Day 13: The End

Today I spent most of the day with Dr. Mills, but after lunch, I spent the afternoon with one of the pediatric nurses so that I could get the nurses’ perspective of pediatrics. 

During the first part of the day, I got to see and learn several different things. The first patient had cerebral palsy, a condition that involves impaired muscle coordination because of some sort of disconnect between the brain and muscles. This same patient was born with a twisted bowel and had to have two surgeries to untwist it. I asked if there was any correlation between the cerebral palsy and twisted bowel, and apparently there is some debate about the answer. Some doctors think the surgeries to correct the bowel cause a shock to the system, which then caused the cerebral palsy, but other doctors say that it is a complete coincidence. Most cases of cerebral palsy are idiopathic, meaning there is no identifiable cause.

There was a teething baby who came in today, and the mom expressed some concern that she thought one of the protruding teeth was blue. Dr. Mills checked his mouth then showed me that there was a little blue bubble surrounding the tooth, but the tooth itself was not blue. It is called an eruption cyst, which is when the blood vessels get irritated and look blue where the tooth is coming in. 

I learned something today that I am extremely surprised I haven’t learned before. Dr. Mills was examining a month-old baby who kept reaching for a black cord, which was directly contrasting in color with the white walls. Dr. Mills watched him alertly interacting and playing with the cord and said that he was drawn to the black and white contrast because babies don’t develop color vision until they are about four months old. Until then, their vision is only able to pick up black and white. I can’t believe that was new information to me! 

After lunch, Dr. Mills asked me if I would like to see the job of a pediatric nurse, so I spent the rest of my time with nurse Toya. She was extremely good at explaining the normal routine of her job. I was surprised at how fast-paced it was. A lot of the time she was calling patients back and asking them all of the preliminary questions, but when she wasn’t doing that, she was preparing her rooms for the next families, charting information for patients, doing labs, or drawing up and administering vaccines. She was very good at showing me the whole system on the computer and how she knew what her next task was. While I liked spending the afternoon with her, I am definitely more drawn to NICU nursing rather than pediatric nursing. Like I’ve said many times before, I think it’s hard to beat how hands-on a NICU nurse’s job is, and that is what I really liked about it. 

As of today, my intensive experience is over, and tomorrow will be a long day trying to put together as much of the presentation as possible. I definitely feel as though I accomplished everything I wanted to during these three weeks, including all four of my goals. As a reminder, these are the goals I had for this intensive: 

-To determine if I would like to pursue a career as a neonatal intensive care unit nurse

-To determine if I would like to pursue a career as a pediatrician

-To explore the differences in practice between pediatric (neonatal) nurses and

  physicians

-To learn and be able to identify the equipment used in the NICU

I got a really good picture of the life of a NICU nurse by spending so much time in the NICU for the first two weeks, and I found myself really liking the job. It fits a lot of the criteria I am looking for in a future career: a hands-on job in the medical field working with newborn infants. While it is no doubt emotionally taxing at times, I could definitely see myself in that role a few years down the road. I really liked the pace throughout the day; most of the time it was very unhurried yet still busy. One of the things I liked the most is that there are no appointments, which I think often tend to create a rushed schedule, which was absent in the NICU. 

Regarding my second and third goals, I don’t think I want to be a pediatrician. While I love kids, I don’t think medical school and becoming a doctor is for me just because I am looking for a job where I am the primary care for the patient, whereas pediatricians like Dr. Mills only spend a fraction of an hour with each patient, and then they’re on to the next. I have reflected a lot throughout my blogs lately on the differences that I observed between nurses and physicians, the biggest difference being that the nurses tend to do most of the hands-on work, whereas doctors (both neonatologists and pediatricians) are there to oversee everything and order everything from drugs and labs to X-rays. 

I most definitely feel like I accomplished my fourth goal. Throughout my two weeks, I learned in an incredible amount about so many of the machines and equipment the nurses use in the NICU, as I have shown throughout all of the blog posts I did. I saw so much more in the NICU than I was expecting. I saw and felt what it was like to lose a baby. I saw babies everywhere from less than a pound to over 15 pounds. I saw very healthy babies and extremely sick, critical babies. And I even got to see a C-section! It really was an amazing experience that I’m sure very few high schoolers get to have. 

