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.


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