Inside the Isolette

Lots of response...

2008-05-23T13:28:00.002-06:00

First, I want to send out a thank you to all who shared your childs' story about Trisomy 13 and 18.

I don't think I integrated the two halves of my last post very well. When I am talking about Trisomy 13 I am talking specifically about what is done at MY hospital. In the first half of my post I talked about how we get only the "sickest of the sick". That means when we get a baby with Trisomy 13 (or Trisomy 18), the baby is extremely ill. These are babies with such overwhelming consequences of their disease that there is next to no chance that they will be the lucky ones who survive. They are 100% dependent on mechanical ventilation (a breathing machine). When I talk about removing support and allow them to "die peacefully", the alternative is to leave them on the ventilator until their body breaks down enough that they will go into arrest(no cardiac function) on their own. This can result in the parents not being there when their child passes away. When we are removing life support we are doing so in a very controlled environment to ensure that the family can spend the baby's last moments with them. We do not promote one route or the other, the family chooses what is right for them. Some choose to continue treatment indefinitely, some choose to withdraw support. It is ALWAYS the parents decision.

I do realize that some children do survive with this devastating diagnosis, and that is wonderful. If I worked at a lower level hospital where we saw some of the less effected babies, I would be much more positive about the outcomes, but I don't work at such a hospital.

As for some of the resources mentioned...

As I Lay Me Down to Sleep is an EXCELLENT program. We have had photographers affiliated with them come a few times at families' request to take photos of the family with the baby etc. They are WONDERFUL.

For the Internet resources...

We give all of our parents information packets pertaining to their baby's diagnosis with complete statistics and possible outcomes. There are also a select few websites that we will refer them to for extra information. In general we tell them that there is a LOT of information on the internet, some of it reliable and some of it not. It is their choice if they want to go out and do their own research. If a family asks me specifically for more resources about actual children with the same disorder, I will send them to 99 Balloons to read the story of Eliot. At some point I posted a link to a video made in tribute of sweet baby Eliot, if you haven't seen it please check it out! For those who posted their websites or other informational websites, thank you for sharing your resources with me. I will take a look at them and definitely will refer parents to them if they seek more information on "real" cases of Trisomy 13 and 18.

wow I haven't posted since MARCH??

2008-05-20T09:03:00.002-06:00

So so sorry to anyone who checks this blog! The time really flies by when you're busy. In general I take a couple of hours per post to prepare everything- mostly changing enough details so that I'm not violating HIPAA but also keeping the heart of the story intact- quite a bit harder than I ever thought it would be when I started out here. That is partially why I post so infrequently- I don't want to have my blog to be shut down, and there are so many stories that I have that can't be told without making humongous errors with HIPAA. With that said, if there is any topic that anyone wants to hear my opinions/advice/whatever on- please just leave it in a comment and I will do my best to post about that topic. Sometimes it is easier to write about what someone else wants to hear than what is in your own head. So with that said I'll do kind of a Q & A today.....a question I get asked frequently by friends/other nurses

Q: Do you lose a lot of babies?
A: YES, we lose a lot of babies, some days we do not lose any, other days we lose 2 or 3. What you have to remember is, I work in an incredibly large unit, and my unit is the top in my state. That means that every other hospital in the state sends us babies when they feel that their hospital is out of options for that baby. We get the sickest of the sick babies. A "normal" NICU unit loses very few babies per year, and I have had friends point this out to me "well my unit only lost four babies in the last year" one said to me. However, I had to explain to her that they transferred MANY babies to our NICU, and not all of those survived. Because we get babies that other hospitals are "out of options" for, sometimes that means we have no options also. Sometimes outside hospitals wait too long before they send us a baby, and by the time they get to us there is not much that we can do for the baby. That is one of the more frustrating parts of my job. So, yes we lose a lot of babies- but a lot of the ones we lose were sent to us because of such overwhelming illness/prematurity that there is not much we can do, even with all of our technology and treatments.

I am going to get kind of off topic here...

