Sam and Dr. Carter run through the hallway as she
explains the details of a patient's conditions. "Four
day old full-term male, lethargic, retractions," she
says as she runs. "Has NICU been called?" Carter asks.
"They're on the way, and Pratt is intubating," she
responds. Dr. Pratt and the parents surround the
troubled baby. "I'm Dr. Carter, what's his name?"
"Jacob," the father says. Pratt has no luck with the
intubation, so Carter takes over. The parents become
increasingly worried. A man enters the room. "Matt
Gillespie, R3, Pediatrics," he identifies himself. Abby
and Neela enter. "Start your NICU rotation, huh?" Carter
asks Abby. "Just as I was getting use to my double life
in the ER."
Dr. Carter tells the parents that Jacob is having
trouble breathing. Pratt, Neela, Abby, and Matt wheel
the baby up to the NICU as the parents ask for answers.
While in the elevator, Pratt asks Abby when she started
her NICU rotation. "About 5 minutes ago," she says. He
tells her it's great, as Sam looks at him. She then
wishes Abby and Neela good luck as they depart the
elevator. "Let's get out of here," Pratt says to Sam. "I
hate the NICU," she says. "Those guys are screwed." The
elevator doors shut.
Day 1, 8:45 A.M.
A
medical student guides Abby around the NICU unit as she
ends her rotation and begins showing Abby where
everything is. Lester is doing the same thing with Neela.
He tells her about a family that has been here for
months, waiting for a miracle for their baby. "Come on,
they're waiting for us," Abby tells Neela. "Thank you so
much for joining us. I'm Dr. Raab, director of
Neonatology," she says sarcastically. "Everyone scrubs
for three minutes, no jewelry," she explains, while
walking by a cleaning area. They step up to a security
door. "You will be issued a code, do not give it to
anyone," Dr. Rabb instructs.
They step up to an infant patient. "Who do we have
here?" Dr. Raab asks a medical student, Kate. "Lloyd
Roberts, ex 38 weeker, admitted for TTN and detox." Abby
looks to Neela. "What's TTN?" Neela replies, "Transient
Tachypnia of the Newborn, resulting from delayed
clearance of the fetal lung fluid." Dr. Raab is
impressed. "Continue, Kate." The medical student details
her plan of treatment for the infant as a nurse walks
up. "Did you name them yet?" she asks. "Everyone, meet
Virgie, 20 years plus as a NICU nurse. Her mission is to
protect the babies from the likes of you," Raab says.
"We have a tradition of giving the babies tough-guy
nicknames."
The students step up to Jacob, the patient admitted
earlier in the ER. They review the condition of the
baby. Dr. Raab assures surgery should cure him. "Dr.
Lockhart, he needs a nickname," Abby suggests the name
'Jake.' Virgie receives a call on the phone. There's a
delivery in room 3. Dr. Raab turns around to see the
medical students just standing there. "What are you
waiting for? Go." The medical students leave, except for
Abby. "Dr. Lockhart, what are you waiting for? Go, you
could learn something." Abby wishes to stay, but Dr.
Raab tells her to go. "He's my patient," Abby says. "Get
CT Surg on the phone and tell them your patient needs
the O.R. right now. Not in 48 hours, not later today,
now."
Neela and Matt hurry down the hall, putting on gloves.
"So if the phone rings, we're supposed to drop
everything and run?" Neela asks. "Yep, 24/7," he
replies. "Welcome to your first delivery," he says as he
opens the door to the delivery room. A Chinese woman,
Mrs. Tseng, is delivering twins. Neela takes the second
baby. "This baby is not breathing."
Day 8, 7:30 P.M.
Dr.
Raab and the medical students begin their evening
rounds. Virgie and Neela discuss naming the baby Inga
until Dr. Raab asks Neela to present her patient.
"Pneumonia is worse," she says. "I think we should
consider ECMO," Neela says, as they all look up at her
in surprise of that decision. "Cardiopulmonary bypass?"
Abby asks. "Isn't that incredibly dangerous on a
two-kilo kid?" Kate asks. "We need to do something
before the prolonged hypoxia causes brain damage." Dr.
Raab asks what the risks are of ECMO. Neela defends her
decision, as Abby begins to agree. Dr. Raab looks at
Neela and tells her to call for an ECMO for this
patient. "Thanks," Neela says to Abby. "She already
thinks I'm an idiot, so there's really nothing to lose."
Neela says she wants to talk to Inga's parents about
ECMO."
Virgie walks up to Abby and is angry because Abby
changed a baby's diaper. Abby apologizes. "Find it,
weigh it, and I just might let you get some sleep
tonight," she says rudely. Abby glares at her. Neela
enters the family room and walks up to Mr. and Mrs.
Tseng until Adam, Jacob's father, steps up and asks
Neela if she has the results of his son's tests. He's
very restless and worried. Neela tells him she'll ask
Abby about it.
