Mile 253: Newborns of Wonder

Above: If you come at the right time, Chicago will welcome you along with many, many others.

WE JUST CAN'T KEEP SAYING
BABIES ARE OH, SO CUTE!

6:15 AM - Stuck between two trucks in the middle lane of the Stevenson expressway, I'm glad I have my music lineup ready to stay entertained for my drive to the hospital. I've got my Spyro Gyra, David Benoit, and Phish albums (one of these things is not like the other?) queued for the morning drive. I've now become a member of what used to be called the "rat race" - nowadays it's "commuting," or the "morning rush." We're required to be at the hospital at 7:15 AM, and I live out in the suburbs. So, I could either risk hitting a traffic jam but get some more sleep, or just take it easy on the drive and start the trek early. For the past week, I've been waking up at 4:45 AM to prepare to do the latter...

The group of students that I rotate with has come to a great conclusion: we love babies. Our attending expects us to know how to examine a newborn by the end of 3 weeks, and with lots of opportunities to practice, I've learned that I actually love interacting with them. I'll be honest, I didn't think babies and me went together, but with the several that I've interacted so far, my confidence with working with them has increased. I've learned that I have this tendency to have an imaginary conversation with the baby, sometimes late-night-talk-show-host style.

(But... one problem I gotta fix: I keep referring to the babies as "hombres" or "bros." Yes, even if it's a girl. As much as I'm into bro-hood, I gotta respect the female gender.)

A Try This at Home Moment.
Some of my favorite facts I've learned have come from the neurological exam of a newborn. If you know someone who has an infant within 12 months of age, you might want to try these reflexes on them. It's just really cool how these behaviors are instilled and can be triggered by simple stimuli from you. Many of these reflexes occur due to portions of the brain still in development at their age. In case you were asking: Yes, you can have someone attempt to trigger these reflexes in you (but if you notice you're pulling off these reactions involuntarily... that's not exactly a good thing!).

Just note: 1) that the sooner the better if you have a newborn (most of these reflexes will disappear within the range of 4-9 months of age, with the exception of the Babinski below) and 2) these reflexes are best shown when the baby's awake and alert.

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1. Palmar Reflex - If you place an object or a stimulus in the palm of their hand, the newborn will go ahead and grab it, no matter what it is.

2. Glabellar Tap - Go ahead and tap the area right above the space in between the eyes. Initially, adults blink and then will stop blinking as the tapping continues. For newborns, they will keep on blinking no matter how long you keep tapping.

3. Babinski - Your turn. Take off your shoes and socks, sit down on a chair where your feet just dangle and close your eyes. Now have the person trace the sole of your foot from heel to toe, following the outside edge of the sole (it should be somewhat like a C shape). Note which way your foot points (it should go down). Now pull it off on an infant or a newborn (their feet should point up). What's really cool is that development of just a tract that controls the foot (which isn't developed in infants until 12 months of age), is what causes a simple difference in the reaction to this stimulus.

4. Rooting Reflex - Newborns love their moms. They love 'em so much that they have a reflex to be nurtured. Stroke the newborn's cheek with their finger. The baby should move their head to the side where the cheek was stroked. From what I've read, this reflex works to help the baby find the mom when they are breast fed. This reflex works best if the baby hasn't been fed in the past hour or two.

5. Suckling Reflex - Touch the newborn/infant by the upper lip with your finger (or slightly insert it into the mouth - wash your hands!). The baby should start sucking on your finger.

6. The Moro (Startle) Reflex - I've saved the best for last! Three ways to pull this off. There's a mild, medium, and a risky way to do this.

- The mild way is to simply startle the baby with a clap right above their head or surprise them with a loud pre-recorded sound.
- The medium way is to take the newborn/infant and pull them up by the arms, until sitting up and then let go to have them fall back.
- The risky way is to support the baby by the head neck and back and pull them away from where they were lying down. Next, simulate a drop by keeping support and lowering the baby quickly about 2 feet. It's fun, but one needs to be careful here and support the baby properly.

In both cases, the baby should extend their arms and legs outward (looking somewhat like an X) in response to the startle (as if they're looking for something to grab on). The baby may then pull back their arms/legs (flexing them) and perhaps they cry. They're just so adorable when they pull this off!

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And with that evidence, the intellectually derived conclusion is: I think babies are cool. Not just because they're cute, but there's a lot more to them than most people think.

