Wednesday, November 7, 2012

A Premie Teaches Me...

This is not my work. Borrowed from All credit given to the original author ().

Some of life's greatest lessons are learned from the littlest ones:

"Lying under radiant heat, hooked to machines, wires, and tubes; fine thin hair covers your small vulnerable body. You struggle for each breath you take. I look at you and marvel at your strength. Strength not measured by physical power but by the power to persevere and overcome daily adversities. You teach me to never take a single breath for granted.

You toil and try, struggle and strive and finally triumph over every single milestone we set for you. The NICU expectations are high, and you continue to amaze me. You are constantly working, extremely patient and tolerant to everything we set before you. You teach me that nothing is impossible.

As you work so hard to digest your food, gain even an ounce, and hold your temperature all on your own- I see the determination in your eyes and your endurance is inspiring. You teach me that hard work pays off and to never give up on a goal. You inspire me to be and do better.

As you cuddle with your mother, snuggled deep upon her chest, I see her smile and I see you peacefully enjoying her warmth and the sound of her heart beating. You teach me to appreciate the simple free things in life as they are worth more than anything money could ever buy.

The definition of brave cannot be more defined than by you. You have taught me appreciation, acceptance, understanding, compassion, patience and hope. You have taught me much more than I could have ever taught you and for that I am grateful.

Those who pause in their world long enough to get to know yours, will know what it’s like to meet a true living miracle and I am thankful I was chosen to be part of it."
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Wednesday, August 15, 2012

Hard Choices in the NICU

With the scientific advancements that have been made over the last two to three decades, infants born at earlier and earlier gestational ages are more and more viable today than they were in the past. We are simply able to save more of the 23, 24, 26 week premies.

However, keeping them alive and sending them home from the NICU is just the beginning. These premature babies face many potential health issues as they grow into childhood and beyond. From the linked NY Times article:

Saving lives this young is not benign. Survivors of extreme prematurity have frequent, and often severe, complications during their time in the NICU. In the worst cases, these children will suffer lifelong disabilities: cerebral palsy; severe visual impairment that thick glasses and eye surgery can only partly correct; scarred lungs that will leave them reliant on oxygen tanks; intellectual and behavioral problems that put them well behind their peers.

When I began my career in the NICU, I was like most people...I thought that nurses and doctors should do everything in their power to save the life of a sick baby. I couldn't stand the thought of a baby passing away. Who can? When I encourage nursing peers to consider joining us in the NICU, nearly all of them decline with some variation of "No way, man. I couldn't deal with babies dying." It's anathema to all moral humans to even consider losing a baby.

As I've grown in my career working with these sweet babies, circumstances and experiences have reshaped my way of thinking about this. Of course, I still want to save every baby we have in our care. We work tirelessly, relentlessly, doing all we can to save these precious lives. Luckily, we save most of them. Sadly, we can't save them all, and I've had my heart broken by the ones that we've lost.

All of the girls and boys that have been called home to God, while under my care, will forever own a part of my heart. The first loss I suffered was the hardest thing I've ever been through. The last loss I suffered was the hardest thing I've ever been through. There have been times where I questioned my decision to pursue this particular specialty. It's just too hard. Too hard.

But those hard days pass, and I get great fulfillment knowing we save practically all of our babies. To send a previously critically ill 24 or 27 weeker home with mom and dad is one of the best feelings in the world. To have them come visit us at the hospital and give us invitations to their 1st birthday party...well, words can't describe it. It's worth more to me than any amount of salary I've ever been paid.

But the real point of this post is this: SHOULD we be saving all of them?

I hate to admit it, but there have been a few times where I prayed to God to please let this baby die. It's something I never imagined I'd do, but I didn't understand the depth of suffering that these kids go through. A few times, my prayer was answered, and the baby's suffering mercifully ended. I've gone through the guilt of feeling relief at the passing of particular babies, because I knew the grief of the parents was unimaginable.

But the ones we save. Those are the ones that are on my mind at the moment. What is the cost to the family, and to the child, when that 24 weeker finally goes home. Not financial cost (which is staggering), but cost to quality of life. As the article stated in the above quote, the children face a lifetime of health issues -- breathing problems, developmental and intellectual problems, cerebral palsy, blindness, deafness, confined to wheelchairs, and so many other things. A number of them don't make it to adulthood.

I don't have any experience raising a former premature infant through childhood, so I don't know intellectually how I would deal with it. I know that the parents want their children to LIVE, regardless of any future issues. "We'll cross that bridge when we come to it."

But, is it morally the right thing to do? Are we inflicting a lifetime of suffering on these precious children?

I haven't yet completely worked out my thoughts on this subject. I'm certain there are many people in my field of nursing that struggle with this question.