We get many babies with suspected chromosomal abnormalities- problems with their DNA. Most people have heard of Trisomy 21- Down Syndrome. There are many other Trisomy disorders out there, many of which are "incompatible with life". So, when a hospital sends us a baby with suspected Trisomy 13 (incompatible with life if no life support measures are in place- many die within a few hours of birth), once we have confirmed the diagnosis of Trisomy 13, we are going to council the parents and recommend that we remove life support for their baby and let it die peacefully. It is rare that we send a baby with Trisomy 13 home to die because they just don't live that long. I love taking this kind of baby- not because I love take babies that are going to die, but because I know this is the only time that the parents will ever have with their child, and I really enjoy making that time extra special for them so that they will remember every moment.

a good question...

2008-03-27T11:00:00.002-06:00

In a recent comment I was asked about the emotional aspects of working in the NICU. Yes it is incredibly sad at times, but at other times it is the most rewarding job in the world. So many of our babies get well and go home eventually. Every time I help a parent hold their baby for the first time or help strap a baby into their carseat for the ride home I get tears in my eyes- incredibly joyful tears that this moment has come at last. One of the best things in the world is watching daddies to Kangaroo Care (skin to skin holding) with their tiny babies- I'm not sure why but I get extra emotional with the daddies. They are always soooooo nervous to finally be holding their precious baby and ask a million questions. When the baby is placed on their chest the look of wonder in their eyes is priceless, absolutely priceless. I have to admit- besides being in the delivery room, helping dads Kangaroo is probably my favorite part of my job. Sure, some babies die- but so many babies LIVE! Some still have medical challenges that they will have to overcome in the future, but to their parents they are perfect in every way. I may not agree with every choice that every family makes, but I respect that it is THEIR choice, they have to do what is right for their own family. Whether that is removing life support and allowing their child to die, or fighting harder than ever even though their child will be disabled, I support their decisions. If I absolutely positively do not agree with what is being done- well then I don't have to take care of that baby- I have never refused to take care of any baby, although I did come very close at one time- however that is another post entirely, maybe I'll share it someday.

So- yes it is incredibly emotional, but I wouldn't trade my job for anything in the world---- well maybe if someone gave me $10 million to quit I would consider it....

no way!

a day in the life....

2008-03-03T11:18:00.002-07:00

my days start earrrrrrlyyyyyyy
0445 wake up and shower!
0545 leave for work
0640 park and take shuttle to work
0650 arrive
0700 morning unit report (overview of the whole unit- anything big that is happening)
0710 bedside report
0730 check out all meds for the day, breast milk supply, etc.
0800-0900 morning rounds by Drs. , round one of feeds/cares, blood gases drawn
1000 round 2 of cares (not all babies)
1100-1200 round 2 of feeds
1200 round 3 of cares, blood gases on sicker kids
1230 lunch break!
1300 hang new TPN
1400 round 3 of feeds, round 4 of cares, blood gases drawn on some babies
1500 afternoon rounds by Drs, usually no changes made except to vent settings
1600 round 5 of cares, follow up gases drawn for any vent changes.
1700 round 4 of feeds, baths, linen changes
1800 round 6 of cares, blood gases if needed

in between there are meds, parent updates, traveling to other units- (ie surgery, MRI, CT scan, general radiology, etc.), therapies (ot/pt, speech- for feeding issues), social work rounds, any crisis that might arise, and of course playing with babies (if well enough :), labs, and starting IVs

wow it makes me tired just looking at all that! Of course being so busy realllllly helps the day go by fast! My primary kiddos right now are fairly healthy so I have been having a lot of fun with them, of course since they are pretty healthy they will be going home soon (fingers crossed!) and I'll be getting some new ones. Parents always ask if I get attached to the babies, and of course I do, but it's not like we're not going to get more babies when the current ones go home. Babies are babies and I love my work, so any baby will do! I do get sad for a day or 2 when my primaries leave but then I get new ones, new kids to get to know and new parents as well, and it is 100% awesome.

back to reality

2008-02-13T08:24:00.002-07:00

Yippee!!!! I am back in the NICU, just in time for Valentine's Day. The healthy babies were tons of fun but they are just too darn healthy! All they need from you is a nice big bottle and a fresh diaper. It was a nice change of pace but I'm glad to be back in my own territory.

