What I learned in the NICU

In 1978 I had just completed medical school and moved from Birmingham to Washington DC to begin my OB/GYN residency training. Within a few weeks, I felt fairly confident on labor and delivery. I had already accomplished several dozen deliveries as a medical student. But my training program required each OB resident to spend a month in the Neonatal Intensive Care Unit. We were expected to learn basic newborn emergency care to support an infant in the delivery room until a pediatrician arrived. The NICU is an overwhelming place, certainly for parents, and even for a young doctor. Back then one room—not nearly large enough—housed warming tables, mechanical ventilators, beeping monitors, and what seemed like miles of plastic tubing. On my first day in that place, it also held a dozen or more little lives.

I was given my assignment for the day-to-day care of three or four very sick preemies. I was well-supervised by excellent neonatologists and senior pediatric residents. The nursing staff were also incredibly supportive and offered the most diplomatic suggestions. I appreciated their kindness and their experience.

As the least experienced team member, I was responsible for a number of tasks that required a physician, but which were considered routine. One of my little patients had developed hydrocephalus. Fluid was accumulating within his brain. The pressure it created pushed aside healthy brain tissue, risking permanent damage. I was asked to perform a daily spinal tap to remove some of the accumulating fluid until the baby was strong enough for surgery. The procedure requires two sets of hands and about 20  or 30 minutes (at least for a beginner). A young nurse who was also new to the staff provided the other set of hands. As the task became more automatic for both of us, we chatted about the weather, college football, life at the hospital, and whatever. After a couple weeks of daily taps, I had developed confidence in my skill at the procedure and in the likelihood that the nurse would accept a date.

Over the years, I learned from Christmas notes that the little boy laughed and ran with his brothers and very much participated in family life. How lucky I was as a new physician to have had this experience. I’ve delivered several thousand babies since then, still amazed to think about how each new life will change the lives of many others. My wife and I recall that baby often. We remember his young parents’ anxiety and their trust as we began each spinal tap. And almost forty years later, we smile to know that our whole family—three children, and now a grandchild—resulted from his little life.