Day 11 and 12: Dr. Mills–The "Bigwig" in Town

The nurses met me on my first day at the office, and the first thing they said is, "You got your walking shoes on, right? Dr. Mills is a fast one!" While I was waiting for Dr. Mills to arrive, I actually ran into Sam Sperlik, my classmate, who has been shadowing a different pediatrician for the past two weeks! I knew she had been with a pediatrician, but I didn't realize we would be at the same place.

Yesterday was a short day because we were supposed to do rounds at the hospital in the morning, but all of Dr. Mills' patients went home. He didn't have anybody he needed to go check on, so I didn't have to come in until 1:30 when his appointments started. Even in that short amount of time at the office, I learned a lot!

The first patient I saw had a strawberry hemangioma, which is a benign tumor formed by excess blood vessels, and it actually looked exactly like a strawberry on her arm. Dr. Mills told me that it doesn't hurt anything and is really just a birthmark that will eventually turn blue then back to normal within a few years.

Another patient I saw yesterday was having trouble with bronchitis and wheezing when she breathed. Dr. Mills let me listen to her breaths through the stethoscope, and I could clearly hear her wheeziness when she breathed out. He explained to me that sometimes the tubules in your lungs constrict, which causes the wheezing, much like a car window. When the window is slightly cracked open, the noise of the air blowing in is much louder than when the window is open wider. The nurse gave the girl a breathing treatment to open up the breathing tubules, then I listened to her breathing again after the treatment, and it sounded much better. Albuterol, the drug, is meant to relax the muscles around the tubules so that they can open more and lessen the wheezing, just like the car window.

An older patient came in who had a concussion a couple days previously and was still having headaches. Dr. Mills let me look in his ears, and in one ear I was actually able to see a blue ear tube, which is a tiny cylinder placed through the ear drum to allow air into the middle ear. The ear tube should have been in his inner ear but instead was in his outer ear because of the trauma of the concussion. Even in just two days, I have gotten to look into a lot of ears, and this morning I saw an example of an ear infection "as bad as it gets," as Dr. Mills said. First, I looked into her healthy ear, and it looked white, clean, and pearly, but then I looked into the other ear, and it was bright red and filled with pus. At least it was a good comparison for me to see!

Channel 11 actually came this morning, and they wanted to interview Dr. Mills for a story on the most common current illnesses, so he took a quick break in between appointments and was recorded on camera. Apparently, starting at five tomorrow morning, every half an hour they will choose a short clip of the interview to share on the news. Everyone was joking with him for being such a "bigwig" in town.

In the afternoon, I met a baby who has had a lot of complications, including a tracheostomy and a recent heart surgery. Dr. Mills had me listen to her heart, which instead of sounding like a normal, even beat, sounded like a gallop or series of three beats at a time. (Between the pediatric office and the NICU, I have gotten to listen to several different kinds of heart beats, including several heart murmurs in the NICU.) The baby had a big scar from the heart surgery, plus a bunch of little scars around it from several different chest tubes that were put in. Attached to her trach was an "artificial nose," which I learned moisturizes the air she breathes in like our nose does for us. If she didn't have that, she would just breathe in dry air, like if we breathed through our mouths all day long.

One of the last patients I saw, another baby, had a very yellow appearance, which is exactly the same as the jaundice I saw in the NICU. The whites of this baby's eyes were even yellow, which showed that the jaundice was fairly severe. Because a lot of the patients I have seen are babies, I have been able to connect quite of a bit of information I learned in the NICU to pediatrics. In fact, I wasn't expecting to see as many babies as I have in the past two days. At least half of the appointments I have been to were babies under the age of sixth months.

One big thing that I have noticed between the pediatric office and the NICU is that the NICU is much more hands-on because it is constant care, whereas the environment is much different when there are appointments all day. In the NICU, the nurses spend over 12 hours a day with the same patient, whereas pediatricians spend about ten minutes with each patient, and most of that time is spent diagnosing and prescribing drugs. One of the parents even said jokingly today, "So have you seen Dr. Mills give any vaccines yet?" It was a good point: in general doctors don't do as much of the hands-on jobs as the nurses. While I don't dislike pediatrics, I really like the constant hands-on work of the nurses (with the newborn babies!) in the NICU.

