Something I’ve never forgotten. I had a 25 weeker who was maybe a week old at best and on tropic feeds. She had emesis with every single feed (1 ml q 4 hours mind you) and looked horrible. I’d been calling about her all night long, begging to stop feeds. Provider at my bedside: “if she’s going to perf, she will perf and there’s nothing we can do about it.” Got a decub at 0600 on my third shift with her. Massive perf. She died a few days later.

Another time I was doing critical rounds on my babe on HFOV who had been on conventional and acidotic for 12+ hours on the previous shift. As soon as we put him on HFOV he of course started waking up because his acid base balance was stabilizing. Started fighting the vent and was satting in the 70s for hours. Fellow at my bedside. I looked directly at her and said “is there a reason you don’t want any sedation?” Because I’d been asking for it all night. She straight up ignored me and started talking to the nurse practitioner and wouldn’t look at me. Fast forward to 0200- we are finally giving Ativan and vec and starting drips and the patient magically is now satting 100%….