In the NICU unit, Neela explains to the Tsengs about the
ECMO and what it may do for Inga. "It's her best chance
at a good outcome," Neela assures. Dr. Raab begins the
ECMO and says it will be a while before there are
results. Mrs. Tseng looks down onto her baby. "If she
was in China, she would already be dead," she says. "You
don't know that," Neela says. "We wanted our daughter to
be born in America so she'd have more options. She
already does," she continues.
Abby is looking through drawers. "Tom, can you help me
out?" she asks. He tells her he's busy. She sighs as she
continues looking. "Transducers, art lines, no
butterflies," she says to herself. The mother of a
patient who has been their for months looks at Abby.
"They're in the cabinet by the sink on the left," she
says. Abby's surprised. "Been here for nine weeks," she
says. Abby thanks her.
She walks up to Jacob's mother, who Carter is visiting.
"Just came to check on Jacob," he says. "His suck is
still weak, but Abby tells me to keep trying," she says.
She turns to Dr. Carter. "This says he may need surgery
in a few years, is that true?" Carter tells her he'll
leave that question up to cardiology. "Occasionally the
area where the aorta was repaired gets blocked from
scarring, but usually they can take care of it in the
Cath lab and avoid another surgery," Abby tells her.
"That's good to know. Thanks, Abby." Dr. Carter is
impressed. Abby steps to a medicine cabinet and has a
conversation with Carter. "You're going to be a dad.."
she says. He nods happily. "How does it feel?" Abby
asks. "Scary, especially when you're up here. Anything
can go wrong," Carter says. "I think you're going to be
a great father," Abby compliments him. Abby is being
called for assistance. She walks away. "Hey Abby,"
Carter says, as she turns around. "You're going to be a
great doctor." She smiles.
On the way to the next delivery room, Neela complains
about always being tired, and Abby tells her it's
because she never goes home. Neela says she's just
trying to help out. They enter the delivery room where a
woman is giving birth to a baby girl. Abby takes the
newborn into her hands. "Poor tone. Check the heart
rate," she tells Neela. "What's the pulse?" Abby asks,
while Neela counts. The father distracts Abby with a
video camera. The baby's healthy, but will go up to the
NICU for tests.
Neela's beeper goes off. "It's Matt," she says. "It's
Inga." Abby sighs. Matt tells Neela that Inga's brain is
bleeding. "It's always a risk with ECMO," he says. Neela
begins feeling guilty. She turns to Abby. "I talked
everyone into this." The baby begins seizing, so Neela
tells Virgie to give her a dose of atavan. "I can't take
verbals from a med student," Virgie replies. Abby
prepare the atavan while Virgie insists that she cannot
do that. "Watch me," Abby replies. "I'm telling Dr. Raab,"
she says. "You do that."
"What am I going to tell her parents?" Neela says,
feeling guilty. Abby tells Neela to go home. "Just go!"
Neela grabs her coat and walks to the security door. She
tries entering it twice, with no luck. "Can someone get
the door, please?" she asks with a tear in her eye. "Get
me the hell out of here!"
Day 17, 3:15 P.M.
Dr. Raab notices Neela's tension. "Bad day, Neela?" she
asks. "Millions of dollars are spent on these babies
when half of them die. Why bother?" "Neela, there are no
guarantees in this work, if you can't live with that, I
suggest you become a bank teller."
Abby rushes to Jake. He has a low pulse. "Has anyone
paged Raab?!" Abby asks. Meanwhile, the Tsengs want to
take a photo of their baby with Neela. Then, Dr. Raab
assists Abby with Jake's intubation. The Tsengs prepare
to leave with their baby, while they must leave one of
them for a little while. Mrs. Tseng gives the recently
taken photo to Neela and thanks her. "See you tomorrow."
"Okay, nothing to do now but wait for the antibiotics to
kick in," Dr. Raab says, concerning Jake. His parents
cry as they watch over him.
Abby and Neela take a break and sip coffee outside. "I
just needed to get outside for a minute. The NICU's so
confining," Neela says. "That's why Matt calls it 'the
box'."
"The NICU's just so sad all the time, how can you stand
it?" Neela asks. Abby tells her it's about taking care
of the parents too. "Turns out tragic family dynamics
are my specialty," Abby says. Her beeper goes off. "It's
Matt," she says. "There's a delivery."
Abby, Neela, and Matt enter the delivery room. Abby's
mouth drops open as she sees Kerry assisting Sandy
deliver her baby. "We have a baby!," Sandy exclaims as
she breathes heavily. Abby holds the baby boy in her
arms, becoming worried that the baby is not crying. She
takes the baby to a small bed where she and Neela and
Matt study it. Dr. Weaver looks up and notices
something's wrong. "Abby?" She walks over to them.
"What's wrong??" Sandy looks over.
"Sorry,
you need to wait over there," Matt asks her. "No, thats
my son, I'm a doctor," she insists. "He's too quiet,"
she says with tears in her eyes. "Give it a minute,"
Abby reassures. Matt continues working on the baby,
until it begins to cry and breathe a little easier. Dr.
Weaver lets out a sigh of relief and hugs Abby, as Abby
congratulates her with a kiss on the cheek.
"I love you," Sandy says to Kerry as she lays on her
bed. Abby looks at Weaver. "I had no idea," she says
with a smile. Weaver joyfully laughs and says 'No one
did.'