Recently was the third birthday of a very special set of twins. When the first twin came to our unit I admitted the baby and took him as a primary (one of my two primaries had just been discharged). I got along with the family really well, and a few weeks later when the other twin was admitted, my other primary had just gone back to it's original hospital, so I took up that twin as a primary as well. It is very rare to have a set of twins as primary patients, usually they are split up because no one ever has two openings for primaries at once. I got lucky I guess. Anyway it was a long stay and I got to know this family very very well. One of the twins got extremely sick at one point and I will never forget making the call to these parents: Your baby is not doing well, come to the hospital NOW. It is a call I have had to make many times, and it is always hard, but this mom asked me to pray over her baby until they could arrive. Being so close to these parents after taking care of their babies for weeks on end, it was very hard for me, but of course I did anyway. Fortunately the baby started to improve soon after and was much more stable by the time the parents arrived. Anyway, I attended their third birthday party and they are happy and thriving! I got to catch up with the family a bit, it was quite an emotional time, quite wonderful to see them so healthy and running all over the place. AMAZING!!

empty nest syndrome for the NICU nurse

2008-01-07T07:37:00.001-07:00

our pod is now completely empty, they have fit our remaining babes into other pods. We are going through a dry spell, which is great for all the babies who aren't sick, but not so great for us nurses. They have offered us to go to PICU or to go to our maternity center and work with the 'normal newborns' and level 2 babies until our census is back up. I am hanging out in the maternity center, it has been so much fun!! There are tons of big chubby 7-8 pound babies (haha big to me!) and we all get to snuggle and rock and love on them the whole shift except when a new baby comes and we do the bath and weight and talk to the nervous dad. I am really really enjoying it but I miss my preemies. Our unit expanded in the last couple of years, and the census doesn't always keep us completely full, so the pods take it in turns being empty. While working over here in maternity, I have gotten to take care of 2 friend's babies. Their due dates were actually about 2 weeks apart, but they had their babies within 24 hours of each other, a girl and a boy.......I'm seeing lots of playdates in their future!

wowie zowie!

2007-12-18T07:29:00.000-07:00

has it really been since OCTOBER since I've posted??? Wow, I guess it has been- time is really flying by lately. Work has been pretty uneventful. My pod has quite a few not-so-sick babies right now, which is awesome for them but not so awesome for great blog stories. The pod has been this way probably since shortly after the last post. It has been quite fun, doing more "real" baby stuff with the patients the last several weeks, but it also gets pretty darn boring sometimes. So, since there is not much news on my front, I'm going to broaden to NICU in the news.....

4 sets of sextuplets were born between June and September this year. WOW. I can not imagine taking home SIX babies and actually doing everything for them 24 hours a day. Set #1 & #2 were born on June 10 this year, the Morrison sextuplets (22+ ?weeks) and the Masche sextuplets(30 weeks). For some reason I was absolutely captivated by these families' stories. Five of the Morrison sextuplets died within the first 6 weeks, one survives. At the time of their birth, I knew from experience that most if not all of these babies would die- in actuality I am quite surprised that one did survive, he is a true miracle. I have the feeling I could talk about this family for hours, so I'll move on- the Masche sextuplets are all alive and well, however mom did go into cardiac failure soon after their delivery- she is now fine as well. Next up are the Byler sextuplets, born September 1 this year, not quite sure on the exact gestation but I think it was a little over 30 weeks. All are doing well at home. The 4th set of the year were the Soldani sextuplets, born September 12 at 29+4 weeks, three were stillborn and three survive. **disclaimer- none of these sextuplets were at the hospital where I work-I have read about them on the internet only**

As you can see there is quite a wide variation with these sextuplets, including how many have survived. I cannot imagine giving birth to six babies, or giving birth to six and then having to say goodbye to half or more. Each of these couples had to make the decision to either reduce the number of fetuses early on or carry all, risking the lives of all but also possibly saving the lives of all. What would you do? Myself, I would never do any kind of fertility treatment. I feel very strongly on this point. Partly because I don't think I could handle having more then 2 babies at one time, partly because I know what would happen if I went into premature labor. I would not resuscitate a child under 25 weeks under and circumstances. I know that many of you out there have children who were born at before 25 weeks, and they are truly miracles. I love taking care of these babies, and their very special parents, but I do not love poking their tiny heels for blood every few hours, watching them suffer and have surgery after surgery before they even go home or get held for the first time, and seeing many of their tiny bodies just give out. I have seen many, many babies survive at this age, but I have also seen many die. I would not take the additional risk of having a baby so early. All my life I have wanted children, but as all moms, I want a child who does not have to suffer and fight for the first few months of their life, maybe even longer.