Day 10: My Time in the NICU Comes to an End

Today was my first and last day with Christina who had two babies, one critical baby and one healthy baby. The doctors tried to extubate the critical baby yesterday and use a different, less invasive form of ventilation, but he didn't last long, and they had to re-intubate him. They've tried to extubate him several times, but he always has to get intubated again. The neonatologists are debating about a tracheostomy, which would really be sad because of how involved it is. This baby has already had several surgeries, including getting his large epiglottis shaved, which is the structure that covers the trachea to prevent food from entering. They hoped that this would help solve his respiratory issues, but they saw no difference after the surgery.

Throughout my time in the NICU, I always saw new little faces when I came in every morning, but somehow I never saw the process of admitting a new patient until today. I watched the process of everything the nurses to do admit a patient, including drawing blood, putting patches on, and putting in an IV, breathing tube, and feeding tube. I noticed that everyone around the baby's bedside were nurses; they did all of the hands-on work to save the baby, and the doctor just came at the end to examine everything the nurses had already done. Again, this is another example of the independence and decision-making ability NICU nurses have, and I would definitely rather be in the hands-on position of a nurse than the overseeing eyes of a doctor.

Like I said before, I tried not to get attached to any babies, but sometimes that just isn't possible, which the nurses have also told me. Today, I fed and snuggled the most adorable baby ever. Even though he is only five days old, he was so much more alert and interactive than any of the other babies. He latched on to my finger and necklace with his hand and rested his head on my chest. Though I know this baby is in a rough situation because of choices his family made, all I and the nurses can do is give him the care and support he deserves. I think that is the most rewarding part of this job.

Next week I start with Dr. Mills, the pediatrician, but the last two weeks have definitely been a good experience. I strongly feel like I accomplished everything I wanted to in the NICU, including my goals. I think I might just have to go back as a cuddler once I turn 18.

Day 9: Finding "Friends"

Today was a somewhat regular day in the NICU. I was with Deb again, who had the 27-weekers (the very first babies I had on day one) with the addition of a third baby who was admitted at 1:30 a.m. last night for drug withdrawal. When I came in, three different people were trying to find his "friends" as they called them, but no one was able to feel them. They said either they are sucked up too far or he doesn't have any at all, and he will get an ultrasound done to find out. As soon as they were finished, I fed and cuddled him for over an hour.

Before today, I handn't done very much with my hands inside an isolette, but today Deb let me change their diapers, switch their oximeters on their feet, take their temperatures, and listen to their hearts. One of the babies still had a really distinct heart murmur, which I was able to easily hear. When I listened to the other baby's heart, the beat sounded crisp and clear, but I knew that he previously had a heart murmur, which confused me a little bit. I told Deb that I didn't hear a murmur, and she said that was because his medications worked, and he doesn't have one anymore! I was pretty proud of myself for being able to distinguish the difference.

Deb walked me through some of the important things she looks for in an assessment from top to bottom. First, she said she looks for ear tags, which apparently indicate that the baby has kidney problems or abnormalities! I would have never guessed that. Second, she said she makes sure they have a palate because sometimes babies can have cleft palate without a cleft also in their lip, so she opens their mouth to make sure they have a normal palate. Third, she makes sure they have an anus, because some babies can be born without one, which obviously is not good at all! In that case, they have to go to surgery to surgically create an anus.

Today I got to see one of the babies get suited up to be flown to another hospital. The baby was actually doing well, but the parents don't live anywhere near St. V's, so they flew the baby out to a hospital closer to the parents. Two of the nurses put on full-bodied navy blue suits that said "Neonate Team" on the back, and they were responsible for going with the EMTs and safely getting the baby to another NICU in a transport isolette.

St. V's has a cuddler program where occasionally people come in to hold and cuddle the babies, and today a cuddler came in, and it turns out she was Katie Holmes' mom! I talked to her for awhile and heard about what it is like to be the mom of a celebrity. Again...never did I expect that to happen during this intensive!

Some nurses that I have been with teach me a lot but don't let me do very much, whereas others are the opposite and let me do as much as I can. I've learned that both nurses complement each other and help me achieve different goals. For example, Kelli taught me so much about many drugs, syndromes and various medical conditions, as well as a lot of the different equipment and machines. She was really good at explaining somewhat complicated things in a very understandable way. On the other hand, Deb didn't teach in great detail but let me do a lot more than Kelli did, which really helped show me what it would really feel like to be in this role.

Baby selfie #3 

Day 8: "Do you faint?"