She smiles and looks down onto her son, Henry.
Day 21, 5:45 A.M.
Neela enters the NICU, holding two coffees. She puts her
stuff down and walks to Abby, who is slumped over a
counter top, sleeping. Neela gives her a cup of coffee.
"Your usual.." "Thank you.." Abby replies as she wakes.
"Bad night?" Neela asks. "Jake is maxed out on dopa and
epi, and in the last two hours, his belly blew up in
front of our eyes. Surgery is on their way." Neela asks
if the parents are here. "No, I finally got them to go
home, only to call them back an hour later to have them
come back."
"Have Inga's parents called?" Neela asks. "No," Abby
replies. "Three days and not a single phone call."
Dr. Corday enters, and says O.R. is prepped for Jake.
Abby asks her if they can wait for the parents to
arrive, but Corday says there really isn't time because
they need to save his viable tissue before there's
nothing left to save. Corday and Abby wheel Jake out of
the NICU and pass an elevator as Jake's parents arrive.
"Abby! Where are you going?" the father asks. "Surgery.
His intestines were injured as a result of the
infection, so we need to cut the bad part." Corday
introduces herself and says the sooner they go to the
O.R. the better. Abby allows Jake's older sister to hold
his hand. "I'm Miranda, your big sister." The parents
are saddened, but understand that surgery is necessary.
Dr. Corday and Abby wheel him away to the O.R.
"My patient has been bumped for so called emergencies.
I've been waiting over 24 hours for ORIF, and it
happened again," Pratt enters the O.R. observatory where
Abby is standing, watching over Dr. Corday and others
perform surgery on Jake. "I came up here to see what's
so important," Pratt says. Abby asks Pratt if he
remembers Jake from a couple of weeks ago.
"Theres really nothing viable here," a surgeon tells
Corday. She agrees. "Abby, the bowels completely
infarcted. I'm sorry. We're closing." Pratt observes.
"That's it?" he says. "Can't live without a gut," Abby
replies. "I'm sorry," he says. Abby shuts her eyes and
groans. She walks away, as Pratt asks her where she's
going. She says she's going to go tell Jake's parents.
Abby steps out into the hallway where Jake's parents
wait. They watch Abby come out. "Kyle...." she says,
sympathetically. He begins to cry, as does the mother.
Abby comforts her.
"Is this the Chinese interpreter?" Neela asks someone
over the phone. Abby removes one of Jake's tubes as she
wipes several tears from her cheeks. "I was connected to
you," Neela says in the background. "Please don't put me
on hold again." She's trying to get hold of the Tseng
family.
Abby wraps Jake up in a blanket and carries him to his
family. She lays the baby into the parents' arms as they
weep. Abby's walks back into the NICU, but watches the
family through a window. Dr. Raab steps up behind Abby.
"How long will it take?" Abby asks. "An hour, maybe
longer," Raab replies. "You helped this family Abby,
they will remember you for the rest of their lives."
Abby walks away. "I'm hoping you'll give Neonatology
serious consideration." Abby turns around and faces her.
"Are you mocking me? Cause it's really not a good time,"
Abby says defensively. "No," Raab says. "You're one of
the best students I've ever had."
Neela gets off the phone. She tells Abby the Tsengs have
gone back to China, abandoning their baby there at the
hospital. "Tell me this is our last day," Neela asks
Abby. Raab steps up to Kerry and Sandy. "How's Henry
today?" she asks. Abby tells them they need to keep
Henry for about a week. Dr. Raab tells Abby to prepare
to give Henry a spinal tap. Sandy asks Raab if she'll do
it, but Dr. Weaver tells Sandy to let Abby do it.
"Dr. Raab, what's going to happen to Inga?" Neela asks.
"If she survives, she'll either be adopted or put into a
long-term care facility. Dr. Raab says it's not unusual
the Tsengs left their baby. "You can't begin to know
what you would do in the same situation," she tells her.
Dr. Raab tells Neela not to be so judgmental.
Abby performs Henry's spinal tap. "You stuck a needle in
my kid's back while you've been awake for 36 hours?"
Sandy asks. "Actually, only 31," Abby replies. "Tube
four, crystal clear." Henry's healthy and ready to go.
Day 22, 5:00
Neela
and Abby present their patients to the new round of
medical students, as Kerry and Sandy prepare to take
Henry home. Weaver gives Abby a bottle of champagne.
Sandy, Weaver, and Abby take a photo together with
Henry. Neela is by Inga's side, looking at the photo she
had with the Tseng family. Abby asks her if she's signed
out and ready to leave.
They head to the rooftop to smoke a cigar and drink
champagne. Neela coughs and comments on how the cigar is
disgusting. "So, you still thinking about Neonatology?"
Abby asks. "Not in a million years," Neela says. "I bet
every attending tries to recruit you," she continues.
"Look who's talking, your mind is a sponge," Abby says.
Abby takes another sip out of the champagne bottle. She
looks up into the night sky and gives out a sigh of
relief.
Reviewed by Cody on February 29,
2004
