Friday, December 12, 2008

Late night update (Friday 12/12)

Although Carolyn spent much of the day with Max, I didn't make it to the NICU until after putting Felix to bed. As I walked through the NICU doors I was met by Dr. P., who looked downcast. He grabbed my shoulder and said "Mr. Lehnert, I'm so sorry."

He was, of course, apologizing for not having emailed me the journal articles on Hirschsprung's Disease we had discussed a couple of weeks ago when we were debating whether or not to tap Max in order to relieve his constipation (see "Another day at the office" from 11/30). Max? Max was fine of course. Although Dr. P. was preoccupied with a couple of truly sick babies, I did have a chance to quietly discuss with him the merits of greeting a parent walking into the NICU with the first words "I'm so sorry". That said, I currently have four different coauthors and two journal editors hounding me so I understand the overwhelming guilt Dr. P. felt for not getting me the articles he'd promised.

There have been big changes in the NICU over the past couple of days. The so-called "step down" NICU has been temporarily shuttered and its few occupants moved to Max's wing, which is the high-intensity half of the NICU. Even with the addition of the extra babies, the NICU felt empty. Dr. P. said that business always fell off during Christmas but then exploded on January 1. Two questions struck me. First: Could this possibly be true? Especially because the NICU doesn't take full term babies; its stock in trade is babies who arrive unexpectedly. What mechanism would introduce a seasonal in premature deliveries? There's a J. Pub. Econ. article in this for an enterprising graduate student (a suggestion I kept from Dr. P., who clearly doesn't need another academic obligation right now). The second question that struck me was: It's Christmas?

Nurse Becky (who I wish to have canonized as soon as possible) felt that the lull in NICU business was more likely simple chance, and that its proximity to Christmas was coincidence. And here's another blow to magical thinking: I left a quiet and peaceful NICU tonight to be greeted by the brightest full moon of the year. The Emergency Room was also incredibly quiet as I was leaving, with the lone security guard snoozing quietly. A Friday night with a huge full moon and it's the quietest I've ever seen Georgetown. Perhaps all the lunacy will happen later.

When I came home I immediately remembered the important data I meant to gather on the current set of issues we're managing: how much does Max weigh? Is he tolerating his feedings despite the addition of an iron and vitamin supplement that is well-known for causing stomach upset? What is his latest head circumference measurement? I don't know if I was suffering from NICU brain or manager fatigue, but after spending two hours holding Max in a relatively quiet and peaceful NICU, I completely forgot to follow up on these important questions. I guess I was being a parent more than a manager.

Carolyn and I continue to try to take it one day at a time. Just because we've had a few good days in a row doesn't mean that future dips aren't coming. But I allowed myself a tiny glimmer of hope today. The phrenology service appear to be losing interest in Max because his head circumference has been stable despite going two weeks without a successful tap. The prospect of having to tap his ventricles directly--an exciting procedure for a neurosurgeon I'm sure--is waning.

Seriously: Max tiptoed to the absolute edge of acceptable hydrocephalus. And yet, remarkably, his body appeared, after we'd given up all hope, to have come to some kind of equilibrium with its CSF production and absorption. He'll most likely always have enlarged ventricles but, if this fragile truce holds, he may avoid requiring an indwelling shunt. This would be a miracle on par with the Cubs winning the World Series. That Carolyn and I--long-suffering Chicagoans--would allow ourselves to hope that Max could avoid a shunt is in itself a kind of miracle.

Since I wasn't a very good manager today, I decided to be a good father instead and asked a wandering volunteer to take a picture of Max and me. (By family tradition, fathers are in charge of the camera.) Enjoy.

At the NICU