News From the Nursery Lab IV

First the good news: Warrior Baby made it over the one pound mark! Not by much, mind you, but definitely going in the right direction!

The bad news: The ECMO baby seems to be beginning her decline. There's not much more to say, only watch as it unfolds however it must.

And, tales of the bad apples in the barrel: As with any profession, there are good and bad employees. Bad choice of words, there. I might better say capable and inept, or words to that effect. You may choose your own. I'll just be the storyteller.

I've recently had dealings with two of the caregivers in NICU who have managed to wrangle a nursing degree without taking the courses that deal with humanity toward patients.

The first nurse who should be stripped of her "cap" (do they even have capping ceremonies any longer?) was taking care of a little one I mentioned some time ago on this blog; this child was the first one who looked up and smiled at me prior to my doing the stick on her.

At any rate, the little girl is still hospitalized, has her good and bad days. Currently she's in an isolation room, which, in NICU only means that we have to don gown and gloves before we go into the room. The isolation is to protect her from US, not the other way around.

So, I gowned up and went into the room. On the foot of her bed was a sign which said, "Please do not wake me, I've had a rough night."

But, it was pretty obvious that she wasn't asleep. She was laying in her crib, sobbing between breaths. The pattern was very specific and rhythmic. I said to her nurse, who was seated at the desk outside the door, "Awwww, she's sobbing..."

And the nurse replied, "Yes, she's been doing that all night."

I reached down and gently placed my hand over her chest. I gave her a little "rock" motion, basically just jiggled her around softly, let her know that there was someone there along the edges of darkness she was trying to peer out of.

She calmed, settled down quite a bit. I kept talking to her, explaining to her what I was going to do to her and why and that it would hurt. It may sound silly to a lot of folks, but I make the assumption that they understand far more than they are able to tell us and I treat them accordingly.

Of course she was not in the least amused when I had to poke her little heel and draw blood. The sobbing began again. I apologized to her, and also to the nurse, who was still sitting at the desk outside the room.

The nurse said to me, "You can just take her home if you want. She's been naughty all night long." (A sidebar on that will follow.)

I said, "She has??? She settled right down for me when I rocked her a bit."

Nurse: "Yes, I came in and petted her a little while earlier, but you know, I just don't have time to pay attention to her for an 8 hour shift."

Now, understand that in NICU the nurse to patient ratio generally runs two babies to one nurse. Depending on the illness factor, that ratio can either increase or decrease.

I finished up my work and pulled off my iso gown and gloves and walked out to the desk to finish filling out the necessary items on the requisition.

The nurse who had no time for a little girl who just wanted to be held for a bit, was sitting at the desk putting on her makeup. Not just touching up her lipstick, but putting on ALL of her makeup. I find that horrendously offensive. Period. Time to put on something that babies could care less about, but no time to comfort.

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Today I was chastised by a nurse.

Bad Kate. My offense? I touched a baby.

Now, understand that we are given instructions on how to take care of NICU babies. The rhetoric is that you are, basically, to tiptoe into their rooms, draw their blood in almost total darkness, move them as little as possible, and not carry on loud conversations. In other words, let the children exist in a world where out of the silence comes a faint sound which culminates in something painful for them.

The reality of the situation is that we do try to adhere to what we have been taught. But, the world is not perfect. Have you ever listened to the folks at the nurses station? They are not quiet. God forbid if you get a room right outside the nurses station. You aren't about to get any rest, not that one does in a hospital in the first place!

At any rate, sometimes we just aren't quiet. Sometimes we drop things. Sometimes we put our trays down a little too hard. Sometimes you can't hold back a sneeze. The world is a noisy place.

And, think about it. Would you really like someone to stick a sharp object in your heel and make you bleed in the dark? Wouldn't you rather know that someone could *see* what they were doing as they drained part of your life out of you?

And, let's talk for a minute about minimal undressing of the child. If a baby is swaddled properly, you're going to have to untuck the blankets to get to the foot. The babies who are a little further on the road to recovery have learned to wear clothes. Sometimes they have a "onesie" on underneath a one piece snap or zipper front outfit. And then they are swaddled.

Okay. If you've ever noticed how those one piece outfits work, they don't make it easy for anyone to find a foot. You have to undress at least 1/4 of the child, i.e., one leg. And then when you're done, you have to put them all back together again in their clothes, and then swaddle them up with however many blankets they were wrapped in. (The record I've seen is four.)

