ER 10.12, NICU: You’ve Come a Long Way, Baby

March 1, 2022

ER 10.12, NICU: You’ve Come a Long Way, Baby

Abby! Gets! Stuff! Done!

Summary: Sam and Carter are running to a trauma room to help Pratt with a sick baby. Pratt has a hard time intubating the baby, so Carter takes over. Gillespie, a resident from pediatrics, joins them and guesses the baby has a heart problem. Abby and Neela come in as well, since they’re on their NICU rotation. Sam’s the only nurse there, so Pratt taps Abby in to do some nurse duties. He goes with the others as they take the baby to the NICU.

The parents are distressed because the baby just saw a doctor recently, and there was no indication that he had a heart problem. The father wants to talk to someone who has more knowledge. Carter tells him the baby might need surgery and promises the baby is in good hands. In the elevator on the way to the NICU, Pratt chats with Abby and Neela, who just started the rotation. Pratt thinks they’ll enjoy all the procedures they’ll get to do. He and Sam wish them good luck and hurry back to the ER, admitting that they hate the NICU and the med students are screwed.

Day 1, 8:45 a.m.: Another student passes patients along to Abby from the night shift. Lester is supposed to be doing the same with Neela, but he didn’t write anything down. He tells her about one baby, whose brain isn’t functioning but who can be kept alive indefinitely on life support. He’s been there for two months since his mother won’t let him go. Her prayer group comes every day to pray with her for a miracle.

Abby and Neela join Dr. Rabb, the director of neonatology, for morning rounds. She’s stern and fairly humorless. Gillespie is the opposite, and I need him to shut up. A student presents a patient, and Abby asks Neela for clarification on his condition. Rabb is impressed with Neela’s knowledge. A nurse named Virgie asks the student if she’s given the baby a nickname yet. She suggests Thor. Rabb explains that they give the babies “tough-guy nicknames” so they’ll seem stronger.

Abby presents Jacob, the baby from the ER, and Rabb asks questions about his diagnosis. Abby isn’t sure about one answer, and Rabb tells her not to guess if she doesn’t know something. She tells Jacob’s parents that the medicine they’ve tried isn’t working, so Jacob needs surgery. Abby says the OR can’t take him for 48 hours, but Rabb says he can’t wait that long. Her bedside manner isn’t great, but she does assure Jacob’s parents that the surgery should cure him. She lets Abby nickname the baby, but Abby just goes for Jake.

The department gets a call for help with a delivery, so Gillespie and Neela head out. Rabb tells Abby to go, too, but Abby wants to stay with Jacob. Rabb reminds her that part of her job is covering deliveries. Abby talks her way into taking over Jacob’s care. (To be fair, Abby used to be an OB nurse and has delivered plenty of babies, so this is probably a better use of her time.)

Neela clarifies with Gillespie that the NICU is on call 24/7. Well, yes, Neela – babies don’t wait for daylight hours to be born. Gillespie says that while they do see some really sick babies, most of the time they’re fine and the NICU is just there as a precaution. Neela asks to do an intubation if one is necessary. He says they should be looking into easier, more lucrative rotations.

Gillespie and Neela make it to the patient just after the baby’s born. He’s six weeks early and the mother didn’t have any prenatal care. Gillespie walks Neela through his care as the mother delivers a second baby. He’s annoyed that no one told them they were dealing with twins so they could bring more doctors in. He tells Neela to take care of the second baby, a girl, but the baby isn’t breathing.

Day 8, 7:30 p.m.: Rabb tells the students that this rotation is like a marathon. They need to eat and sleep when they can, and not stick around if they don’t have to be there. Neela presents the first twin, who’s doing well. His sister isn’t. Neela objects to her nickname, Inga, but Virgie says she didn’t come up with her own fast enough, so the twins are Dirk and Inga. Neela had hoped to call the girl Surinder, which means “warrior.” Virgie says she’s thinking too much.

Anyway, Inga has pneumonia, and Neela thinks she needs bypass before her lack of oxygen causes brain damage. Rabb disagrees, but Neela keeps advocating for her idea. Abby backs her up, and Rabb eventually allows it. Abby says Rabb already thinks she’s an idiot, so Abby had nothing to lose by supporting Neela. She’s working that night, and she tells Neela she can leave, but Neela wants to talk to the twins’ parents first.

Virgie blasts Abby for changing a baby’s diaper, since it screwed up Virgie’s records. She orders Abby to find the discarded diaper and weigh it. Meanwhile, Neela goes to see the twins’ parents, the Tsengs, but Jacob’s father, Kyle, bugs her for an update first. He strikes up a conversation with Mr. Tseng, who says he and his wife were visiting from China when the babies came early. When Kyle asks if they’re okay, Mr. Tseng just says that Dirk is strong.