In the end, it boils down to this. I'm not smart enough to work out the moral implications of this decision. So, I'll continue to do everything in my power to save as many of these babies as I can. I am a NICU nurse, and as it says on my Facebook check-in at work, we're "saving babies". That's what we do: Save babies.

Besides...we don't know what will happen to them as they grow up. They might all be the good story, the story that some of my readers lived, with me, over the last 3 years. A tale that starts in fear and chaos, but in the end shows a picture of a beautiful, preciously healthy boy crawling across the floor, through his 1st birthday cake, making a huge mess and creating a room full of smiles and full hearts.

So, that's where I am right now. Save them all, because...until proven otherwise...they are all going to grow into a good story.

Your thoughts are welcomed.

Click the link to read the article:
Hard Choices in the NICU.


Caring For NICU Parents

As RNs working in the Neonatal ICU, we are typically given a patient assignment ranging from 1 critically ill infant on a ventilator(s) to 3 to 4 "feeder/growers". Sometimes, depending on the babies involved, these assignments can be overwhelming and keep you running all night.

However, the baby is only one (large and important) part of our responsibility. Too often, care of the parents of our sick babies is neglected or considered unimportant. Still, one of the most common phrases you hear around the NICU is "A stressed parent leads to a stressed baby".

These parents are thrust into an environment that can be terrifying to them. They are scared for their baby. They likely don't understand what is happening with their child. The equipment, jargon, and noises are frightening. Often, they feel guilty for having their baby so early. Probably most importantly, they have had all control regarding their infant taken from them, and are dependent on strangers in scrubs to keep their baby alive and well. With the advent of Google, most modern parents will search the internet for information about their baby...and will find the worst-case-scenario which will just add to their stress and fears...and most likely doesn't even apply to their child. Lately, everyone's an instant expert.

The cliche about stress, above, happens to be true. And since it is, it only seems logical for caregivers to make an effort to alleviate as much of this stress as possible. It's an added task tossed on top of an already great list of things to do, problems to handle. But, it must be addressed.

Too many times in my NICU career, I've had parents of a 7 day old infant tell me that they haven't been given the chance to carry their baby, or Kangaroo Hold, or feed, or check a temperature, or even change a diaper. Not once in a week! Both the baby AND the parents need this contact!

There exists a multitude of excuses that we as caregivers use to try to get the parents out of the way. I've heard several recently, from parents:
  • The baby's temperature is low. 
  • I don't want to risk losing the IV by wrapping the baby and carrying him.
  • We just fed him, and he needs to sleep so he can digest the milk.
  • The baby's "sats" have been going up and down too much lately.

Unfortunately, it often comes down to the fact that the nurse is busy, there's too much going on, or just pure laziness that leads us to try to set the parents aside. We have another baby to feed, or a med to give, or the other baby is de-satting. Or, it's my break time. When we use equipment as an excuse, parents become intimidated and might be reticent to hold the kid later. They're already afraid of all the accoutrements we have attached to our patients.

I choose to believe that it's a minority of nurses that do these things. Involved parents are good for the health of the baby, and we all want the babies to become or remain healthy, so we're all certainly going to do everything possible to attain this goal.  Right?

Certainly, there will be times where we just can't oblige the parents when they want something. The NICU does become very hectic at times, and frankly...the parents can simply wait till their next visit to cuddle their angel. But we need to be sure we're not just putting them off because we see them as an imposition on our time.

So, my fellow NICU caregivers: Let's make a commitment to ourselves to help these parents get through the trauma of having a sick baby. Let's educate them, involve them in the care of their child, treat them with respect, and understand that they are as much our patient as is their baby.

Do it for the babies.


Tuesday, August 14, 2012

Welcome, and an introduction.

Hello, and welcome to the Premie Power blog. I hope you find my thoughts cogent, coherent and most of all, interesting. I have a passion for Neonatal ICU and in particular, caring for premature babies. I found my passion at around 40 years of age...a bit late, but better late than never, they say!

I am a Registered Nurse, working in a Level IIIB Neonatal Intensive Care Unit in the Rio Grande Valley city of McAllen, TX. We care for the sickest of infants, from 24 week premies to full term babies that need only temporary support.

Many of the babies that I have had the pleasure to have under my care (and their parents) have touched my soul, and I will carry the memories of those precious humans to my grave. I remain in contact with a few of them, and relish the rare chance to see them, either through pictures or out about town. Many of them, I will likely never see again. Too many of them are spreading their angel wings in heaven. ALL of them are special to me, and will always be a part of my heart.

Thanks for stopping by and reading my thoughts, and I hope you enjoy your time here.