Morning medical rounds began on time, with doctors, nurses,
social workers, and pharmacists standing in a tight circle.
Kim explained to Sophie that the team moved from pod to pod
to discuss the condition of each baby, any changes over the past
twenty-four hours, the latest lab results, and the plan for the
day. Rounds could take anywhere from one hour to all morn
ing, depending on the census of the unit and the acuity of the
babies—the sicker the babies, the more there was to discuss.
Sophie watched as rounds were interrupted by a stout woman
dressed in a hideous pantsuit marching into the pod. Her heels
clicked on the linoleum floor, and her hair was pulled back in
a tight, efficient bun. Nobody’s shoes clicked in this unit. The
woman walked over and started talking to Kim. She glanced up
when she felt all eyes on her.
“Please, don’t let me interrupt,” the woman cheerfully said to
the gathering of people.
Kim and the woman stepped back from the crowd and shuf
fled through some papers. They spent a minute more together,
then the woman left and moved on to the next pod. Sophie casu
ally asked who the woman was.
“That’s Rita. We jokingly call her ‘lovely Rita, the meter
maid.’ She’s the utilization review coordinator. She keeps track
of the daily NICU census—how many babies are here each shift,
every day. She uses the numbers for planning staff numbers and
reports the census to her boss. She also considers how critical
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JULIE HATCH
each baby’s condition is. The sicker the baby, the more of a nurse’s
time they will take, which means more nurses need to be staffed.
It’s a constant work in progress, having enough staff scheduled so
that nobody is forced to do overtime. If there are too few babies,
then a nurse has to take the shift off. We’re unionized, so there’s
a system in place. But the hospital would prefer to have higher
numbers of babies in the unit and pay for overtime than to not
have enough babies. Rita keeps track of all these moving parts
and numbers that change daily, even hourly sometimes.”
“You said this unit holds forty babies?”
Kim nodded. “Sometimes there are fewer, sometimes there
are more, all depending on how many preterm babies are deliv
ered on any given day. Full moons? Forget about it—it’s crazy
busy,” she added.
A nurse from Pod D came over to Kim and Sophie.
“Sorry to interrupt,” she said, “but, Kim, I need your help
with a dopamine drip. Can you double-check my math on this?”
“Sure.” Kim introduced Sophie to Christy.
Sophie smiled and gave a little wave.
“Nice to meet you, Sophie. You’re the lucky mother of this
cute little guy?”
Sophie smiled even more.
“Looks right to me,” said Kim. She handed back the paper
with Christy’s calculations.
“Cool, thanks. Lunch today?”
“Sounds good. Anyhow”—Kim turned back to Sophie—
“there was a time when the NICU census was way too high, and
we were working our butts off—twelve-, sixteen-, sometimes
eighteen-hour shifts, including our days off—to keep this place
running. At the end of that stretch, which went on for close to
six months, management came and told us what a good job we
had done. Their way of thanking us was by having catered meals
brought in for each shift. Catered meals were sandwich platters
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THE VERY BEST OF CARE
from a local deli. Pretty pathetic. We were all so burned out it
wasn’t worth it. And food certainly wasn’t the answer we were
looking for. After that, the union got involved and has made sure
we don’t get taken advantage of like that again.”
“So that’s why Rita is here going over patient numbers with
you.”
“You got it.” Kim smiled at Sophie.
“I don’t see Dr. Wagner on rounds.” Sophie shifted the
conversation.
“No, these are medical rounds for the NICU only—the docs
and staff that are caring for these babies. Dr. Wagner isn’t car
ing for any of these babies. His job was done once they were
delivered.