Neela explains the procedure Rabb is doing on Inga, which she’s optimistic about. Mrs. Tseng stays with her while Mr. Tseng goes to feed Dirk. Mrs. Tseng notes that if Inga had been born in China, she wouldn’t have access to the medical care she’s getting here. They wanted their daughter to be born in America so she could have more options. Neela realizes the babies’ birth in America was intentional. Mrs. Tseng says she and her husband wanted their kids to have a good life – isn’t that why Neela’s parents sent her to America?

Abby can’t find some supply she needs, but the prayer-group mom tells here where it is. She’s been there with her baby for nine weeks and has picked up some stuff. Carter’s visiting Jacob, who’s doing well but might need more surgery in a few years. Abby gives Jacob’s mother, Helen, some more details and assures her the additional procedure isn’t that invasive. Carter’s impressed with Abby’s knowledge and confidence. Abby wishes Rabb felt the same way.

Carter tells her that he and Kem took a tour of the delivery “suites” at County, which he doesn’t think really qualify as suites. He admits to being scared about being a father, especially when he’s standing in the NICU, seeing all the things that can go wrong. Abby tells him he’ll be a great father. He replies that she’ll be a great doctor.

Abby’s sent to help with a delivery, and Neela offers to come along, since she doesn’t think she’ll be able to sleep if she goes home. Their next mom just needs a forceps delivery, and it’s standard to have the NICU help out, which is good in this case because the baby needs extra help when she’s delivered. Abby and Neela get her fixed up without the parents catching on that there’s anything wrong.

Neela gets paged back to the NICU to help Gillespie with Inga. The procedure Neela advocated for isn’t working, and Inga needs surgery. Neela feels responsible because she pushed for the treatment, but Abby says Rabb wouldn’t have approved it if she didn’t agree with Neela.

Inga starts seizing and Neela tells Virgie to give her medication for it. Virgie won’t take med orders from students, so Abby administers something else. Virgie warns that Rabb will kick them off the rotation. Abby says she’ll take full responsibility. Neela, however, feels enough guilt since her suggestion has probably left Inga beyond help. She starts crying on her way out of the ward, since she can’t get the exit keypad to work and she just wants out.

Day 17, 3:15 p.m.: Dirk is about ready to be discharged, and while Inga is still sick, she’s proving to be stronger than expected. Abby tries not to criticize a woman who has named her baby Cher but spelled it Chair. Gillespie asks Abby and Neela if they’ve heard any good dead-baby jokes recently. Neela hits him with the seriousness of Inga’s condition – she might never wake up. She complains to Rabb that they’re spending millions of dollars to keep babies alive when half of them will never have meaningful lives.

Rabb notes that decades ago, Inga would have been considered too premature and small to be “viable.” In other countries, she still would be. Neela doesn’t think they did her much good, considering all the complications she’ll face. Rabb says they gave her a chance. They do their best. There are no guarantees in medicine, and if Neela can’t handle that, she should find a different job.

Abby helps get a baby ready for discharge, then goes to take care of Jacob, who’s septic. She tells his parents that he’s tough and will get through this. Virgie takes a picture of the Tsengs with Dirk, which will go up on a wall with photos of the babies who have previously been discharged. Rabb joins Abby as she intubates Jacob.

Virgie takes another picture of the Tsengs, who ask Neela to join them. They’ve decided to keep calling their son Dirk, since the name has brought them luck. Mrs. Tseng takes a long look at Inga before they leave. Neela tells her it’s normal to be nervous about taking a newborn home, but they’ll be great. She expects to see the Tsengs tomorrow, when they come back to visit Inga. Abby’s successful at intubating Jacob, whose parents are losing hope every time he has a setback.

Abby and Neela meet up across the street and get coffee. Neela’s struggling to deal with the uncertainty of being a doctor. She thought she would love being a med student. Abby notes that they’re supposed to try different rotations to find out their best fit. Neela blurts out that she had a baby brother who died when he was just six days old. She was three at the time, and all she remembers from that time is eating ice cream in her mother’s hospital room. She can’t stand being in the NICU, which is sad all the time.

Abby thought she would hate it, too, since she was freaked out by premature babies when she was an OB nurse. But she’s seen that part of the rotation is supporting the parents, and her troublesome childhood has made her great at that. They get paged back to the hospital to help with another delivery, and they’re shocked when they see who the mother is (well, one of the mothers): Sandy! After Weaver’s miscarriage, Sandy didn’t want to get pregnant, but clearly she came around, and now the couple has a little boy, Henry.

