It was halfway through my 72 (yes, seventy-two!) hour in-house shift… I was getting a little tired, and we were called to a delivery. I grabbed my charge nurse and we ran over to prepare for a potential neonatal resuscitation in a quiet little town in New Mexico late into the evening. When we showed up, I did my routine: I got the baby warmer/stablette ready, I checked the oxygen, checked the suctioning and laid my blankets out. I turned to her and noted, “Wait, there’s no intubation tools. Where are they?” She looked back at me, the fetal heart strip had looked acceptable, “Well, we aren’t going to need those.” I urged her to find them and eventually she tracked them down to have at bedside. The resuscitation needed a little bit of oxygen for a short amount of time to perk the newborn back up, but afterwards everything was fine, we didn’t need them in the end, but mentally I was always running in the fast lane… Later on into the night, it hit hour 71 of 72 and I was summoned urgently to a Neonatal Code Blue – a baby’s heart was slower than it was supposed to be, CPR was in progress, here we go; where are the intubation tools? Are we ready this time…

***

In residency, I remember when I worked at night time in the NICU, I would always scan every pregnancy we had pending to figure out exactly how far along we were, what the estimated weight of our pending premature deliveries would be, and running resuscitation scenarios in my head, and then, my night shift would end and that preparation didn’t matter anymore. I refused to sleep on those shifts and was ready to run at any given moment. It was a little neurotic but I was never caught off guard and that one time when we were running to a surprise twin delivery at 3AM, I was running through numbers in my head… What tube size, what dose of meds, what next…

Once upon a time, I used to practice karate and when I obtained my black belt, we were instilled with an acronym that i’ve carried through with me every day since: “CAN I = Constant And Neverending Improvement.” Among the people I know in my circles these days, I consider myself one of the lazier ones; but, in some ways, hopefully I keep a fire burning beneath the surface to keep up a high intensity response when it’s needed. You would probably not want a Doctor that isn’t ready to go 0 to 100 when it’s needed. Whenever i train my medical students and my learners, doctors, nurses or respiratory therapists I always push the team to think through the worse case scenario, to set up every possibility and to be ready for the unexpected. Just as i tell every new parent that ends up with a scenario they didn’t expect for their baby (oxygen, hospitalization, surgery, etc.), you can never be fully prepared.

So, sometimes it seems excessive. I remember in training as I was coming to the end of my residency, i practiced a neonatal resuscitation with a team at a delivery in the ways of one of the best neonatologists I know, Dr. Hamilton. I announced loudly that I would lead, i designated roles, I discussed what tools i’d need for a prolonged resuscitation. The experienced ancient RT looked up at me yawning, “Oh. So we’re running through all of it huh? I mean, it doesn’t look that bad.” It wasn’t, but I didn’t back down with running a mock resuscitation. I run each call at the highest fidelity to a disaster as I can. Even at the most prepared we can be, we’re never totally prepared, but I try actively to avoid a Laissez-faire mindset…

***

… The intubation equipment was by the bedside, the crash cart was opened, I successfully intubated the baby and the resuscitation came to a point of stability and we made it to a safe transfer to the higher level of care hospital. I treat every single phone call as a potential emergency, the moment I don’t will be the moment that I’m unfit to practice Medicine.

Image Credit: https://theadotblog.com/2016/02/03/always-be-prepared-for-everything/