I'm not really all that mysterious


Odd, the synchronicity of this post from someone who is going to be a father. (P.S., the asking of highly detailed, extremely specific questions is not a sign that someone is going to be a good father. In fact, it is extremely annoying to the average health care provider, whether midwife, nurse, or physician, and for some reason, the information they have never seems to comport with either the reasonable guidelines suggested by the American Academy of Pediatrics, or the reasonable guidelines afforded by what is traditionally called “common sense.” One could even go as far to say that such nit-picking and attention to often irrelevant detail is a sign that things may go very badly, and that this individual may very well stifle all things that are good about being a child. The specific details of feeding regimens—except in regards to what will allow your baby not to choke to death from aspirating milk—are pretty pointless, since the correct answer to the question of “When should I feed my baby?” is “When he/she is hungry” and believe me, they’ll tell you when they’re hungry, and the correct answer to “What should I feed my baby?” is “Milk” for the first six months of life. There is a raging debate as to whether you should use breast milk or formula, and the data has a lot of good things to say about breast milk, but if, for whatever reason, this is not going to be an option, I would not let your baby starve to death because someone tells you that formula is evil. Bottom line: you’re doing fine, in my opinion.1

Since I’m not in a relationship, much less married and about to have a kid, you might think this is an odd thing for me to wonder about. But I did spend the past 26 hours in the special care nursery, and I rounded on all the newborns both yesterday morning and today.

You would think that seeing nine well newborns on the mother-baby unit would take far less time than seeing nine sick newborns in the special care nursery, but I forgot to take into account that parents don’t always feel like they know what they’re doing. (Which brings up an interesting question that a talkshow morning host brought up the other day: why do we need marriage licenses but don’t require baby licenses, considering how much more knowledge is required to succeed at raising a child than in maintaining a marriage? At least, that’s what I think.) For some reason, it takes far more time to discuss feeding than it does to discuss the possibility of pneumonia, or bacteremia, and the need for treatment with empiric antibiotics until blood cultures are back.

I never thought I would be 30 years old and somewhat knowledgeable about child-rearing techniques. Not from actual practice (although I do remember being a kid, so I often fall back on that to try and predict what the average 6 or 7 year old is thinking) but simply because of clinical training.

I am also hanging out with emergency medicine physicians lately, since I’m doing a Toxicology rotation. I wish there was some kind of route into this field without having to do emergency medicine. I guess I’ve always had a strange fascination with poisons, particular those that have CNS effects. Toxicology has all the excitement of saving someone from certain death, without all the messiness involved with cracking someone’s chest open, or flaying their belly open, and it has all the intellectual stimulation of figuring out strange and complex syndromes to boot.

But I digress.

The point being, most EM physicians are horrified at the thought of doing nothing. That is one of the things that drive me insane about the typical emergency department: they admit all these patients to you who have all sorts of things done to them that don’t really help them, but now require a higher level of care. I’m not saying that they necessarily cause iatrogenic problems (although that happens too.) But emergency medicine training simply does not seem to teach people that sometimes the better part of valor is to step back and watch and wait. (The typical rebuttal is, “I would’ve gone into internal medicine if all I wanted to do was watch and wait. Touché.)

But, to me, the idea of doing nothing seems awesome. This is really one of the things that I dig about pediatric primary care. Most kids come in and they’re not really sick, or at least not “sick” sick. (Yes, that’s a technical term.) When they’re not “sick” sick, you can just reassure the parents, tell them to give the kid lots of fluids and Tylenol or Motrin if they need to, and that you expect things to get better in less than a week. And if they get all uppity and crazy and demand to see a specialist, you can pretty easily stall for time by ordering some bullshit “routine” blood tests to placate them (although it sucks for the kid.) By the time you get around to reading the results and calling them back, the kid is usually better. (Never mind that you tortured some kid with venipuncture, that the test results don’t mean jack-shit, and you’ve just wasted some health care resources. At least the parents can’t accuse you of doing “nothing”.)

(I will never get sick of quoting this Fatman clinical pearl: the optimal delivery of health care is to do as much nothing as possible.)

But back to neonates. Especially with the first-time mothers, it’s kind of weird for me, a guy who has no kids, to be teaching a mother with a kid (albeit a kid who is only a few hours old) how to (1) try to feed them (2) how to burp them (3) what to do with fevers (4) how what they’re doing is not really vomiting (5) that the black, tarry stuff in their diaper is normal (6) that the fact that they’re totally tinged orange-yellow is normal. (Sure, at least for half of the stuff, the lactation specialist tends to do a better job, but I can manage in a pinch, usually.)

But I suppose, to take a GI Joe quote out of context, knowing is only half the battle.

The question is: am I ready for fatherhood? Highly doubtful.

Lately I’ve been having this recurring dream of having two daughters (which if you think about it, is kind of nightmarish, although, luckily, they’re not teenagers yet in my dreams.) The elder is named Mireya Angelica, the younger is named Amanda Desiree. (Where does my brain come up with these names? Yikes!) In my dream, I remember being called “Daddy” and that made me burst into tears.

Will it ever happen? Again, the magic 8-ball in my mind says “highly doubtful,” but even extremely low, infinitesimal probability is not the same as no probability, so it may in fact be interesting to find out what happens in the next 10 years or so after all.

See. Watch and wait. I knew I went into the right field.

Technorati Tags: dream, medicine, pediatrics

  1. NOTE: any medical advice on this blog should not be a substitute for speaking to your own physician. Following anything I say on this blog is a possible sign that you are extremely mentally ill, in which case, you should either proceed to your nearest emergency room, or call 911.

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