The nurse practitioner Steve hastily walks up and says, "Grace, are you allowed in the OR?" I reply, "It depends on your rules and if you allow me to be in the OR." He motions me to go with him and says, "C'mon we're going to see a C-section!" I jump out of my chair and half run beside him.

As we walked down the halls and rode in the elevator he prepared me for what I was about to see. His first questions were, "Have you ever seen a surgery? Are you ok with blood? And have you eaten today?" He explained that if I felt nauseous at all, I could step out right away because if I fainted, I would have to go to the ER and it would be a big ordeal. He told me that it happens quite often and not to be embarassed if I feel like I can't watch. He explained that once we got to the seventh floor, I would need to put on hair and shoe covers, a face mask, and a jacket to cover down to my wrists. He also warned me that sometimes the smell can be overwhelming and hard to get used to.

He opened the OR door, and we walked into the bright white room with a bed that was completely surrounded with people wearing blue scrubs. They were already pulling the baby's head out! Steve got me to a place where I could see them get the rest of the baby out of the incision. It was very bloody, but it didn't make me nauseous, and I thought it was amazing to see the process of cutting into a belly and pulling out a little baby! Once the baby was out, I followed Steve into a small room where I watched him evaluate the baby and take Apgar scores. Everything happened so fast because we got there right in the nick of time. Eventually I think it would be amazing to see everything from the time the doctors make the first cut into the belly.

Less than an hour later, Steve walked up to me again and said, "Follow me if you want to come see a vaginal delivery!" Of course I jumped up and followed him again. The NICU doesn't get called to every delivery, especially if it is expected to go smoothly, but in this case, the baby was in danger of Meconium Aspiration Syndrome (MAS). Again, as we made our way to the seventh floor, Steve talked to me the whole way, explaining exactly what was going on with this delivery. He explained that MAS occurs when the baby stools in the amniotic fluid, which isn't supposed to happen and can be an indicator that the baby is in distress and something isn't right. This meconium can get into the lungs with the amniotic fluid, which can then block the alveoli. He used a balloon analogy and explained that air can still get into the alveoli and lungs, but with the blockage, that air wouldn't be able to exit back out. In other words, the meconium can cause serious respiratory issues.

We got to the seventh floor and opened the room, but the baby had already been delivered a couple minutes before we got there, which was a bummer, but I got to watch Steve evaluate the baby. He told me that they can get a good idea of how long the baby has been sitting in the meconium by looking at how green the umbilical cord, fingernails, and vernix covering the baby are. He asked me if I had ever seen a normal umbilical cord, which I had, and the one on this baby was spotted with dark green, which meant that the baby had been floating in the meconium for awhile. Her fingernails were also tinted green, as was the vernix on her body, but she was crying and kicking and otherwise looked great, which is a good sign that she likely doesn't have MAS.

Like I said in my first blog, I didn't know exactly what this intensive would bring, and I definitely did not expect to see a C-section! I can't really make that a goal now that it's already over, but it's something that I can add to the list of many things I have been able to see and do throughout this independent study!

Day 6 and 7: Here One Day, Gone the Next

Yesterday the person at the front opened the door for me, and I asked, "Which babies does Christina have today?" She looked at her chart and said, "Well actually, Christina has mandatory time off today." It was supposed to be my first day with Christina, but I ended up spending the day with another nurse, Lynn, who had two babies I had never had before.

As I walked down the hall to the very back of the NICU, I noticed that three cribs that were still there on Friday disappeared. Sometimes I find myself just assuming that the same babies will be there forever and nothing will ever change, and then I get surprised when a quarter of the babies are replaced with new faces in just a single weekend. I'm glad that I'm here long enough to see the beginning and end of some babies' stays in the NICU because it gives me a bigger picture of what it is actually like to have to let go of the babies after a short time.

One of the babies Lynn had was new to the NICU and was having seizures from bad drug withdrawal. Her head was all wrapped up in gauze, and tons of tiny little colorful wires came out of the gauze, which connected to a screen showing all of her brain wavelengths and activity. The doctors eventually read the patterns to try and determine the cause of the seizures. The baby was on about four different medications to try and reduce or eliminate the seizures. She was on a B-6 vitamin because a B-6 deficiency can cause seizures, but after examining the patterns in her brain, the doctors were able to determine that it was not the cause of the seizures, so they took her off the B-6 supplement.

