Jo, M.D.

It's been several months since this 10 day stretch of night shifts. And that's because night 8/10 was the worst night of my entire life and the month following that was the saddest month of the entire life.

Night 8/10 was my first night ever in the PICU, first shift at all in the ICU (outside of NICU). I had gone down the night before to shadow and the boy from night 5/10 was struggling to breathe. I sat with his mom as she cried in the next room while the fellow intubated him.

"Will I ever get to talk again?" He said.

We all nodded yes to him. We did our best to reassure.

I walked with his mother to get a latte from Starbucks and she told me all about him. His new gaming computer that he got for Christmas that he wanted to play. His two older siblings with their kids, and how he got along so well with them even though they were step-siblings. His mom really likes pistachio lattes.

Night 8/10, I go immediately to see him. Hopeful.

And I am already traumatized by what I see. He is edematous, covered in purpura, sedated and paralyzed, catheters at his neck and arms. All I can think is that he has to make it. I have to watch him so closely so he can make it.

His labs were drawn almost every hour. His potassium, his blood pH, his lactate levels. Everything was on the edge.

It was 4:43, the nurse noticed his heart rate was dropping. She checked his pupils. Fixed. Dilated. And we started compressions. 45 minutes.

5:36 was his time of death, and I still want to cry as I write this.

His mom wasn't there. I heard her sobbing on the phone.

He never spoke again.

And in the next several weeks, 9 other children died. Including little miracle from night 1/10. I cried for weeks. It was so hard for me to keep going when I felt the incompetence of being in the ICU for the first time, to feel so sad for all the kids and their families, and to just keep pushing. The secondary trauma was real.

To any resident's out there who are feeling it, just wanted to let you know how those days went. I went to therapy, I took a full elective month afterwards, I processed it with the fellow on call. My residency program rose up to meet me as I felt like I was free falling out of this. I hope you all have been able to find these supports where you are at, and if not, that I am happy to process with you. Phone a friend. You aren't going through this alone.

Walked in to one of the patients having a PT prolonged to 23.... WHAT (normal is 13 or less). His liver enzymes have been getting worse since he got admitted but he hadn't gotten any chemo that could have led to such intrinsic failure. He was the before mentioned 6 bolus patient. During the day got plasma x2 and then lasix + albumin + lasix. Halfway through albumin started to have an RR 55 (he's a teenager). So so so much fluid. Poor Kid. Had to send him to the PICU for VOD treatment and fluid balance.

Literally hung around the rest of the night. I was so prepared to correct his liver dysfunction but needs a little more than the floor can give. Another friend I'll see in the ICU.

The usual "We've got a direct admit coming from 30 minutes away" at the beginning of shift.

Shows up 9 hours later.

I know this little kiddo and he's my first admit of 2022. Unique genetics of sickle cell HbSS with beta-thalassemia zero. Back at it again with another virus + fever. It feels fun because I'm pretty interested in Pediatric Hematology, much for the continuity and unique manifestations blood disorders have in the body. All this to say, my boy got his classic - ice water, scheduled antipyretics, and lots a love.

Favorite part of the night was when I was going to check in on one of my patients. Walked past a room and the patient, probably 5 years old, was just outside the room playing with the computer station on wheels. Just full on scanning his bracelet, clicking things, sitting on the ground having a good time in the hospital hallway at 11:30pm. Not an adult in sight.

And you know what, I just let him have at it because why the heck not. Have a good time buddy.

Later in the shift was waiting for a new diagnosis (now I know T-cell ALL) with COVID to get a CTA to rule out a PE and the poor ED got 4 traumas all at once. Policy is they can't go to CT without someone with "clean hands" so literally went down myself after 3 hours because we all need spare hands am I right?

4 admissions right off the bat. 1 COVID positive B-cell ALL, 1 neutropenic fever with aplastic anemia, 1 CF admit with abdominal pain, and transfer from PICU who got 6 boluses for hypotension in 24 hours (!).

Slept for 6 hours (?!?)

Was up stalking old patient charts and was reminded of something another resident said:

"Watch out for kids named Neveah or Miracle..."

I feel uncomfortable with that from the get go. Kids names can be weird and there's all kinds of voodoo and superstition around that. But that kind of mentality is something I avoid at all costs. However, I did come across one of those names.

Previously remembered her from my infectious disease rotation. She has an aggressive leukemia which rapidly switches genetics and failed to go into remission after multiple rounds of chemotherapy. I met her when she acquired a rare fungal pneumonia (scedosporium for the curious). She ended up recovering from it and after an experimental therapy went into remission, ultimately qualifying her for bone marrow transplant (BMT).

Fast forward to now. Me in my little call room reading her chart. She's sedated on ECMO after a sepsis work up post transplant. And the most devastating news.

Her leukemia came back despite transplant.

Worst part of all of this is her mother is due to have her next child any minute now.

It just sucks. This little baby gets to enter into their big sister dying right before they arrive. Just full on shittist things about life juxtaposed with birth, joy, excitement, maybe even hope despite the despair of failed BMT. This mom, I remember how protective she was of her daughter when the revolving doors of consultants and MAs, and nurses would tire them out. I can't imagine what it's like to be the oncologist, and I read his note. I know that particular attending and can just picture his stream of consciousness. It's painful to read when you know the lives behind it all.

because I’ve been ON TIME in my continuity clinic today. AND all my notes are currently done. AND while I’ve been waiting for my next patient I’ve cleaned out my emails and put together a list of recipes I’m gonna cook this weekend.

Last week one of my co-residents had to seem my last patient and I was running 40 minutes behind. Appreciating the lower complexity patients making our clinic seem more realistic. Did send 2 kids for COVID testing whomp whomp. But had normal 11 y/o, 9 y/o visits which I haven’t done in ages because our clinics have been primarily telemedicine for the last year.