By Jodi, RN of Peek-a-boo ICU
A cold February wind danced as tree branches swayed side to side in the distance. Frost on the windows gave way to the sun as it began to peek through the thick clouds blanketing the sky. It was another gloomy winter day in the city, but I was tucked away, warm and content, ready to start my shift; behind the closed doors of the NICU. The hustle and bustle through the halls was apparent as I hung up my jacket and glanced down at the report sheet. Deliveries. “Great,” I thought to myself as I slurped down my last sip of morning coffee. Walking to the desk, I stopped and pulled up the active labor strips.
And there it was…no movement, no accelerations, no activity…a flat line. I felt my shoulder slouch as my heart sank to the floor.
A woman in triage, a baby in trouble, and a nurse scrambling for answers. This was the beginning of what would be a terrifying and horrific battle to save the life of one little boy.
Tucking my hair in beneath my collar, I sat down at the computer and began to gather what little information that was available to me at the time:
Mom, 28-year-old, primigravida, post dates at 41 weeks. Reporting to triage with complaints of no movement for over 24 hours. Pulling up the labor strip again, I knew I needed to begin assembling myself and my supplies, for what looked like to be an impending delivery of a baby in very serious trouble.
The phone in my pocket began to vibrate and a shrilling ring proceeded. The team was needed in OR Room 2 STAT. Pulling myself together I began to run towards the maternity unit calling out for help as I pushed open the door. As I headed down the hall, stethoscope swinging in the breeze I had created, I saw a man standing in the corner, hands clenched together. His head was down but as I passed him, he looked up at me. His blue eyes seemed to pierce right through my skin, sending a chilling sensation down my spine.
Rushing through the OR doors, I picked up my hat, mask, booties, and gown and quickly dressed in the appropriate OR garb. Our NICU team assembled at the radiant warmer as the OB doctor made his first cut. Mom lay motionless on the table. An IV inserted into her forearm pumping fluids into her still body. Her eyes covered with tape and a breathing tube inserted down her throat. This mechanical world was keeping her alive as we attempted to bring a new life to the physical world.
A life so deeply in trouble.
The heat of the radiant warmer, the sound of the oxygen pumping through the tubing, the hum of the team gathered around, and the smell of flesh burning in the near distance all faded away as the baby was lifted out, and I heard the word “TIME” echo against the walls.
TIME. TIME. TIME.
It was time for this little life to begin. Yet, it didn’t.
A lifeless and limp boy covered in thick brown secretions was placed under the warmer and our team began to work on him. He was intubated and suctioned. His heart rate would rise and fall with each intervention we took. Epinephrine now surged through his body as we puffed air into his lungs. Sweat began to pour down my back and my fingers became numb as I continued to squeeze the bag, breathing for him. We were on minute 13 when a glimpse of life came from his now frail and worn body.
Stabilizing him, we moved quickly out of the OR, down the hall. As we pushed our way through the double doors the same blue eyes were there to meet me. His pale, wet, and worried face spoke to me in silence. I motioned to him to come along to what would be his son’s new home – behind closed doors, away from a world of normalcy, and into a world known as the neonatal intensive care unit. This baby’s life was just beginning, but he was in for quite the fight and I was afraid that he was not up for the challenge.
Through the dark hours of the night, he held on by the thinnest of threads. Willed to live by determination, he clung to life hour after hour, with the help of every medical machine and procedure his little body could endure.
He was connected to a bird’s nest of wires and tubes. His eyes covered, a ventilator sprouted from his little mouth, an OG tube secured to his lip; venting the air from his stomach, and suction tubing draped over the bedside within arms’ reach when needed. A radial line placed to keep an eye on his falling blood pressure; an umbilical line taking over his belly button, and a pharmacy of medications pumping into his veins keeping him alive and stable.
His mother now recovering from surgery lay in a room down the hall surrounded by family and close friends. Her world so different than just 24 hours ago. Her story completely changed from the one she had planned and dreamed about for the last 9 months.
A paper lay crumbled by her bedside. A birth plan that would never be. A baby book, a little outfit, and booties that would have to wait. Her plan for a natural labor and delivery with little medication, her baby laid upon her chest, able to breastfeed and fall sound asleep; now nonexistent. These images gave way to wires and tubes, phenobarbital, dilantin, gentamicin, TPN, blood tests, catheters, oxygen saturations, and ventilator settings. Her plans now all crushed by the new world of the NICU.
Her first baby pictures were laced with tape and tubes. Her first kiss beneath the ultraviolet rays of the phototherapy light. Her first time holding her little boy would be weeks away, and feeding her son was something that would take time and patience.
Unable to stay away any longer than a few hours at a time, this mother often camped out at her son’s bedside. Learning the unspoken NICU protocol. She became an expert in numbers, settings, and statistics. She was familiar with terms like meconium aspiration, sepsis, PPHN, and pneumonia. She became her own expert in neonatal care and lived and breathed all things NICU.
Day after day, his fragile body became stronger and stronger. We would cheer him on, with each milestone he would hit and with each amazing improvement he would make. Another tube gone, another hurdle crossed, and one step closer to home. He was a fighter, and he was winning the battle despite all the odds stacked against him.
This little boy is one of the many unsung heroes of the NICU – the term babies that fight day in and day out to survive. The parents that question what went wrong, and struggle to fit into a world sometimes overshadowed by prematurity. Family and friends don’t always understand the ongoing issues that may linger after the NICU, and often disconnect, leaving the parents confused, isolated, and alone.
But their issues are valid, their concerns are real, and their babies are worth celebrating and acknowledging. Their story, their journey through the NICU is often one filled with so much uncertainty. Questions that can’t be answered, doctors post-NICU that may not understand, and an unpredictable path of growth and development. It is so important as a community to embrace these babies and their families and validate their journey. Helping them to know they are not alone can make all the difference in the world.
I have been a Registered Nurse for 17 years. I currently work full time in a single room family centered care level 3 NICU. I am a member of NANN; National Association of Neonatal Nurses, A Developmental Care Specialist, BLS and NRP certified as well as S.T.A.B.L.E. trained. I am the creator and owner of PeekabooICU.net and PeekabooICU.org as well as the Peek-a-Boo ICU Facebook page and Twitter feed.
Peek-a-boo ICU was created to provide support to parents as they face the emotional journey of the NICU – empowering parents with knowledge, offering support, and encouragement along the way. The NICU is never in anyone’s birth plan. Parents are thrown into a world they don’t know and never expected, drenched in fear of the unknown. All too often they are given information they don’t understand and are faced with a future that is so uncertain. They don’t know what to ask, how to act, and often feel overwhelmed and lost along the way. Peek-a-boo ICU was created to offer parents easy to understand information that pertains to the NICU and premature birth – answering the questions that parents may have, offering emotional support, as well as a NICU nurse’s perspective on all things neonatal.