Rehearsals

Above: Michael J. Fox on the cover of his 2002 memoir, A Lucky Man

"IF YOU WERE TO RUSH INTO THIS ROOM RIGHT NOW

AND ANNOUNCE THAT YOU HAD STRUCK A DEAL -

WITH GOD, ALLAH, BUDDHA, CHRIST, KRISHNA, BILL GATES, WHOMEVER -

IN WHICH THE TEN YEARS SINCE MY DIAGNOSIS

COULD BE MAGICALLY TAKEN AWAY, TRADED IN FOR

TEN MORE YEARS AS THE PERSON I WAS BEFORE,

I WOULD, WITHOUT A MOMENT'S

HESITATION, TELL YOU TO TAKE A HIKE."

©2002 Michael J. Fox

I remember sitting with my mom and dad watching the Back to the Future movies when they used to come out on network TV all the time in the early late 80s/early 90s (a quirk about us is that we NEVER ever had Cable). And there was a young actor on the screen (his name, Michael J. Fox) portraying the timeless character Marty McFly. I'll admit that his squeaky voice and priceless looks of shock when the time was right made his acting quite convincing. It was from then on that I became a fan of Fox, as I was always trying to catch reruns of Family Ties on vacations away from school (I was already too old to catch the first-run episodes) and moved onto some of his other films, one of my favorites (go figure) was Doc Hollywood in 1991.

And it is with that movie that Fox begins his 2002 memoir. With the recent release of Fox's new 2009 book, Always Looking Up, a story of how he has maintained his optimism with the onset of Parkinson's disease, I've decided to go backwards and read his last memoir (as my going to bed book), A Lucky Man.

1990. Gainesville, Florida. According to Fox in the first chapter, he mentioned how he initially thought that the first signal to his actual condition was the shaking of his pinky. He went to the University of Florida, near the location of his current filming to get a diagnosis. As I was reading, Fox's account of what the doctors had him go through seemed quite proposterous, including tasks similar to those of Sobriety Exams when the highway patrol pulls drunk people over and intense explorations of the opposable thumb. Unfortunately, the doctors didn't identify his disease through these series of examinations (also potentially due to the unusual age of the onset of his symptoms).

Now, let's flash to where I get my perspective on the same exams that Fox describes.

2009. Roseau, Dominica. In the weeks before our Physical Exam practical (see the entry "Inside the Mind of an Examining Med Student") a bunch of us Ross fifth semester students would get together in a room and drill through the numerous examination routines that we'd be tested on. Kinda just like a rehearsal for our great acting debut. In medical school, we have quite a long list of tasks grouped by each organ system (i.e. gastrointestinal, respiratory, etc.). And one of the great systems was Neurological. It wasn't exactly the most loved of all our exams as it was the longest. With our time limit of 10 minutes on the real exam to get through a whole systemic examination (selected by random) required much luck (or forgiveness from our respective proctors).

Above, as Fox describes those "intense explorations" of the thumb, I'm reading it with the perspective of a med student: during our scripted routines, we learned that rapid movement examinations, such as those involving the thumb, are checkups on our Cerebellum. One of the cerebellum's functions is to make sure we can do rapid, repetitive movements on a normal basis. And those "sobriety exams" are out there to make sure that a patient's sense of balance (with contributions from the Vestibular compartment within your ear), control, and ability in walking are intact, making sure that those critical connections between the brain and the muscles aren't, per se, "cut."

However, at our stage you may find it weird how we took those same dramatic routines that Fox described: With laughter.

It's odd. Sometimes as a medical student (inexperienced and all), I'll look at the stuff we do with a patient's perspective. It makes sense as I've been a patient for 23 years of my life, but in medicine technically only for almost two. As I was reading Fox's 2002 memoir, it made me realize that I need to start looking at the stuff we do in a new perspective: not anymore as those silly movements that any normal person could do, but with that idea that "everything has a purpose." Fox isn't wrong: the actions in the neurological exam have great ability to make even the smartest person in the world look like an idiot (they probably had him do the follow-the-finger-with-your-eyes-like-a-little-kid test for the muscles that move your eye). But in order for me to move on and be a clinician, I have to realize that these tasks we have to rehearse over and over in medical school, as silly as they seem, can carry multitudes of information towards potentially making a difference in someone's life.

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Fox turns out to write a lot like me, utilizing italics in his manuscript to stress points and always interrupting his narration with self-thoughts and contradictions in order to get his point across. I highly recommend reading Lucky Man, and I'm definitely looking forward to reading Always Looking Up.