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
Wow! That is amazing! It really sounds like your going to be pretty involved in the experience. I bet you'll learn a lot relating to goals in the coming weeks. Have fun!
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