Ok off of the rant, I have probably peeved some people with that, which is not my intention. Next up is Dennis Quaid. His twins were accidentally overdosed with a drug called Heparin (prevents clotting in IVs-allows them to be used for longer periods of time) and received an adult dose(10,000 U) instead of an infant dose(10 U). This is not the first time this same situation has come up, it happened over a year ago at another hospital, if I remember correctly several babies died from the overdoses. The Quaid twins were born at term and had returned to the hospital with some type of infection, which is when they were overdosed. They are now home and apparently healthy, a month later. The Quaids are now suing the company who makes the heparin, saying that the labeling on the adult and infant heparin is too similar. Touche. I completely agree. While the labeling does state the concentration of the heparin, the bottles are very similar.

From reading the news articles from both cases of heparin overdose, someone from Pharmacy stocked the adult heparin in the NICU med cart on accident, then the nurse gave the high dose (10,000 U) on accident, not checking the label. This is human error, however it would not have occurred if the vials were significantly different for each concentration. Being a nurse I can completely understand how this happened. You grab the vial, it looks the same as it always did, you forget to check the concentration because your unit only gets one concentration, and BOOM you've overdosed a baby. However, if you grab the vial and it looks different- say it is a completely different color- you are highly likely to check over the label completely before even pulling up your dose. Or, you can do as our hospital did, and switch to individual one time use prefilled heparin syringes- only containing 10 U of heparin each, no other heparin stocked in the entire hospital. Even though there is no other heparin stocked, we still must double check the label on each syringe (with another nurse)when we go to give heparin. This policy is fairly new but I do believe it will prevent any heparin overdoses at my hospital.

Ok ok I'm done babbling, I'll post again when something interesting comes along....

the ups and downs

2007-10-18T11:58:00.000-06:00

I LOVE my job, it's the greatest job in the world. However lately there have been a few more ups than downs in terms of patients, a lot more sad babies than happy ones. I hate writing about all sad babies! It seems like that's all I've seen lately- trisomy 18, birth depression, heart failure, and NEC. I thought the streak of babies dying in my pod would even out, but we seem to be getting sicker babies lately. To top it off, an old patient is back in the hospital, in Peds ICU, and it's not looking good this go around. So, I have been racking my brain for a happy baby story to tell. The story doesn't start off so well. The baby was diagnosed in utero with a heart condition, with no knowing if the baby would even survive delivery, much less how bad it would be. He was born at term and brought straight to our unit, where he coded twice before being placed on ECMO (extra corporeal membrane oxygenation-basically a machine that can do the work of the heart and lungs when there are no other options left). His bought with ECMO was complicated and long, but he finally weaned from the machine and was able to have surgery to repair his tiny heart. The surgery was a major success, and within just TWO WEEKS of surgery he was home and healthy. I ran into this patient and his mama in the store the other day, and he is absolutely thriving. He has his battle scars, but will likely need no further intervention for his heart. YAYYY!

Ok so my post from earlier in this month was fairly enigmatic. I realize that people want to know what the situation was, but in this case I feel I just can't share it. I feel like it's a rare enough occurrence and a big enough thing that my talking about it would be a big time breach of HIPAA, no matter how many details I change. The cases I talk about here are things that I see over and over again in my years as a nurse, and happen at every hospital with a level III NICU, a very broad topic that I refine down to an experience that I had at one time, which in some cases happened years ago and also at different hospitals. I am very sorry that I can't share more aobut that particular experience, I really wish that I could vent about it and get some feedback, however I don't want to go the way of some other medi-bloggers I know of.........

now, don't do this if you aren't ready to cry in the next few minutes. I was sent a link to a video about a baby with Trisomy 18 recently. I did not care for this patient, they were not even at my hospital. We have had several babies with trisomy 18 lately, and whenever I see one I think of the little guy from this video. This is what parenting should be. These parents were so very dedicated to their baby, and it shows. This is the kind of parent I want to be.

http://youtube.com/watch?v=th6Njr-qkq0

**sorry I don't know how to make that be a real link, I'm no good with computers!!

GRRRRRR!

