Assume the Position: Memoirs of an Obstetrician Gynecologist by Richard Houck MD
Authors: Richard Houck MD
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babies during their first 28 days of life. The ‘Father of Neonatology’, one of the country’s experts, was at Pennsylvania Hospital. Spending three months with him was a special experience. There were three of us in training with him during this rotation: a pediatric intern and a resident from the University of Pennsylvania, and an obstetrics intern from Pennsylvania Hospital. It was critical for us to learn how to care for sick babies. Depending where we might wind up in clinical practice, rural or otherwise, we might be the only person available to keep these young, often critically sick infants alive for an extended period of time until help could arrive. So we learned what kinds of problems put these critically ill infants in the intensive care nursery in the first place, how to intubate them, place them on respirators and make the proper respirator machine settings if they were too premature to breath on their own. We learned how to put in umbilical lines for fluids, dosages for antibiotics and other critical medications, and how to maintain acid base balance, critical for early infant health. It was all-terrifying for me. After all I wasn’t a pediatrician. The patient’s couldn’t communicate their medical needs. There was so much to critically assess in such a short period of time, in such a small human being. Even more terrifying was every third night on call when I was the only one in the NICU caring for up to 20 or more premature babies at times. As we were required, we attended each of the Cesarean sections as the ‘pediatrician’. Although I would have preferred to be performing the delivery itself, during this three-month period I was on the receiving and not the delivering end.
One night I was called to attend what appeared to be a routine repeat Cesarean section on a mom who had arrived in active labor. Still in the “once a C section always a C section” era everything was expected to be routine with the baby, so I was expecting nothing out of the ordinary. I was handed a term baby that for some reason had awful Apgar scores, was blue with minimal shallow respirations, grunting and retracting. This was a clinic patient with no financial resources or insurance, it was past midnight, and I was it as far as pediatrics for the evening. Clinic patients were almost always entrusted to the resident house staff in training, i.e. me. I stabilized the baby, intubated and bagged it immediately, put in umbilical catheter lines, checked x-rays for line and tube placement, took it to the neonatal ICU, and waited for initial labs and blood gases to come back. When I was satisfied with the results, I called the Father of Neonatology and Chief of Service on the phone to inform him of a new admission to the NICU, apologized for waking him, gave him the details and numbers, and asked if I missed anything. He said: “Is this a fourth floor baby or a fifth floor baby?” which meant was it a ‘ward’ baby or a “private” baby, in his language non-pay or insurance. I responded that it was a ‘fourth floor baby”, meaning no insurance. He said, ‘Keep up the good work and I will be in later this morning.”
By the time of morning rounds, after an exhausting night with no sleep, I was so proud of the work I had done. I kept this baby alive all by myself while not only producing perfect laboratory acid base numbers but also caring for all the other neonates in the neonatal ICU. The Father of Neonatology arrived for morning rounds. When it came to this baby he took one look at it, pulled out the endotracheal tube and turned off the respirator. I was aghast. He said, “You have just saved a Mongol for the world. If he is going to live, he is going to do it on his own.” I suspect he knew the infant would make it without the respirator, but I couldn’t have made that judgment at that time. I had never seen a newborn Down
One night I was called to attend what appeared to be a routine repeat Cesarean section on a mom who had arrived in active labor. Still in the “once a C section always a C section” era everything was expected to be routine with the baby, so I was expecting nothing out of the ordinary. I was handed a term baby that for some reason had awful Apgar scores, was blue with minimal shallow respirations, grunting and retracting. This was a clinic patient with no financial resources or insurance, it was past midnight, and I was it as far as pediatrics for the evening. Clinic patients were almost always entrusted to the resident house staff in training, i.e. me. I stabilized the baby, intubated and bagged it immediately, put in umbilical catheter lines, checked x-rays for line and tube placement, took it to the neonatal ICU, and waited for initial labs and blood gases to come back. When I was satisfied with the results, I called the Father of Neonatology and Chief of Service on the phone to inform him of a new admission to the NICU, apologized for waking him, gave him the details and numbers, and asked if I missed anything. He said: “Is this a fourth floor baby or a fifth floor baby?” which meant was it a ‘ward’ baby or a “private” baby, in his language non-pay or insurance. I responded that it was a ‘fourth floor baby”, meaning no insurance. He said, ‘Keep up the good work and I will be in later this morning.”
By the time of morning rounds, after an exhausting night with no sleep, I was so proud of the work I had done. I kept this baby alive all by myself while not only producing perfect laboratory acid base numbers but also caring for all the other neonates in the neonatal ICU. The Father of Neonatology arrived for morning rounds. When it came to this baby he took one look at it, pulled out the endotracheal tube and turned off the respirator. I was aghast. He said, “You have just saved a Mongol for the world. If he is going to live, he is going to do it on his own.” I suspect he knew the infant would make it without the respirator, but I couldn’t have made that judgment at that time. I had never seen a newborn Down
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