough place to be in. Poor little guy. I'd give him a kidney.

Anyways, great experience though. 3 weeks to go! Also, Sarah and Diane, my case study is coming to see you guys for a doctor who specializes in intestinal motility. She may potentially be on TPN for the rest of her life (she is 32) if he can't help her out...