News From the Nursery Lab 2008-3

Wow...things have been hopping in NICU the last week or so. Thought it was time I popped in and gave you an update.

The little guy with hydrocephalus has had surgery to repair his spine...and it's quite the impressive scar, too! But, it's all closed now. I hope that when the stitches come out he'll be able to be on his back once in awhile. The shunt to move some of the fluid in his head has reduced a fair amount of swelling in the back of his head. I hope to get a chance to talk with one of the nurses who'll fill me in on his condition one of these days. Can't help it...he's so sweet that I just want to know! He is awake and alert alot of times, and he does eat by bottle; the nurses have told me they hold him on their lap with him laying on his belly, and I guess he just snarfs his bottle right down and wants more. It's so good to hear things like that. It just makes me grin.

Dorotea is thriving. I can't believe how big she's getting. She's undoubtedly helped by all the love and prayers that everyone is sending. Thank you all who remember her in your prayers. She's quite the special little Warrior.

I had a situation develop this week that almost made me cry...and those of you who know me know that I don't cry very easily, let alone cry at work. But this got me, even though there is some reasoning to it all.

Yesterday I headed over to do a draw on one of the babies. Walked into the room and began to set out my things to do the draw. The nurse was in there with me, and I heard her say, "There, I've got a foot out for you."

I looked over at the bed and there was no baby in the bed. I said, "Oh, excuse me, but I need to have the baby put in the bed to do the draw."

Nurse said, "No, the father wants to hold the baby."

Kate: "I'm sorry, but our SOP states that we are not allowed to draw babies when they are held by people. We need to have them in their bed for the safety of both the baby and the lab tech."

The nurse came over to me and put her head next to mine and pretty much breathed a sentence into my ear.

"This baby is dying. Didn't you see the butterfly on the door?"

Well.

In the first place, NICU doors have all sorts of pretty things on them. Holiday stuff, coloring book pictures from brothers and sisters, photographs. A butterfly on the door was nothing out of the ordinary in the grand scheme of things.

Seems the powers-that-be had decided to follow the lead of some other places and place an indicator on the doors to alert staff of THINGS THEY SHOULD KNOW before entering the room.

But, they didn't bother to tell anyone but the nurses about it. Sounds just about right, doesn't it?

So, under those circumstances, I agreed to make the attempt to draw the baby while it was being held by Daddy.

I wedged myself in the tiny space allotted to me.

Tiny? Yes. The floor was occupied by a sleeping relative who was sprawled out next to the chair. Next to that relative was yet another relative also snoozing on the floor. Another chair past them was occupied by yet another person. So, that left me approximately ten inches of width to place my feet.

I'm bent over like a skier ready to do a jump.

And, I've got three tubes to fill. The order was for a blood gas and 'lytes, a CBC with diff, and a CRP.

For those of you who don't know, a blood gas basically checks on the respiratory levels indicated through blood; a CBC with diff is a complete blood count with a few drops of blood put on a slide (diff) and read by the hemotology department for an actual cell count. A CRP checks for infection.

I drew two of the three tubes. And my back went into total spasm. I attempted to go down on one knee to ease it up, but there wasn't enough room. So, I told the nurse to step across to the lab to ask one of the others to come get the final tube. She decided to cancel the test instead.

Now, here's what almost made me cry. I've already been told that baby is dying. And, Dad is sitting there with this look on his face - the kind of look that is part shock, part horror, and part deer in the headlights. He's grieving, holding his dying baby.

And I'm so damn mad. I'm mad because the doctors have ordered all those tests. What the fuck do we need to have a blood count for on a baby that's dying? What the fuck do we need to have a test to check for infection? In truth, if baby is dying, why do we need to draw its blood in the first place?

I had to stick a baby with no hope of survival with a lancet. And, I'm thinking, "What if removing this blood means the difference between this baby taking two or three more breaths in its daddy's arms? What if this is shortening this child's life by a half hour?"

I'm hurting right along with that family, but not only with sadness, but because I see no reason that this is necessary in the least.

I said something to one of my fellow techs. He'd had this same dilemma with another baby a few weeks ago and he sought out Dr. "God".

Dr. God told my coworker that the lab tests tell him what direction to go. He can get a pretty good idea how much longer the baby will live - information that will allow him to help the parents make decisions on whether or not to move the child to a step down unit, or perhaps a Hospice unit. Or if death is very close, to remain in the NICU.

I understand that. What I object to is creating unnecessary pain for someone who is already known to be dying. If there is an infection, let the infection take the person. If the blood counts are such that life cannot be sustained, then perhaps that's the way things should be. But, don't make me look into the haunted eyes of parents who have anxiously looked forward to this child and find that it will be taken from them far too soon. Parents should never have to outlive their children.

The irony of this situation is this: This morning, I had to draw the baby in the room next door. The nurse was in the room with me. I asked how the dying baby was doing.

She said, "About the same. It's just a matter of when."

I asked her if there was any sort of prognosis. After all, I'd just seen the baby bundled up in Dad's arms with nothing but a foot sticking out.

She said, "It's all up to the parents."

There are moments when I'm dumber than a box of rocks. I admit it. This was one of those times. I questioned her a bit more.

What I couldn't see were all the tubes and wires that indicated the child is on total life support. All that's left is for the parents to decide when the machines will be turned off. It will only be minutes after that that the child will cross over.

I understand how the parents must feel, even though I've never had to make the horrific decisions they are facing. How do you say, "Okay, now turn off the machines that help my child live?"

But, the simple truth is there's no miracle waiting. For all practical purposes, the child is already in the arms of the angels. It's just the parents who aren't ready. Yet, they still hold out that hope, waiting for news that will never come until they can't do anything more than let the child go. So, instead of telling the doctors "no more lab work or other invasive things", they keep hoping beyond hope that something will happen and we keep doing things that prolong.

It's not right. It's playing God AGAINST God. And nobody wins.