Week 5: …eMeNo…Ppppp

This week I spent a few hours in the Medical Intensive Care Unit, Neonatal Intensive Care Unit, and Pediatric Intensive Care Unit.

I saw many interesting cases in the NICU including a child that was 8 months old and still seeking care there. He had been in the NICU since birth but his twin sister was at home doing well. He had a shunt defect in his heart, ductus arteriousis, which is not uncommon for premature babies, however, this child had significant complications post surgery and had extreme oxygen deprivation to the brain leading to serious brain damage and the doctors assume the child is now completely brain dead as a result.

Another child we checked on was also a twin and he was dealing with a few respiratory complications. In this case, his sister was also home and doing well, but he was still at the hospital being treated. Something I learned fairly quickly when I walked into the NICU is that given the NYC lifestyle, many parents wait to have kids. The later women wait, the more likely they are to have complications in pregnancy. As a result, many couples opt for some sort of therapy to enhance chances of a successful pregnancy resulting in multiples often twins or triplets. In this case, the woman was taking medication to increase ovulation and the husband was sterile so they used donor sperm. Their daughter appeared normal and was doing well, however, the son had underdeveloped genitilia and an extra scrotum. As it turns out, the male donor is a carrier for prader willis which does not show up in the genetic screens typically done for donors. Pradar willis affects 7 genes and plays a role in a number of long term complications for the child, primarily uncontrolled hyperphagia due to constant feelings of hunger which results in excessive weight gain. In light of this news, the parents were seeing a genetic counselor to talk through some of the complications, but from what I gathered, the father of the child is in denial that his son has any sort of genetic condition and when the topic comes up he refuses to address it. It is clear the couple was expecting no complications having opted to go with a sperm donor.

To top off my week, the most memorable experience was in the MICU where David and I met a 93 year old man and his wife both survivors of the Holocaust. They had both been admitted to NYP only a few days apart. Both had elevated levels of Coumadin (a blood thinner) and the thought was that either the home care provider had given them the wrong dosage or that the pharmacy had somehow actually mixed up their prescription. Despite this complication, the older gentleman was also experiencing irregular heart rhythms and a pacemaker was deemed necessary. David and I were able to do follow up on the patient post insertion of the pacemaker and he seemed to be doing very well. The old gentleman was constantly thanking us in Polish for our care of him. It was good to be able to follow up on our patient and track his progress since the patients I have been seeing with Dr. Gauthier in Nuerology are on medication and only come for a few scheduled scans a year to track lesions.