The other baby Lynn had was born with his insides on his outside. They call them "gut babies" in the NICU. He already had surgery to fix it, so now he is just in the healing process. He tends to be very fussy and want to scream at the top of his lungs when he is in his crib, so Lynn asked me if I wanted to cuddle him. His screaming stopped the second I started to rock him, and pretty soon he was fast asleep. I rocked him for over an hour until it was almost time for me to leave.

Today the person at the front opened the door for me, and I asked, "Which babies does Kelli have today?" She looked at her chart and said, "Well actually, Kelli has mandatory time off today." Does this story sound familiar at all? I ended up with Angie, who I met at the beginning of last week. I walked down the hall and the nurses said, "Speaking of the devil! We thought you'd have school off today!"

Angie had the same two babies as yesterday. Soon after I arrived, I saw one of the babies seizing badly, which I never saw yesterday. It looked like her whole body was twitching and flailing. One of the nurses pressed a red button on the monitor, which marks that they witnessed a seizure so that the doctors can pay special attention to that area of the monitor. Angie showed me that the way to distinguish a true seizure as opposed to tremors is by firmly placing your hand on the seizing area, and if the flailing continues, it's a true seizure, which is what happened. Her seizing lasted for 40 minutes while the nurses dosed her with more medications.

The other baby was screaming all day again, so I cuddled him for most of the day, which really calms him down. One of the nurses came up and commented, "He's really going to get used to you."

Day 5: Homeward Bound

Today was a bittersweet day in the NICU. One of the kids who has been there for over four months was finally discharged! While I'm sure his parents were thrilled, they kept repeatedly saying, "We will really miss seeing you guys every day." I can only imagine the bonds parents build with the nurses, doctors, and staff, especially when seeing them every day for 120-some days straight. Deb was in charge of this boy, so I got to see the complicated process of discharging a patient who still needs lots of medication, oxygen, and 24-hour assistance at home.

Deb had two of the same babies today, and because they are big and almost ready to go home, I was able to do a lot of their care. I changed quite a few diapers, took several temperatures, changed a couple oxygenation cuffs on their feet, and of course fed and snuggled them even more. That's the best part!

Because St. V's is located in down town Toledo, quite a few of the babies who are admitted to the NICU are going through drug withdrawl. I have helped care for several of these babies. The nurses use a system called Neonatal Abstinence Syndrome (NAS) scoring to determine the severity of drug withdrawl and how bad the baby's symptoms are. Deb gave me the sheet that they use to score babies, which assigns a certain number of points to each symptom the baby exhibits. Any score above an eight is considered too severe for the baby to be discharged, and ideally the scores should consistently be zero to three. There are a lot of symptoms of drug withdrawl, but a few are high-pitched crying, tremors, muscle tightness, poor feeding, and watery stools. I have seen all of these symptoms among several of the drug withdrawl babies in the NICU.

The NAS scoring chart

Day 4: Snuggle Some More

I was back with Deb today, who had four healthier babies, only one of whom needed to be in an isolette. They are considered special care babies instead of intensive care babies, even though they are all in the NICU.

The first thing I did when I found Deb was sat down in a big arm chair, got a cute little girl and a bottle handed to me! It took her less than 15 minutes to down 40 mLs of milk, then I sat there and held her for another 45 minutes while she quietly slept away. I wouldn't mind doing that all day, every day! A little while later I got to feed and hold another little girl for a long time until her parents arrived and asked, "So are you her nurse today?"

I have made a lot of progress in accomplishing my first and last goals, and even to some extent my third goal. Like I recounted in my past several blogs, I have learned so much about a lot of the different equipment that is used here, in addition to several of the different drugs and disorders that are commonly used and seen in the NICU. Kelli especially explains everything very thoroughly, and I have learned about a lot of the conditions and disorders in much more depth than I originally thought I would. Being able to see it first-hand helps that knowledge to stick, too.

I have found a lot about a NICU nurse's job that I really like. One of the big things I like is they get to make a lot of decisions on their own, and they aren't under a doctor's finger at every second. Another thing I really like, as opposed to the experience with the midwives, is there are no rigid appointments. However, there is still a lot of interaction with people besides the babies. Most parents come on a daily basis, and the nurses spend quite a bit of time updating and talking to them. One of the things I like the most is that these nurses are directly taking care of the babies, which is something I really want to do. NICU nurses are literally at the baby's bedside all the time and are the main caregivers for the babies.