2007-10-05T11:55:00.001-06:00

I can't give a lot of details because the situation is wayyyyy to "unique", but I am SO very angry right now. There are certain things that, once done, should automatically terminate one's right to keep their child, especially if that child is going to need specialized care. I am generally fairly tolerant of parents' activities, but something happened recently that has made me lose some of the faith that I used to have in preemie parents. I know that most of them are wonderful and would do anything for their baby, but there are one or two out there who go along and make you think that they are totally devoted to their child for months and then just go past the point of no return. I really wish I could say more since this is bugging me so much, but I can't. Better just to end this post before I say anything else, but ARGGGGHHHHHHH.

The happier side of things....

2007-10-01T17:56:00.001-06:00

As part of my job, I regularly attend deliveries. Some are admitted directly to the NICU after birth, but many times I'm there as a precaution. A NICU nurse is present at all cesareans, and any term delivery that has a risk factor for the baby, such as when the amniotic fluid is meconium stained or the mom has a fever. We may or may not admit the baby, but we're there just in case. Being there for the birth of a child is one of the best parts of my job, I LOVE it! Getting to be the one to yell out "it's a girl!!" or "seven pounds, six ounces!" is absolutely wonderful. It's so great to be a part of what is (most of the time) such a joyous occasion for the parents. I have to admit, if I ever wanted a change of pace, labor and delivery would be the place for me!

the final snuggle

2007-09-25T06:40:00.000-06:00

The last week has been quite hard emotionally for me. Actually the last couple of months, period. But the last week was definitely harder. We sometimes get babies in our unit whose moms are MIA....checked out of the hospital never to be seen again, or have already given up all parental rights because they don't want their baby for one reason or another. This particular baby was another case where rights had been signed away basically the minute the baby was born. The baby was very sick and eventually was taken off life support after coding many times. Since there was no family to speak of and no way to get ahold of the baby's biological family, there was no one to come hold the baby at the end. I had lost many a nights' sleep over this child worrying about what would happen to her. I volunteered to be the pseudo-mom and brought in some clothes for her, did sponge baths, and put bows in her hair. One morning last week I got a call that she was coding once again and that they were going to stop resuscitation, and would I like to come hold her? I dropped what I was doing and headed for the hospital, praying that I would get there in time. I did. They kept her on the vent until I got settled in a cozy chair, then handed her to me. I rocked and sang to her, and within a few minutes she had passed peacefully. Emotionally this was one of the hardest moments of my nursing career, but also one of the best. As a nurse it is my goal to ease suffering, and in the case of a baby's death to do whatever it takes to make sure that they are comfortable and surrounded by love. Through the tears I knew that I was easing her journey out of this world, a journey that would have been spent alone in an isolette had I not gotten there in time. No baby should ever have to leave this earth without someone to snuggle them, whether it is their mother or a relative or a nurse that loves what they do.

the blahs.....

2007-08-29T06:50:00.000-06:00

My last few shifts at work have been INSANELY busy. Now that I have a couple of days off I am absolutely exhausted. I know I should be cleaning the house, grocery shopping, or doing some other equally productive activity. But no, I'm sitting around on my computer in my pajamas being lazy. I have a feeling that I will be doing this a good portion of the day. I always feel this way after I've had a crazy day. It's not just that I'm physically tired, I mean it's not like babies are heavy or anything! My BRAIN is tired. Drawing 12 blood gases, taking 2 separate patients to surgery, giving about a thousand meds, having a patient in isolation, doing 10+ sets of vital signs, getting both patients back from surgery, doing a novel worth of charting, and assisting with an intubation....all in one day. It sounds like a lot but in reality you still have time to sit down and take a rest a few times during the day. However even when you're sitting down your brain is still going a million miles a minute. How is that baby doing in surgery? It's been a long time why hasn't the OR called? Was that last blood gas really 'ok'? Did the doctor do the right thing in changing that vent setting? Was that last med given on time? Did I chart ANYTHING today? What time did I do all that stuff anyway? How do I tell the parents we couldn't get ahold of that their child is having emergency surgery? How will they react? How do I explain NEC to them? How do I explain the high frequency ventilator the baby is on?

