Today in Expecting Rural Hospitals to Do More With Less, our Well Baby Nursery is, per system protocol and with the blessing of the Big City Neonatologist who was kind enough to listen to the case and my plan and say it sounded good and to call back if it doesn't go as expected, managing an infant with neonatal hypoglycemia who failed oral management with glucose gel and is now on a dextrose drip
Which on one hand I am very glad we can do - the infant is now doing well and responding appropriately, we're titrating down as expected, and I don't want to send an infant over 100 miles from home if I can safely keep them in the community with their parents
On the other hand, in a bigger hospital, this infant would almost certainly be in some flavor of NICU under the management of a neonatologist who did not do the infant's induction of labor (which was somewhat urgent in nature and started during a clinic afternoon that included palliative care for a patient with ESLD, a pediatric patient following up after a hospitalization for an asthma exacerbation, a post-op incision check for a c-section patient, perfectly well-controlled type 2 diabetes, and more), manage the labor all night, deliver them, and also be doing postpartum care for their mom and other random OB triages if they come in
I'm not complaining and am in fact feeling very blessed to do my job and to be able to make such a tangible positive difference in my community, but I am suggesting that you hug the RNs and full-spectrum Family Doc at your local critical access hospital and maybe offer them a coffee - they probably need it after the last 36 hours