He’s having trouble breathing, and though Gillespie doesn’t want Weaver to get too close while the team works on him, Abby says it’s okay. She reassures Weaver that it’s nothing serious, and it turns out she’s right. Henry will just need some antibiotics and a little time in the NICU. Neela invites Weaver to cut the umbilical cord.

Day 21, 5:45 a.m.: Neela arrives at the NICU with two cups of coffee, one for her and one for Abby, who fell asleep at the end of her shift. Jake is worse and needs more surgery. The Tsengs haven’t come back, and they haven’t even called to check on Inga. Elizabeth comes to get Jake for surgery, saying they don’t have time to wait for his parents to come back. They arrive just as Elizabeth is leaving with the baby. They’ve brought their daughter with them, and Abby lets her meet her little brother for the first time.

Neela checks on the prayer-group mom, who told her friends not to come today. The baby is now three months old. His mom thought she could pray hard enough to convince God to give her a miracle. But now she doesn’t want her son to suffer anymore. Pratt complains to Abby that one of his patients got bumped from surgery for Jake. Oh, waaaah, your person can wait. Unfortunately, Jake is too far gone to save, and Elizabeth apologetically tells Abby there’s nothing she can do. To his credit, Pratt is sorry.

Abby starts to go tell Jake’s parents what’s going on, but Pratt thinks she should take a minute to get herself together. She doesn’t want them to have to keep waiting and wondering. He advises her to let Rabb give them the bad news. Abby knows Pratt wouldn’t do that if he were in her position. She talks to Jake’s parents as Pratt watches through a window, unable to hear their obvious distress.

While Neela tries to get in touch with the Tsengs, Abby wraps Jake up like he’s any other baby so his parents can hold him until he dies. Rabb tells her that she helped his family and they’ll remember her for the rest of their lives. Rabb advises Abby to consider making neonatology her specialty. Abby thinks Rabb is mocking her, but Rabb says Abby is one of the best students she’s ever had.

Neela has learned that the Tsengs went back to China. The family they have in the U.S. doesn’t know how to reach them. Henry is going well and is about ready to go home, but he’ll need a few more days of medication, unless Weaver and Sandy let Rabb do a lumbar puncture. Weaver would be fine with that if this were her patient, but since he’s her son, it’s a completely different decision. Sandy, however, is fine with it since it means they can go home.

Rabb tells Abby she can do the procedure. Sandy asks Rabb to do it instead, but Weaver trusts Abby and changes Sandy’s mind. Neela asks Rabb what will happen to Inga. If she survives, she’ll either be adopted or go to a long-term-care facility. And since there can’t be that many people out there eager to adopt a child with special needs (and whose special needs haven’t even been determined yet), we can probably rule that out.

Neela doesn’t think the Tsengs would just abandon their baby like this. Rabb says they’re probably scared and believe she’s better off this way. Neela might do the same if she were alone in a foreign country with no job, home, or money. Neela says she wouldn’t, and neither would Rabb. Rabb replies that Neela can’t know what she would do without actually being in the situation. If she keeps judging people, she’ll come to hate being a doctor. Weaver praises Abby’s technique on the lumbar puncture, which Abby admits to doing after 30 hours on call.

Day 22, 5:00 p.m.: It’s the last day of Abby and Neela’s NICU rotation, so they get to pass their patients off to a new set of students. Weaver brings Abby a bottle of champagne because Henry’s lumbar puncture came back without any red blood cells, which they call champagne tap. Weaver and Sandy ask Abby to take their going-home picture with them.

Neela takes the Tsengs’ picture with Dirk off the wall and sticks it to Inga’s incubator. Abby takes her to the roof so they can smoke cigars and drink champagne to celebrate the end of their rotation. (It’s actually cider, because Weaver knows Abby doesn’t drink, and I think it’s awesome that she remembered that.) Neela says she’ll never specialize in neonatology in a million years, but Abby should. She thinks every attending probably wants Abby for their department, though. Abby has something that makes her special, while Neela’s having a harder time picking stuff up. So for the first time, Abby’s on top and Neela’s falling behind.

Thoughts: One of the babies is named Humphrey. Who would do that to a poor, defenseless child?

It’s a shock to learn that Sandy went through a whole pregnancy without Weaver telling anyone, but it’s Weaver, so it makes sense. She hates sharing her personal life with her colleagues.

I like how they show Abby and Neela’s friendship progressing – at first they just chat a little, but then they’re bringing each other coffee (and know each other’s usual orders) and celebrating stuff together.

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