Those kinds of thoughts run through my head every second that I'm at work. It's hard to shut that off after I leave. Frequently my brain is still running in NICU mode until I go to bed, and I wake up not wanting to do a single thing but relax and stop thinking about my job. I LOVE my job, but to think about my sick patients 100% of the time will definitely give me ulcers and migraines.

2007-08-22T07:06:00.000-06:00

Pretty much every week, we admit at least one baby that is term, just born, and whose mom has had a perfect pregnancy. Even though they have all that going for them, many of them die. They have lost oxygen at some point during delivery, or their placenta tore off too early, or they were stuck for too long. Sometimes their mom was in a car accident or fall...these are a little easier to understand. But it absolutely breaks my heart when a mom goes through a completely normal pregnancy and then loses the baby anyway. Not premature, no congenital defects, but dead all the same.

It makes me scared to get pregnant.

Such a great feeling

2007-08-13T06:32:00.000-06:00

I am happy to report that my primary patient is doing very well. In June I blogged about him, how I didn't think he was going to survive much longer. He is still here and doing great!!! He is still on oxygen but no longer on a ventilator, a step that a few months ago I would not have thought possible! After all those weeks of one on one care, barely leaving his bedside-he is well. After one particularly hard shift with him- pushing emergency meds, blood, platelets, plasma, and watching his BP drop despite all the dopamine and dobutamine- I said goodbye to him. I knew in my heart when I came in for my next shift he would no longer be with us. But he was! And the next day, and the next. I have a very good relationship with his mother, and after he got better I told her through my tears about saying goodbye to him. He is truly a miracle. I have seen babies beat the odds many times before, but never one with this much against him, medically. The day I got to snuggle with him for the first time, unhooked from the ventilator and all the IV's, I cried and his mom cried with me. It was such a happy happy day, a moment I will never forget. As he squeaked at me and waved his tiny hands around trying to grab on to me, I was overcome by the true tenacity of life, and for this baby, who surpassed the expectations of every doctor who has seen him.

it's been awhile.....

2007-08-10T14:37:00.000-06:00

I have not been in the mood to blog for a couple of months now. My "Pod" which usually carries 14 babies has lost several kids over the last several weeks and it has been hard on morale. I have the feeling there will be at least one more loss within the next 2 weeks. The baby has had multiple surgeries and procedures to help fix a congenital problem but it just has not worked. I have become very connected to this family and I can tell that they are starting to struggle. Mom rarely comes in or calls any more. She sat at the baby's bedside for weeks, months on end and has now decided that there are almost never any changes, so why does she need to be there all the time? I feel that she has started to distance herself from the baby, perhaps knowing that we will not be able to save him.

My one complaint here is that the doctors have never told this mother that there is nothing left that they can do. I know this mom very well and I believe that if she was told this she would choose to hold her baby and withdraw support, letting him die peacefully and in his mothers arms. She still holds out hope, because even though the doctors know there is none and frequently discuss this amongst themselves or with nurses, they have not told her so. This poor child is in pain and is suffering every day that he lives. I know this situation happens frequently. I am definitely NOT an advocate in withdrawing life support for preemies. Preemies are highly resilient and many surprise us with their outcomes. However, in cases where treatment is obviously futile and the child is in surgery almost weekly to no avail, or in cases where there is such brain injury that an EEG shows low or no activity, I support it. I know I will probably get some nasty comments about this, but it is how I feel. I take care of these babies every day and the last thing I want is for them to die, but there are times when I feel that it is the only thing that will lessen their suffering. I would much rather help a mama give a wonderful bubble bath, dress her baby, take lots of pictures and footprints and then peacefully (for the baby) say goodbye than be doing forceful compressions on their poor tiny chests and forcing air and medications in their bodies that just want to let go.