At lunch today, Dr. Schell, the neonatologist came in to eat with Deb and me, and we had a really interesting conversation about the differences between NICU nurses and nurse practitioners. Dr. Schell asked me about my plans for the future, and I told her that I would like to attend Xavier because they have a four-year nursing program. She highly encouraged me if I start my nursing education that early to continue it and become a nurse practitioner. Nurse practitioners, she told me, not only get paid much better, but they work a lot more like physicians rather than nurses, meaning that they have a lot more decision-making power. However, their lifestyle is very different. At St. V's, the nurse practitioners work one 24-hour shift and one 16-hour shift, whereas the bedside nurses work three 12-hour shifts. The nurse practitioners also aren't with the babies all the time like the bedside nurses are, so that would be a con for me. I really appreciated Dr. Schell taking the time with me to talk me through a lot of the questions I had regarding the differences between several levels of neonatal nursing.

Day 3: Baby Snuggles

I was with Kelli again today, and she greeted me with a big, enthusiastic, "Hello!" when I walked in. She had the same two babies again with the addition of a third. The third baby was born at 36 weeks with a twin, but he had a few concerning respiratory issues while the other baby was ok, so he was the only one who had to go to the NICU. He is healthy and able to maintain his temperature well enough to stay in a crib as opposed to an isolette.

Kelli explained that babies have periodic breathing where their breathing slows down for a bit then gets quicker again. One of the babies had a spell when we were standing by the crib when his breathing slowed for too long and his heart rate started to drop. His breathing and heart rate eventually picked back up again, but it was an episode that was definitely noteworthy because the nurses have to make sure apnea (when breathing slows for too long) isn't a problematic and recurrent issue. This is when Kelli explained the triangle of breathing, heart rate, and oxygenation: if one drops off, the other two will follow, such as when the baby's breathing slowed and therefore his heart rate dropped too.

I got to see phototherapy for the first time today, which I learned is to treat jaundice, or a yellow color in the skin caused by too much bilirubin, a yellow-colored pigment of red blood cells. In the womb, babies need lots of these hematocrits and hemoglobin cells, but outside the womb in babies usually under 38 weeks, it causes yellow skin because the liver isn't mature enough to get rid of the bilirubin in the bloodstream.

Kelli let me listen to a heart murmur today, which sounds a lot like sand paper scratching back and forth as opposed to the normal "swish swish" of a normal heartbeat. Kelli explained that many drugs can be used for more than one purpose, including indomethacin, which is an anti-inflammatory drug used to close heart murmurs. Patent ductus arteriosus (PDA) is the blood vessel that connects the aorta and pulmonary artery in the heart, which remains open in babies inside the womb because their circulatory system is much different and they rely on the mother for gas exchange and circulation. Patent foramen ovale (PFO) is the hole between the left and right atria, which is another structure in the heart that doesn't close and can cause heart murmurs in premature babies. The murmur that I heard had both open PDA and PFO. The drug indomethacin, however, is the same as ibuprofen, which is an anti-inflammatory drug that we often use but for a different purpose. This is why pregnant moms aren't allowed to take ibuprofen because it would inadvertently close the PDA and PFO in the womb, which is obviously problematic.

Today I got to be more hands-on than I have the past two days! First, I got to change one of the 27-week baby's diapers. I got to stick my arms in the separate little arm holes in the isolette and change the tiniest diaper while my fingers got slippery from the humidity inside the isolette. Kelli then asked me if I wanted to change his patches because he kept ripping them off, so I worked to carefully plug the patch cords into the correct receptors and stick the patches in the right spots on his little body.

I also got to hold a preemie for the first time today! He was big and healthy enough, so I sat down in a big arm chair, and Kelli handed him to me. After a few minutes she comments, "You're just glowing!" How can I not when I'm holding the cutest little baby in my lap?!

Day 2 in the NICU

I walk into the NICU this morning to find a swarm of people huddled around one of the isolettes. It was the 23 week old baby. They pulled a wall around the isolette to create some privacy while the doctors and nurses performed chest compressions to try and get a heart beat going again, but unsuccessfully. All of the nurses and doctors knew this was the inevitable outcome, and it was only a matter of time.

