ER and Babies

One thing that I always find interesting about the nursing profession is that even though all of us are nurses, we are definitely not all created the same. For instance, I don't do big people. I just don't. I don't enjoy taking care of people who are older than about 2 years old. Once they can talk... I'm done.

However, I have many friends in the ER field of nursing. That scares the shit out of me. I love the fast pace of the ER, but having that many really sick, really hurt folks all the time would not be what I want. And the nurses there are all like badass... seriously. Don't screw with them.

So the other day, we had to run over to the ER to get a baby who was going to be born in a trauma room due to mom having had a car accident and she was hurt pretty bad as well. We take all our transport gear and head out. We get there with the warmer and the bags of crap and whatnot and are directed to the correct room. The doctor and nurses in there are just wided eyed and (dare I say it) terrified looking until they turned and saw us and said, "Oh, Thank God, we did not want to have this baby without you guys here." So I guess, at that point, we were the badass nurses, right? Kind of made me strut a little until the baby was born and proceeded to pee all over me. Way to put me right back in my place tiny human.

Flippin Stupid Parents

I got into NICU nursing because I was a NICU parent at one time. I am one of the most caring for the parents nurses in our unit. I really am. I understand the complete fear and lack of control you feel when your child is laying there and there is absolutely nothing you can do about it. So I try really hard to be over the top awesome to the parents in our unit.

However, there are some uberly stupid parents out there.

First time father whose full term baby boy is in our unit because he was in major respiratory distress after delivery and required CPAP. He knows EVERYTHING.
NURSE: We'll be checking your son's bilirubin level tomorrow, let me explain what that is.
FATHER KNOW-IT-ALL: Oh I know all about that. I had 5 younger siblings.
NURSE: Ok, great, so you won't be worried if you come in next time and he is on some bili-lights.
FATHER KNOW-IT-ALL: No way, there is no way you are putting my son on any of that shit. He doesn't need it.
NURSE: Ok, maybe we should go over what this means...

Or...

NURSE: (making casual conversation) So what is it that you do for a living?
FATHER KNOW-IT-ALL: I'm an FBI agent, ex-pro football player, who protects us from the Chinese and Koreans.
NURSE: Oh, really? That's very interesting. How do you do that?
FATHER KNOW-IT-ALL: Oh, it is very involved. A lot more complicated that what you do for a living.

And then we get the awesome, mother's of the year whose children are there because they are withdrawing from the illicit drugs that she took while pregnant with them.

NURSE: We're going to be giving your child some medication because she is in pain. This will help her rest and calm down the withdrawal symptoms.
MOTHER-OF-THE-YEAR: Oh, hell no! You ain't giving my baby any drugs! You keep drugging her up and that's what is making her this way! And don't you even think about giving that damn vaccination. My baby isn't going to get any of those chemicals injected in her!

Sure... ok...

Makes me want to facepalm so hard.

Whose Decision?

We have a patient right now who has been in our unit for over 4 months. He was a 24 weeker, just one the cusp of viability outside the womb. He developed many different life-threatening disorders including MRSA (received during the actual delivery), necrotizing enterocolitis - which required multiple surgeries and caused a major wound on his abdomen, and a huge bleed on his brain. His head has grown exponentially with the bleed and the last MRI showed very little brain tissue is left.

So what do we do? We care for him, love him, do all we can, but at this point, where do we go? Most would say, "Let the parents decide." And I totally agree. It is the parents' decision alone. However, his parents have been in only a handful of times during his long NICU stay. They call at times, and have even recently (on urging of the staff nurses and other staff members) stated they would be in to talk with the doctors but then never showed up at the times they said they would come and never called to give any explanation or alternate times. As nurses, we have a hard time getting in touch with them at all.

Now, do I think they love their son, yes. I really do. I think the whole experience has completely overwhelmed them and they don't know what to do and so have shut down. I see this a lot. Either the parents are completely over the top involved and want to know everything, or they can't handle it at all and excuse themselves from the reality of it.

But, especially in this case, what do we do? Do we just "stay the course" and wait on nature to take it's course? There are other treatments for this little boy out there, but with his brain matter basically eaten away, he will never be more than a baby. We can "make" him survive for a time at least. Or we can let him peacefully leave this earth. But it shouldn't be our decision. And yet, we are making it, because there is no one else to make it for him.

I've read a ton of blogs and articles about when to save a baby and when not to. Most lay-people who comment on these articles are appalled that someone might NOT save the baby. And really, as nurses, as doctors, as people who got into a business of saving lives, the very idea goes against every fiber of our being. But in cases like these, I really feel we do a lot more harm than good. Yes, his heart may continue to beat (and if it starts to stop, we can always place a pacemaker), and his lungs continue to exchange oxygen (and if that isn't working correctly, how about a different ventiltor setting or ECMO), and he is getting the nutrients he needs from the formula we give him (or we'll just stop that and give him nutrition exclusively through his central line). Do you see our problem?

Who makes the decision of when to stop?