Rotation #1 Children's Hospital Oakland

Though I just finished my first week here, I've completely fallen in love with being at Children's Hospital Oakland. The atmosphere is just amazing and the people (at least those I've met) are absolutely wonderful. Children's hospitals in general are a special place to be, just because where else can you find a hospital where every single doctor is strictly dedicated to treating only children? No longer do I have to navigate through (or run into) loads and loads of attendings and residents who treat adults and elderly. Every direction I turn, I see physicians who are dedicated to making the lives of children happier, healthier, and stronger. And let's face it, most pediatricians are just nice people to begin with.

I've met only a handful of the residents here at CHO but so far, every single one of them have been nothing but welcoming. They introduce themselves to you which is something that's hard to come by already. They embrace you as a student, they help you navigate the ways of the hospital, and most importantly, they help prepare you to be a resident physician. Let's face it, in less than a year, I'll be in their shoes so I better start learning now!

For this month, I'll be in the NICU which is a truly special place to be. The NICU stands for Neonatal Intensive Care Unit and this is where all the ill premature or full term babies come. Technically, a neonate is defined as an infant less than 4 weeks old, however, occasionally we also get those infants who are up to 3 months old. These kiddos are some of the cutest, most adorable children. The machinery and medications have advanced so far in the last 10-20 years so that now, we are able to keep a 23.5 week old fetus alive. Just to give you an idea, a baby should live in the mom's uterus for at least 37 weeks before being considered full term.

What I find most amazing is that the lungs of the fetus do not start secreting surfactant until about 24-25 weeks. Surfactant is a part fat, part protein molecule that's absolutely critical in the survival of the baby after they are born. This molecule helps keep the lungs expanded and prevents the lungs from collapsing when you take a breath. In babies younger than 24 weeks, it is impossible to stay alive without the presence of surfactant in their tiny bodies. At Children's Hospital, because of what our NICU can do to support these very premature babies who have not yet started producing enough surfactant by themselves, these neonates who may have died if they were born 20 years earlier, now have the chance to grow and develop under our watchful eyes. That's not to say that they will develop perfectly...in fact, many of these children are often born with immature organs and developmental anomalies and therefore, end up having terrible complications while in our NICU. Still, I am always amazed to see these little guys and gals fighting to stay alive. 

Even babies who are late preterm or term can develop severe infections, breathing or feeding difficulties that land them in our NICU. It is astonishing to see what babies are susceptible to and everyday, we do our best to diagnose, treat, and manage them so that the little ones can return home with their families. The NICU attendings are fantastic teachers and even better physicians. After years of learning and experience, these attendings can tell right from wrong in an instant. You can easily see that they are constantly worrying over each baby's condition at all hours, even when they are not on-call. Each day as we make our morning rounds, my goal is to soak up as much information as possible and (hopefully) store it all in my brain. 

What's special about Children's Oakland is that it is the only Level IV Neonatal Intensive Care Unit in the East Bay. What that means is that they have the capabilities to provide the highest level of care for neonates with a full range of pediatric medical and surgical subspecialists and pediatric anesthesiologists on site. At our NICU, we see the sickest of the sick. Our patients are the patients flown by helicopter from a different hospital that's not equipped to handle the baby's condition or situation. In front of my eyes now, I see babies with ischemic bowel, retinopathy of prematurity, and intraventricular and brain parenchymal hemorrhages. I wish these babies did not have these problems and wish they could have avoided being admitted to the NICU but as a student who's learning, I feel so fortunate to be able to see infants with conditions that I only used to read about in books. For me, this is really the best way to learn.

I am gushing about my experience thus far at Children's Hospital Oakland, but it is only because even though my hours are terribly long, I wake up every day feeling excited to go to the NICU. I may be exhausted and tired all the time, but I am never dreading going to work. I was nervous before I started this rotation as I've never worked in an Intensive Care Unit before, let alone in a neonatal ICU where all the babies are so fragile. In fact, my last Pediatrics rotation was last year, over 8 months ago! After being at CHO for one week though, it already feels incredible to be working with children again. 4th year medical school is getting off to a great start and I hope it continues to be just as great!