Medicine for Little People

“Ah, the paediatrician is here” The midwife in the labour ward operating theatre states.

I go to look around for them, while having the sinking realisation that the ‘paediatrician’ – is me.

I smile, opting for the non-verbal response….as it feels less like lying.

So imagine that you have somebody in front of you who is sick. I mean really sick. Having laboured through medical school and clambered the slippery ladder of my first two years as a qualified doctor I should be able to handle this. It’s the simple principles of airway, breathing and circulation (your ABCs…).You see once you have stabilised these you can breathe a little, buy yourself some time, and work out the precise nature of what has made this person very sick.

Only problem is, the somebody in front of me who is sick is 3.5kg in weight, has a head circumference of 32 centimetres and is about as long as my forearm. Paediatric and neonatal (less than 4 weeks of age) medicine has just clubbed me around the face with a wet nappy and then pointed and laughed. I stand over the neonatal resuscitation table in the theatre having been handed a crying, slimy thing that has just produced from mum on the table – with a little help from the Obstetricians scalpel. I dry him off vigorously to stimulate a cry (a sound you always want to hear after a caesarean section as it means baby’s lungs are working) and look at this little fella. He is pink, crying, his chest is rising and falling (i.e. he’s breathing) and has a good heart rate when I listen with my stethoscope (all of which pretty much fills his chest).

Waiting for the baby to arrive on the neonatal table in theatres....

Waiting for the baby to arrive on the neonatal table in theatres….

For the first time in what feels like 5 minutes…I exhale.

Still this 3.5kg bundle that I am looking after over in the emergency theatre, rather unaccustomedly dressed in my pink theatre paediatric scrubs, needs antibiotics and close monitoring, as mum was a little unwell and there’s a chance of infection transference to him. That means I need to out a cannula in his vein.

DO YOU KNOW HOW SMALL A BABY’S VEIN IS!!!

My first attempt was a shambles. I technically, was over-powered by a baby. The second attempt was marred by my audience of the new dad watching me as I repeatedly poked his new-born child with a needle. The third attempt, by some miracle only known to higher powers, went it. I took some blood from the cannula to check for infection. Again, another new process I soon learned means squeezing the arm of a baby so blood vacuums out of the vein painfully slowly. This again looks horrible to the uninitiated eyes of the new dad…

The above is only a snapshot of the almost vertical learning curve that my new rotation in paediatrics and neonatal medicine has taught me. In the past 2 weeks (having been finally allowed back to work after the ‘hole in the lung’ incident…still ongoing), I have mastered the impossible rubik’s cube that is the baby grow, how to pick up a baby without terrifying its parents – or the baby, how to communicate with children from 2 years to 17 years (something that requires knowing what’s cool…not what you think is cool), and putting on my reassuring face when I really have no idea what is going on. Thankfully I am incredibly well supported by my senior team, who are great.

Paediatric and Neonatal medicine is not just a down-sized version of adult medicine – it is another world. No, make that another galaxy. Their physiology doesn’t behave the same as adults, the history taking and examination is a tailor-made, painstaking balancing act that would rival Indiana Jones when he swapped those bags of sand for the treasures, and the fear of missing a critical condition is something that focuses the mind to a degree that I haven’t experienced previously.

Lift to freedom at the end of my first long day on the Special Care Baby Unit.

Lift to freedom at the end of my first long day on the Special Care Baby Unit.

With all that said, I love it. Partly because it is such a privilege to look after lives that are not years, not months, not weeks or even days but HOURS old – and partly because I get to unleash my inner child as I try to engage with these children. An added bonus is I get to wear stickers with smiley faces on my I.D badge…

Right time to watch CBBC. You know, after-all, it’s important to know what the kids watch….