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A baby's feet

A moment of hope in the neonatal intensive care unit

Shadowing a physician, Stanford medical student Lauren Joseph experiences the somber, yet hopeful setting of the intensive care unit for babies.

I grew up well-acquainted with the concept of the neonatal intensive care unit -- an intensive care unit for babies -- because my mother worked in one as a nurse. She used to take me there after school sometimes, and from a distance I viewed in wonder the tiny babies, who looked almost like alien creatures in their incubator spaceships. 

Many years later, now a second-year medical student, I decided to shadow a physician, Jamie Powers, MD, on her nightshift in a NICU.  

After quick smiles and introductions in the hospital lobby, I followed Powers to the unit, a low-lights nursery room filled with tiny cribs and plastic baby incubators. We walked directly to the station of Baby G, who had arrived less than a half hour before I walked in the door. Born after 23 weeks of development -- much less than the average 40 weeks -- she looked in color and size like a sweet potato, with little ribs just barely thicker than a toothpick, which pulsed up and down as she struggled to breathe.

Baby G wasn't born "sick" per se, but she needed to be born early because her mother had severe and worsening pregnancy-induced high blood pressure, a condition I learned about just a few months ago in our women's health curriculum. 

I watched Powers perform a bedside procedure on Baby G. Using tiny gauge catheters, she threaded first an IV and then an arterial line into the special blood vessels that newborns still have: a vein and two arteries that transport blood through the umbilical cord. The NICU team would need access to Baby G's blood for daily laboratory tests. Bright red blood flashed into the tip of each tiny tube after insertion -- the same sign that I learned to confirm IV placement in an adult.

"How much blood does a tiny baby like this have?" I asked. 

"Just under 1.5 ounces," Powers said, "Less than a shot of liquor."

After the procedure, the night slowed, and I took the opportunity to chat with Powers. She told me about the challenges of working with sick babies in the NICU, balancing two pregnancies and full-time work and taking on procedures that no one else is willing to do.

"I'm the only doctor that does circumcisions in this hospital," she said, "Everyone else is scared to do something so permanent." 

Before leaving, I asked to round the babies one last time. We walked by each crib, cooing and smiling-- "Hey little baby. Happy sleeping"-- reviewing each case's features. The tiny patients in that little, one-room nursery spanned a wide range of health statuses, from one baby's recent graduation from an incubator to an open crib, to a baby with every "bad" outcome, including a massive brain bleed. 

When we returned to Baby G, we saw that her father was by her side. It was an unforgettable scene: the father stared in silence at his tiny baby in the dim nursery's blue light.

Powers explained to the father that things are going to be rough. "It's going to get really bad," she said. "Alarms are part of the experience. You're going to hear every monitor go off. We expect that. This little one has to fight for a while, and we'll help her. First, we get through the first 48 hours. Then 72 hours. Then we're in a really good place. But first, we get through these 48 hours." 

"Okay," said the father, watching the baby's tiny hiccup-breaths. Powers lingered. They stood together in silence. What felt like an entire minute passed. 

"Do you have a name for the little gal?" Powers asked.

"Anna," said the father.

"Well, happy birthday, Anna," Powers said, glowing in the soft, blue nursery light. Tears welled in my eyes.

In a year and a half of medical school, I've learned a lot about the physiology of normal limits in human adults. In babies, though, there is so much more potential for growth and healing -- and according to this neonatologist -- babies sometimes seem limitless.

Though the setting of the NICU is somber, it also carries promise. As Powers explained to me, these little ones aren't just rebounding from a bad accident or illness, they're growing into self-sufficiency for the first time -- for example, breathing on their own. 

In this tiny room just a few nights before a holiday, I basked in the humanity and hope that sometimes hides in scary circumstances. As I move into my last ten weeks of classes, and later into the wards, I want to take this lesson to find and relish hopeful and sweet moments amid the chaos.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category

Lauren Joseph, LoJo, is a second-year medical student from California. She enjoys reading and writing, and her written work has been featured in STAT News. When she's not studying, you can find her running, enjoying the sun, and laughing with friends and family.

Photo by Janko Ferlič

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