Ok, sorry for the rant. It's been an emotional time in my pod, and my brain is probably not right at the moment

A Sad Day

2007-06-19T07:11:00.000-06:00

Miss Mila passed away yesterday evening. She was not a patient or a friend, someone I never met except for her mother's loving myspace page. Mila was only 2 years old when she was diagnosed with a brain tumor, and was 2 1/2 when she passed. Her single mother has shown much strength throughout this ordeal and needs all the support she can get. Please visit her website at
www.myspace.com/andiwuvsmila (may need to add as a friend) OR

www.myspace.com/gavinbooth
Gavin is updating Andi's website while she is coping with the loss of her daughter and has many of the same posts. You do not need to be a myspace member to see his page. (I believe)

Some days....

2007-06-14T12:12:00.000-06:00

I find it very hard to go to work. The last few weeks that I have worked I have taken care of the same critically ill baby every single day that I have worked. I am losing hope for this little one, feeling that he will slip away at any time. I have been extremely busy physically and mentally every day that I have been working with this child, but I cannot bring myself to choose another patient and have someone else take care of this tiny peanut of a baby. It would be all the much easier for me to take a big chubby healthy baby ready to go home, but who would be there for my special child? Other nurses who do not know him, how to calm and soothe him, what is normal for him. I hate these times more than any other: accepting that there is nothing left that can be done for the baby, that their life will be complete at any given time. Though it is natural to shy away from such situations, I find myself wanting to be there at the end, to make sure all is done to make the transition peaceful and meaningful, and to do what I can for the family in their time of greatest need.

Note to Nurses

2007-06-12T19:03:00.000-06:00

If a baby has some small abnormal condition...such as EXTRA FINGERS OR TOES....maybe not medically the most important condition.....please pass it along to your fellow nurses. It can kind of freak you out not being forwarned of those kinds of things.

HIE

2007-06-08T07:28:00.000-06:00

HIE- Hypoxic Ischemic Encephalopathy- basically occurs when the baby does not get enough oxygen to their brain for an extended time at some point before their birth.

The baby was otherwise perfect. A term baby born to a good family who had made a lot of life changes and sacrifices to have her in the first place. Her heart rate dropped significantly before her birth for a prolonged period, calling for an emergency c-section. She had developed HIE during the time that her heart was not pumping enough blood to her brain. I should mention that this baby is very important to me, a close friend's child. I took care of the baby every day that I worked, watching her deteriorate. She was on a ventilator because she couldn't breathe on her own. Her poor body wasw bruised and swollen from her traumatic birth and all the medications we were pumping into her. My friend, *Beth*, never got to hear her baby cry or see her open her eyes. After almost a month with no improvement, *Beth* and her husband made the hardest decision of their lives. They decided to remove their darling baby from life support, knowing that she would never recover, never breathe without the help of a ventilator. I was working the day that they removed her breathing tube. I could not bear to take care of the baby that day...a certain amount of distance is required for a nurse to retain her composure while removing life support, and I felt in this case I couldn't handle it. Another wonderful nurse took care of the baby, and she allowed me to help my friend hold the baby, make footprints, cut a lock of hair, and make bracelets for both mom and baby. It is not so hard to do these difficult things if you don't know the family personally. It is your job and even though it is very sad and you are very emotional, when you don't know the family it is easier to let go, to be professional. I still talk to *Beth* at least once a week, just as we always did, but now we don't just talk about our husbands, shopping, and the latest gossip. We talk about her sweet angel, and I am blessed to have been a part of her short life.

so this is a blog, eh

2007-06-08T07:13:00.000-06:00

For my first post on my first blog, I am happy to say that I have no idea what I'm doing! I am an RN in a Children's Hospital in the wonderful town of Somewhere USA. I work in Neonatal Intensive Care (NICU) and if you don't know what that is then LOOK IT UP! It's the most amazing job in the world. I have been an RN for several years now and have seen a lot come through the doors of my NICU. I love my job with a passion, but it comes with a lot of ups and downs. The ups are wonderful and the downs are heartbreaking. Sometimes venting is necessary, and this is the place to do it. My wonderful husband--lets call him Mr. Julia--is an amazing person but I can tell by the glazed look on his face sometimes that he doesn't want to hear about yet another sick baby. So if you want to read: Rock on! If you don't....I don't care.