On a cold baby

I have not spent much time with children, much less an infant, and never a neonate that is only hours old. It seems a terribly important thing to do: hold and care for a fledgling human. The idea thrilled and frightened me.

When we students arrived on the hospital’s third floor, after a turnaround or two, we filed into a small room with stained wood paneling next to the oxygen hook-ups: an effort to make the space more comfortable, but the harsh fluorescent lighting, drab white floor tiles, and flickering medical equipment are a far cry from home. On the ground, a car seat laid waiting for the infant and his first journey home. Between the baby and the door, a warm smile from the pediatric resident with a lovely Haitian accent. I’ll never forget the bubbly intonation to ‘baby’: extra emphasis on the b’s with short choppy vowels.

The resident, once we washed our hands and settled into a surrounding semi-circle, explained the flow and reasoning of a neonate physical exam, utilizing the live model of a tiny, squalling one-day-old infant. As we approached the crib, only the baby’s pudgy face was visible with the rest of his body wrapped by sweaters and blankets. Cords sprouted from the baby burrito and attached to the wall monitors. His face wrinkled and his lips pursed as the resident carefully unwrapped the package, exposing pink flesh to the cold hospital air.

The baby wasn’t terribly happy about this, crying and writhing on his back. Reminded me of a white belt practicing an ineffective open guard, with arms and legs flailing in the air. The resident walked us students through the physical exam, starting with inspecting the skin and ending with reflex testing. Similar enough to an adult, these little patients have unique quirks and signs because they will likely fuss and cry as the exam continues, we should listen to their hearts as soon as possible.

As the resident finished up the didactic explanation, we quickly removed our gloves and I looked forward to a good sit. While coaching in NH, I could stay spry on my feet for long periods of time, but with the seated demands of academics, I’ve lost that perishable skill. So, I wished to give my heels and back a break when our fourth year preceptor asked if anyone knew how to swaddle a baby. We collectively shrugged.

I recall glancing at the infant, before our conga-line of medical students filed out of the room. The baby seemed to calm down a bit, falling into a fitful sleep. His hands and feet seemed a different texture now, than during the exam. The skin looked thin and papery, with a tinge of blue. His face a ruddy pink.

I didn’t think much of it at the time. I was tired. I wanted to start the drive north, before Tampa traffic began. I figured someone else would take care of it. I’m just a med student, I don’t know how to swaddle a baby.

Excuses. I shouldn’t wait until responsibility is forced upon me. Placing a blanket on his small frame would have been enough probably not to keep the infant warm in the long-term, but would have marked my ability to care about the patient’s wellbeing and comfort. I assumed he would be okay because someone else, a skilled nurse or another pediatrician, would help him. How many modern medical errors happen because of this assumption?

I’ve been hearing about a dramatic drop in medical student empathy and compassion during the third and fourth years, during the rigors of clinic. Do the demands of interviewing countless patients, navigating the medical hierarchies, and lack of sleep cause this loss of bedside manner? Am I starting to see this change in myself?

Just last week, a patient reached out and wanted to know how I was doing. Last year, I spent a few extra minutes with him in the clinic to understand his background, to coach him, and to help motivate his movement practice. He mentioned that when he’s struggling, he thinks of me and our discussion.

How could I spend that extra time with a patient last year, but now leave a baby cold and exposed in a hospital room? Is being aware of this shift in myself enough to battle it? Am I aware of its extent?

As I battle to stay afloat and pass second year, I need to sustain some level of attention, some bit of vigilance towards my future patients. Passing my exams is the short-term goal. Helping others heal is why I signed up for this craziness in the first place.

One day, I might save a life with my insightful clinical reasoning.

For now, I will settle for putting a blanket on a fussy baby.

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