So, in short, what you learn "in class" is not the reality of your working world.

So, I appeared at the baby's room to collect an arterial sample for a blood gas. The order was also for a CBC with diff. (That's a complete blood count with a requested differential slide to be made in the lab.) The blood gas goes in its own syringe, and then another is drawn for any additional labs which I then transfer into the appropriate containers at the bedside.

The nurse and I walked into the room. As she began her preparations to draw the sample, I looked at the baby. This baby was under the "bili" lights. These are high intensity lights which help get the liver functioning properly.

This baby was bright red. Lobster red. It looked way too much like a bad sunburn to me. And baby was uncomfortable. She was jerking around in her bed, trying to find a way to get away from whatever was bothering her.

And, I reached out and I touched her leg, and softly stroked it as best I could around all the tubes and wires. She settled down, again aware that somewhere was a voice and a gentle touch.

The spell was broken.

"DON'T TOUCH THE BABY!" the nurse snapped at me. I jerked my hand away, afraid that I'd done something to either mess up her draw, or had disturbed something in the maze of tubes and wires.

"These babies don't need to be touched. They have to remain quiet. They get upset if someone tickles them. They just don't like it!"

Well, ex-cuuuuussse me! It sure seemed odd to me that the baby quieted down as soon as I touched her, and as soon as I took my hand away, she began her uncomfortable movements.

I was glad to see that the overnight shift was about to change. I hoped that the baby would get a day nurse who had a nurturing touch for a baby less than 24 hours old.

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I hear this a lot. "He (or she) has been naughty all night."

What? What is the meaning of this? NAUGHTY???

Yes, I know it's just a descriptive term, most times just used to describe a rough night. But some nurses use the word to convey that their patient required their presence at the bedside during the night.

"He or she was naughty. I couldn't get anything done because I had to be in here with SusieQ all night."

Hello???? Isn't that what you're supposed to be doing? Taking care of the needs of this child? The makeup and the surfing of the 'Net can wait. That baby is your priority, not your checkbook, not the fact that your diet Coke bottle is empty.

Remember all the stories about "aliens" who pick up unsuspecting folks and bring them to the space ship for all sorts of bizarre tests?

How must it feel to a baby? It must feel much the same as being kidnapped by people from outer space.

You've been in a warm temperatured "womb" for several months. You've heard the voices of lots of people, some young voices, some old, but there is at least one that you have heard consistently. She keeps referring to herself as "Mommy". You look forward to meeting this "Mommy" person. Somehow you just know that she's the one who has kept you safe and warm, and made sure you are nourished.

The day comes when that "womb" feels cramped and you just want to get out. Or maybe you feel forced out. And you might hear Mommy yelling or moaning. You want to leave the warm place so you can find her and make her feel better, because you just know that she's in pain. And you feel pain and dimly understand that you and Mommy are connected in this pain.

When the pain goes away, you find Mommy. Her voice is louder and you find out that you can be warm with something called a hug. And even though this new place is bright and strange, you know you'll have Mommy.

But then, you're taken away from Mommy. There's horrible bright lights, there's things being done that HURT. It's not warm and safe anymore. Where's Mommy?????

Eventually that big light that hurt your eyes gets shut off. You're left alone. Your arm might not be able to move; as hard as you try, it will only move a little bit and you remember that not very long ago you could swoosh it all around. There's this thing wrapped around your leg that squeezes it really hard every so often. It doesn't really hurt, but it's scary because it feels almost like it could hurt, but then it goes away.

Every so often someone comes in who isn't Mommy. They do something - it seems to be a good thing because the wet thing is taken away and a dry thing goes in its place.

And suddenly you might hear Mommy's voice. And, suddenly you want to feel that feeling of what you'll learn some day is a hug. But Mommy doesn't touch you because she's overwhelmed because there are too many wires and other stuff in the way. And, pretty soon her voice is gone again.

You hear a keening sound in your head. Once you heard it outside your head, too, but one of those painful things did something to make the noise go away. It felt better when you could hear the noise both inside and outside your head. And you know if only Mommy could hear it, she'd come. But, she doesn't...not very often. Not often enough.

And, you are scared because you're alone. And you wiggle and scrunch up your face and move as much as you can, because sometimes it makes voices come to make you feel not so alone. And in some sort of way, you know that eventually everything will be fine.

So, don't tell me that the little ones in your care are naughty. My definition just doesn't match yours, and I doubt we'll be able to find a way to make our descriptions of the word match.