Insights on Residency Training

Ahmad Yousaf, MD, is the 2015-16 Ambulatory Chief Resident in Internal Medicine at Rutgers New Jersey Medical School.

I dropped the little booger off at daycare today. I was over-prepared, and the nanny’s face said it all, “this is your first time, huh?”
It was. Before this, Safiya was being taken care of by her loving grandmothers and a wonderful nanny that was literally like family. But now she is almost 2, the nanny had moved on to greener pastures, and grandmothers have jobs and other things going on in their lives. I know this post has started off like a mommy/daddy blog, but this is different from the cliché “First day of Daycare” sob story (or, I like to think it is, at least). This is how I felt today:

http://https://youtu.be/JghkG4WydNk

We have a story:

Safiya was born at 3:39 PM on 11/8/13, even though she was due 8 weeks later. She was an SGA neonate born to a mom suffering from pre-eclampsia whose blood pressure was twice the normal range. After 2 days of labor and 2 days of steroids, she came into the world with a little squeak that literally almost made me fall to the ground as I understood what that little mouse noise meant. I imagined that, at that very moment, her blood circulation reversed as her lungs went from unwelcoming high pressure to loving and kind low pressure. Blood rushed into her pulmonary vasculature, and, as she took another deep breath between squeaks, oxygen diffused across tiny, wet alveoli and was delivered to her 3.5 lb body. As the NICU team worked on her, I looked over their shoulder at the acrocyanotic newborn and instantly fell in love.  My wife gradually recovered, I was a wreck, but the baby was fine.

She spent the next 28 days in the neonatal ICU surrounded by the beeping of her telemetry monitor that alerted the doctors that she was apneic for short periods of time… Those moments of breathlessness left her mommy and me in a state difficult to describe: Imagine floating alone in a pool in the dark of night and, when you come up for a breath, you hit a glass ceiling. Your body begins to panic as it starves for oxygen, and you slam on the glass as the blackness envelopes you. You hear the beep. You see the number on the monitor go from 60 to 30 and then to 0, and you punch harder. The nurse runs over and stimulates the tiny being from behind the NICU incubator, and she awakens. And just as she takes that deep breath, you break through glass, get your head above water and gasp with her.  That happened for 28 days… every day. We were a wreck, but the baby was fine.

We took her home on a cold, rainy day at a fighting weight of 5 pounds on an apnea monitor and caffeine. She felt like a feather in my palm, and her gray eyes stared at me like I meant something. I would place her chest to my ear and hear the harsh sound of blood rushing through the hole in her ventricular septum during systole. Every time, I was relieved that it was beating. Relieved that she was breathing EVERY TIME. Being a physician didn’t help. Being a pediatrician who had just spent his final senior month in the NICU didn’t help. As a matter of fact, it made it worse. I dreamt of intraventricular hemorrhages, pulmonary hypertension, and cerebral palsy. I tested for spasticity as she weakly sucked on a bottle, and I would wake up in the middle of the night to reach over to her bassinet and make sure I could feel her chest rise.  When she arched her back from reflux, my heart arched with her. When she turned red from infant dyschezia, I would find myself unable to swallow. When her arms jerked in her sleep from benign neonatal myoclonus, all I could think about was getting an EEG. When she slept through a meal or had two consecutive spit-ups, I wanted a blood gas and an ammonia level because I was sure it was a urea cycle defect. My wife and I were a wreck, but the baby was fine.

All this while, my wife and I were in the throes of residency. My wife commuted to the city and sat in hours of traffic on the cursed Cross Bronx Expressway while covertly pumping breast milk that provided immunity for her little bundle of joy and anxiety (yes, she pumped while driving).  I would run a code at work and give a family bad news and then rush home to have Safiya sleep on my chest while I read about inflammatory bowel disease and the side effects of a variety of HIV meds. I would come back from night call exhausted but exhilarated to hold her and sleep with her close enough to me that I could feel her breath on my face. We were drowning in our everyday lives, but it kept us from drowning in our worry. We were a wreck, but the baby was fine.

Here we are today: A day when I entrust her to a group of strangers surrounded by more adorable little strangers that may bite or kick or even kiss her… I dropped all the hundred or so little containers of random foods that my wife had packed into her little cubby and moved towards the door as she was distracted by a coloring book. She cried a little when she caught me sneaking away, and I took that as an excuse to run back to her. I picked up her now 30 lb frame and gave her a hug and told her I was right down the street.  She looked at me in the eye through angry tears and clearly did not approve. A few seconds later, I ran out of the room when she was again distracted by the clock in the room. I watched her through the daycare window for a while as she played with her new friends and toys. I took a picture… or 7… and sent them to my nervous wife in the Bronx. We were a wreck, but the baby was fine.

Alhamdulilah.

~Yousaf