I met my knew nurse Kelli, who had the same two babies I was with yesterday. Throughout the course of the day, she explained in great detail so many things. She took me through one of the 27-week babies head to toe and explained every bell and whistle attached to him that is keeping the little guy alive.

The first numbers she explained were the three temperature measurements. One is the baby's temperature, one is the isolette temperature, and one is the temperature that the isolette could be in order for the baby to maintain his same temperature. Kelli had me stick my hand in the isolette to feel how hot and humid it is, and she explained to me that the humidity allows the babies to maintain their moisture, sodium, electrolytes, and other minerals. A baby born at 23 weeks has skin that is only about four cell layers thick, whereas a fully-grown person has skin that is about 20 cell layers thick–a huge difference. Because of this, it is easy for babies to lose heat and moisture through their skin, so the hot and humid conditions in the isolette help prevent that. As the babies grow and can regulate their body temperature better, the nurses slowly wean them from the isolette by dropping the temperature inside until the babies are stable enough to stay in an open crib.

The first examination she did was of the baby's skin, which should be pinkish-red; pale or blue skin says something isn't right. She then explained the cannula, or the tubes going into the baby's nose, which deliver pressure into the lungs. This, in the long run, can cause some damage to the lungs, but not as much as an oscillator does. Next was the tube going through the baby's mouth, down into the stomach. She explained that the pressure from the ventilator can force air down into the stomach, so the tube helps babies "burp" or release that air. The patches on the baby's back and chest are each connected to a different machine to measure things like temperature and heartbeat, which the machine then displays in numbers. This baby also has an IV, which goes in through the umbilical cord! I didn't know that was something they did in babies, but apparently it decreases the risk of infection. Lastly, the strap with a red light going around the baby's foot measures the oxygenation levels, which the machine displays in yet another number.

One disorder I learned about today was Cystic Fibrosis, which is a genetic disorder that affects the mucus-producing glands in primarily the respiratory, digestive, and reproductive systems. The glands produce abnormally thick mucus, which can cause problems with blockage and infection. I learned about this because one of the babies here often has a lot of mucus in her mouth and nose, so Kelli drew blood today to get tested for CF.

Both of the 27-week babies get chest physiotherapy (CPT) done. I learned that this helps prevent the alveoli in the lungs (which are involved in cellular-level respiration) from collapsing.

One thing I asked about today that was unclear to me was the difference between a brain bleed and a stroke. I didn't know that babies can actually have strokes in utero because of a blot clot or other complications, but that is different from the brain bleeds that a lot of very premature babies get. A brain bleed is bleeding within the ventricles (which is a water system in the brain), and when it gets bad enough, such as a grade IV bleed, blood can leak into the brain itself and cause much more damage to the tissue. However, a hemorrhagic stroke is when blood vessels that oxygenate and feed brain cells rupture and cause bleeding within the brain. Both can cause the same outcome but are not considered the same thing.

Something I have noticed is that the nurses try to check everything on the babies, give meds, change their diapers, and feed them all at the same time so that they don't have to keep disrupting their sleep every ten minutes. Instead, they can do everything at once then let the babies rest for as long as possible, which is when they grow and gain the most weight.

Another thing that I am seeing and hearing a lot is that everything in the NICU has a consequence. For example, being on a ventilator can cause damage to lung tissue, but it is necessary to keep the baby alive. Kelli keeps saying, "The lesser of two evils." That is a really important reality that I am glad I am learning in the NICU.

The three temperature readings 

Timed pumps that administer meds slowly 

Heart rate, respiration, and oxygenation measurements 

Day 1: Calm Chaos

This intensive, I will be spending two weeks in St. Vincent's Neonatal Intensive Care Unit and the third week with Dr. Mills, a pediatrician. Even with just a day's glance, I can tell it is going to be an eye-opening three weeks.

Currently, my goals for this intensive are pretty limited because, to be honest, as much reading as I did, I didn't know exactly what these three weeks were going to entail. There is a strong possibility that I will be adding to this list soon, but here is what I know I want to accomplish so far:

-To determine if I would like to pursue a career as a neonatal intensive care unit nurse
-To determine if I would like to pursue a career as a pediatrician
-To explore the differences in practice between pediatric (neonatal) nurses and
  physicians
-To learn and be able to identify the equipment used in the NICU

I have already started chipping away at the first and last goals, and by the end of these two weeks, I will have PLENTY to reflect on.

