Adam was only hours old when I met him. He had been born during the night to a new mother following an uneventful pregnancy. He came into the world in half a days time. The mother delivered her son, without drugs but in a hospital, the norm for Grenadian women. When I met him he was wearing a blue and white sleeper and looked perfect. Tiny, sleeping, a brand new baby. Mother was resting, exhausted but awake and father had just come back with breakfast for both of them.

Adam was one of my first pediatric patients, ever. I was in Grenada at the end of my 2nd year of medical school and it was my second hospital day. After a short introduction from our preceptor on how to interview the mom we were left alone. The mother's story was like any other pregnancy. She gained weight, maybe a bit too much, 40 lbs perhaps, she didn't really know. The delivery was okay, she said it was longer than she expected but no real problems. And then we examined Adam. As we did so our preceptor came back. She asked us to look carefully at his head and eyes and where they were, how far apart there were and if they lined up with his ears. As I slipped off his baby hat I noticed that his ears did look a little low... Then she helped us take off his sleeper and we took off his tiny baby socks.  His feet were curved at some unnatural angle as if they were tomatoes staked to the ground. His hands were clenched but fingers were extended as if they had been glued into position. I listened to his heart and heard a murmur that got higher with each expiration. Another student listened and said Adam was wheezing but I'd heard wheezing before and this was not it.  No, this murmur was a discernable patent ductus arteriosum. My first.

We finished our exam and helped dress Adam. The parents asked our preceptor about his feet and hands and they were told a surgeon would come and talk to them about options. I later asked about genetic testing, it looked like textbook Trisomy 18 but our preceptor just shrugged and said that Grenada lacked such resources, it would take money and time to do genetic testing and so was unlikely...

Adam would be a year old this month. I'm just reflecting on some of my firsts.

Happy Birthday Adam.

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