Thursday, January 28, 2010

NICU

Our pediatrics rotation involves our choice of two "alternative experiences" as they call it. We could choose from NICU, PICU, ED, Psych and I think one other (obviously I didn't pick the one I can't remember).

Please understand because I must follow HIPPA guidelines and privacy of the families I utilize "preemies, babies and it's" throughout my post instead of referring to the gender.

I chose NICU for my first choice and ED for my second. Anyway, yesterday when I got up to my floor, I was instructed to report to the NICU for the duration of my shift to learn as much as possible. I was super excited. My exposure to newborns was very, very limited and my experience with preemies was non-existant. I walked over to the sink and scrubbed in next to a somewhat large woman who had been brought in by transport. She seemed very agitated and I tried to stay out of her way as we entered at nearly the same time.

I reported in at the desk and was surprised to see over 30 babies!!! Most were 30-35 weeks. One preemie was soooo little, only weighing in at 2.5lbs and entering the NICU around 1.8lbs. That baby was less than 25 weeks at birth.

I met another preemie who , a real fighter. The baby was being weaned off morphine and going to be extubated in the next day or so. It sounded like a hopeful scenario as I spoke with the mother who was unmarried and looked less than 20 years old. This was her second preemie!! Her first had also been born a preemie died at birth.

After I left that mother to spend some time with her preemie alone, I noticed the woman that I had entered the NICU with sitting in her wheelchair with her hands in an incubator stroking her preemie! The baby was on an oscillatory ventilator. I didn't stop and observe or speak with the mother as it seemed inappropriate. In some ways, I felt like I was at the zoo, walking by each cage and observing the animals, only these were preemies, fighting for their lives in the NICU.

The next room had this phenomenal nurse with 30 years of NICU experience who was unbelievably kind and began explaining many of the conditions and interventions used and seen in the NICU. It was no surprise that the majority of the preemies came from families who were ignorant of good prenatal care and health habits, abused some type of drugs and/or alcohol or were themselves babies having babies. It really pissed me off and made me sick to think, even if these kids make it out of the NICU, they may never have an good childhood or healthy life.

As the day wore on we saw a preemie with it's belly button in the left rib cage, a rather large forehead and what looked like a permanent "elvis sneer." There were a few babies with MRSA too and one preemie who was born with it's intestines on the outside of the body! After touring the NICU and learning a bit about many of the preemies and their conditions we headed back to our awesome nurse to get some more in depth information on some of the preemies conditions.

We were observing and learning how to care for a preemie who had developed Necrotizing Enterocolitis (NEC) and lost what I believe to be about 60-70% of it's colon and had a stoma. I felt I could spend days and days in here and never learn or see enough.

****WARNING THIS PART OF THE POST CAN BE VERY SHOCKING AND I DO GO INTO SOME DETAILS****

Another nurse came into the room at that time and asked us point blank "Do you guys want to watch a baby die?" My stomach dropped and started doing flip flops. Was she serious? Who says "yes" to that? She informed us that the baby we had seen on the oscillator, with the mother I had entered the NICU with had an oxygen saturation level of 7%! A normal human is at 98%-100%, a person with a respiratory disorder (e.g. COPD) is usually put on supplemental O2 when their saturation level is 88% or less, so 7% is just unfathomable. KT, who was in my class was also with me and looked over at me with that look "yeah, that would be a great experience to watch and we want to, but it is someone's baby!!" There were about 4 or 5 nurses in the room with the family as the baby took its last few breaths. It is a terrible site to watch people struggle for air for a few breaths, then nothing, and then they manage another breathe or two before it's all over. It is not a peaceful breathing. It looks like torture! When the preemie died it was wrapped in a blanket and removed from the NICU, to a private room so the family could say good-bye.

After, we took the body to the treatment room and did post-mortem care on the preemie. The IVs had to remain until the coroner had a chance to examine the baby and make a final diagnosis. Molds or the baby's hand and foot were taken along with a little bit of hair and made into a keepsake for the family when and if they were ever ready to have it. I thought it was morbid, but maybe after time the family would be glad they had that to remember the baby by. I just wanted to nudge the preemi and say "hi baby." The preemie looked like it was sleeping, but you could see the physical changes occuring, blood was flowing to the lowest points, the heels and the backside as the preemie became very pale on the frontside, this is known as livor mortis. The preemie was definitely not as warm as it should have been either, indicating algor mortis too. The last step after washing and changing the diaper was to wrap the preemie up. We then headed to the morgue. I had never been in a morgue. It was on the bottom floor, but it is not marked easily and we had to call security to let them know we were coming. I was very unattached at this point. The transfer paperwork was completed and we left. It was also time for me to report back to my floor for a post conference, so I thanked the NICU nurses and headed back up.

This one day has completely opened me up to working in the NICU. I thought I would detest Peds and OB, because parents aren't supposed to out live their kids, but maybe, just maybe I can do my best to help those preemies have a fighting chance at a long healthy life.

1 comment:

KimZepp said...

Yes, that was very difficult to read. I can't imagine being there as a nurse, let alone as a parent.