Over the winter break, I read "Girl in Glass" by Deanna Fei, which is about a mother (the author) who had a premature baby at 25 weeks, and she recounts what it is like to have a critical baby in the NICU for several months. It set the stage perfectly for my time in the NICU, and I already find myself familiar with some of the lingo and medical terminology that the nurses use. The only difference is now I'm on the other side of the story, the other perspective, and it's really pretty amazing.

So, I wake up early this morning, and I find myself with a few butterflies in my stomach, mostly because I really have no idea what to expect and hope that I just don't get lost in the hospital. Going to St. V's once for my midwifery intensive in the fall really helped because I was already familiar with where to park, where the main lobby and elevators were, and so on.

I stopped at the front desk to get my yellow "observer's badge" then headed up to the second floor and followed the signs to the NICU where I met the lady I have been emailing for the past several months (Eda). As soon as I stepped in the NICU, I felt such a calm serenity that blankets the unit with the dim lighting. She gave me an entire tour of the NICU, where all the supply rooms are, the pumping rooms, the suite where parents can stay over night, and the U-shaped organization of the babies' "rooms." Then she took me to get me scrubs–don't worry...I DID take a scrub selfie–where I chose the smallest size, which were still so big on me the pants barely stayed above my waist. I then "scrubbed in" to the NICU, where I scrubbed up to my elbows for three minutes with a scratchy sponge; my skin was bright red by the end. I can't count on two hands how many times I've washed my hands today–I think some lotion might be in order over these two weeks!

Eda introduced me to Deb, the nurse whom I shadowed today, who at the time had her hands in a tiny baby's isolette (the technical term for an incubator). From the very beginning, Deb was great about telling me to ask her any questions I wanted, and she answered all of them very thoroughly. Every day the nurses get a different "assignment," as they call it; in other words, they rotate around and have different babies every shift they begin. Today, Deb was in charge of two babies who were both born at 27 weeks, 13 weeks early. They were tiny–just a couple pounds–and I could just see their fragility with their purplish skin slightly transparent and stretched over their thin bones. Their hands and feet looked oddly disproportionate to the rest of their body, yet both of them are currently pretty stable and doing well, even though they are referred to as "sick babies" in the NICU.

Every machine in the NICU has a different sounding beep to it, and at any given moment, there are usually a few different machines beeping away: calm chaos I call it.

One of the machines I learned about was Nava, which is a respiratory machine that includes a tube extending into the baby's stomach with electrodes on the end of it. These electrodes communicate with the brain, telling it when the baby is expanding its diaphram and when to inhale air. The baby initiates all of the breaths. Although, according to the nurses, Nava hasn't been researched very much, and they aren't convinced it helps at all yet.

When babies are born so young, it is common that they have a heart murmur because their circulation and gas exhange is far different inside the mother, but these babies don't get the chance to adjust to the outside world when they are so premature. I got to see the medication Deb used to hopefully help close and heal the murmurs.

Acros the hall from Deb's seemingly small babies was a baby who was born at 23 weeks, and she is TINY–400 grams (under a pound). I was told that with the latest techonology, babies who are born at 25 weeks or later have a great chance of surviving, but 23 weeks is extremely young. When they're that little, they are very prone to bad brain bleeding, which results in a lot of dead brain tissue. I was introduced to a lot of the ethical dilemmas surrounding this: at that point, one of the nurses said, the child has no quality of life, and they merely just exist. Some brain bleeds get so bad and cause so much damage that the brain can't even function enough to signal the eyes to blink. The nurses wanted me to be exposed to all the ethical dilemmas surrounding this baby, so I was involved in all of the conversations: what to do next. Even if the machines could keep the baby alive now, the probablitity of a ruptured lung is high. I asked approximately how many babies in the NICU die every year, and Deb said that last year was exceptionally high with five or six babies, which is lower than what I expected, given there is a high chance I could see an infant death even this week.

Because I was wearing scrubs, some of the parents just assumed I was a nurse and knew what was going on. Several different people asked me today if I was watching their baby or if I had a map for the whole unit. I feel so official.

Deb told me towards the end of the day that by the end of the week I will definitely be able to hold and feed some of the healtheir babies! I am so excited! There is also a possibility I will get to observe more births, which would be amazing. Stay tuned for more!

My promised scrub selfie 

One of the covered isolettes