I have a pretty disturbed work/play balance in my life. Even when I'm off, I read for work, I talk about work, and I blog about work. My layperson friends are actually enablers of my affliction, because they like (or pretend to like) hearing about my job as much as I like gabbing about it. At any rate, I get a lot of comments along the lines of "It must be very hard to see babies die." In reality, NICU work is hard, but not for the reasons that you might think.
For starters, death is not nearly the worst thing that happens to babies in the neonatal ICU. Make no mistake - sudden deaths are quite difficult. It can be devastating when a resilient preemie is bopping along for weeks and then falls victim to NEC, dying within the same shift that he became symptomatic. But difficult as they are, sudden deaths in the NICU are more rare than TV dramas might have you believe. Most of the time, a NICU death means a sense of peace following a long period of suffering. It means freedom from a protracted assault of painful interventions that were, sadly, probably futile all along. The death is not the hardest part... by any stretch.
What's hard about this job? I'll say it. Sometimes, it's the kids that don't die. It's taking care of the kiddo with a lethal bone disorder who fractures nearly every time we touch him. He doesn't breathe on his own and he never will, but we have technology to do that for him. Diaper changes are excruciatingly painful for him, so we give him pain medication prior to providing even this routine care. Those meds ceased to touch his pain weeks ago, but it's all we have at this point, so why not? I go along with this insanity under the guise of "respecting a family's wishes." I continue the torture for one more shift. But it's not one shift. It's 155 days. And counting.
That is hard.
What else is hard? The judgment calls. We're taking care of this beautiful, growing preemie. It's time for a tube feeding, but something is different this time. The baby's belly is just a little more rounded than I remember it being earlier. It doesn't feel quite as soft now either - or is that just the baby's muscle tension from me annoying her? It's the middle of the night and I'll likely be able to convince the impressionable young resident to do what I want. Do we stop the feeds, get X-rays and collect labs? In the quest not to overlook something ominous, will we delay a baby's feeding progress, unnecessarily alarm her parents, and expose the baby to unneeded tests?
That is hard.
Beyond that though, there's something that may be even harder. Nurses sometimes get trapped between policy and reality. I've got this kiddo with very complex heart defects. We're going to send him to the operating room this morning in an attempt to rearrange some of his anomalous circulatory structures. However, the risks are very high. The policy is that parents cannot hold babies who have this type of arterial line in place. The reality is that this could represent the only - yes, that kind of only - opportunity that Mom has to hold him. Do I feign ignorance of the policy and hope the wrong person doesn't walk in on us? Or do I just let her stand there at his bedside, tearful and clumsily stroking his head, because that is the only way she knows to comfort him?
And that right there... yeah, now that is hard.
For starters, death is not nearly the worst thing that happens to babies in the neonatal ICU. Make no mistake - sudden deaths are quite difficult. It can be devastating when a resilient preemie is bopping along for weeks and then falls victim to NEC, dying within the same shift that he became symptomatic. But difficult as they are, sudden deaths in the NICU are more rare than TV dramas might have you believe. Most of the time, a NICU death means a sense of peace following a long period of suffering. It means freedom from a protracted assault of painful interventions that were, sadly, probably futile all along. The death is not the hardest part... by any stretch.
What's hard about this job? I'll say it. Sometimes, it's the kids that don't die. It's taking care of the kiddo with a lethal bone disorder who fractures nearly every time we touch him. He doesn't breathe on his own and he never will, but we have technology to do that for him. Diaper changes are excruciatingly painful for him, so we give him pain medication prior to providing even this routine care. Those meds ceased to touch his pain weeks ago, but it's all we have at this point, so why not? I go along with this insanity under the guise of "respecting a family's wishes." I continue the torture for one more shift. But it's not one shift. It's 155 days. And counting.
That is hard.
What else is hard? The judgment calls. We're taking care of this beautiful, growing preemie. It's time for a tube feeding, but something is different this time. The baby's belly is just a little more rounded than I remember it being earlier. It doesn't feel quite as soft now either - or is that just the baby's muscle tension from me annoying her? It's the middle of the night and I'll likely be able to convince the impressionable young resident to do what I want. Do we stop the feeds, get X-rays and collect labs? In the quest not to overlook something ominous, will we delay a baby's feeding progress, unnecessarily alarm her parents, and expose the baby to unneeded tests?
That is hard.
Beyond that though, there's something that may be even harder. Nurses sometimes get trapped between policy and reality. I've got this kiddo with very complex heart defects. We're going to send him to the operating room this morning in an attempt to rearrange some of his anomalous circulatory structures. However, the risks are very high. The policy is that parents cannot hold babies who have this type of arterial line in place. The reality is that this could represent the only - yes, that kind of only - opportunity that Mom has to hold him. Do I feign ignorance of the policy and hope the wrong person doesn't walk in on us? Or do I just let her stand there at his bedside, tearful and clumsily stroking his head, because that is the only way she knows to comfort him?
And that right there... yeah, now that is hard.
