The Last Patient of the Night – Q1 2023

 Sabah Fatima Iqbal, MD

The parents rush in, the baby in the crook of the father’s arm, a long bare leg dangling beneath the hastily wrapped blanket, a hat askew, half covering a little eye. The newborn cry of fury. It is late; 10 minutes before close, 10 minutes before we step into the cool night air, lock the doors, turn down the lights on another night of pediatric Urgent Care. But this mother is worried; the baby cries; she thinks it may be too much. He eats, perhaps too little. They are baffled as to why the hospital let them take their mewling little child home without more instructions. They are tired, dark rings under their eyes.

The baby looks well: He is vigorous, strong, and even without touching him, I can see his tone is good, his color pink, his breathing even and regular. He is, however, furious at his leg getting cold, and the parents are squinting at me as we talk, because they can’t hear me over his cries.

So, I take the screaming bundle, lay him on the white paper sheet of the exam table, arrange the baby’s blanket into a quick triangle, and wrap him into a tiny baby burrito with all the skill of a mother-of-two-pediatric-emergency-physician. His arms and legs are tucked away. I tighten the blanket, lift him up and start the bounce-step-bounce-step that all parents learn. The crying halts suddenly. Quiet descends. And now, we can talk.

We talk about feeding – he’s normal, diapers – he’s normal, crying – he’s normal. We talk about babies, how they like being swaddled, like being held, how this is a very, very hard time for everyone. How this is all normal. The father’s shoulders soften. The mother says, “Can you come home with us tonight? Please? Because this is the first time he’s stopped crying in six hours.”

I continue the bounce-step, bounce-step because this is the best part of my day; the sweet baby warmth, a parent ready to learn. This is the keystone of pediatric Urgent Care, providing practical guidance and medical knowledge in a small dose — enough to get them through the night, the next few days, until the next well check.  Straddling the gulf between the medical home of the general pediatrician and the constant chaos of the ER, Urgent Care allows for the deep and critical connection of helping families in their moments of crisis.

And when we step out of the exam room, the baby calm, the parents relaxed, the nurse is standing guard; the clinic lights are off. The office closed. She is waiting for the last patient of the night. “Dr. Iqbal, does the baby need anything?” It’s late, but she’s ready to draw a bilirubin, start a PO trial, check a diaper. “No, Miriam,” I tell her, “The baby is fine and ready to go home.” She walks them out, her training as a car seat safety technician kicking in as she expertly checks the car seat straps of the infant carrier to make sure it is secure, and offering the mom a squeeze of the hand, another last commiseration and reassurance.

 Dr. Iqbal is the Regional Lead, South Atlantic Medical Director with PM Pediatrics