One of my most favorite duties in my job is to discharge patients. Not because I don't like them, but because I'm so excited for their families. This is the day they've been waiting to reach! I got to discharge one of my favorite little girls this week. She had spent a long 98 days in the NICU and had a lot of reasons that she shouldn't have ever been able to leave, but she did. She smiled in her car seat as her mom loaded her up into their new car.
I whispered to her to have a wonderful life and I hugged her mom and I said goodbye.
I've been asked if I get attached to these little ones and the answer is OF COURSE! Especially little ones like her who have been with us for a long time. But I would never want them to stay forever. They have a family, a home, people who have prayed and hoped and wished for them to be home. I want to help them get there. That is the most fulfilling thing about being a NICU nurse. When you say goodbye, it is sad to know you probably won't get to see her again, but more than that is the hope for what will come with her!
So, goodbye, little one. Have a great life. Make the most of everyday!
Wednesday, May 22, 2013
Monday, May 13, 2013
Observations
Observations from this past week of work...
1. Getting a handprint that looks like a handprint of a baby is extremely difficult! Babies like to ball their little hands up the minute you put it down on the paper. And trying to explain to a tiny that we're making their mommy a cute Mother's Day card does nothing to help the situation. So sorry, hospital, for the amount of printing paper I went through. But the cards did turn out super cute and a tiny handprint makes every mother tear up.
2. Sometimes Mother's Day sucks. My friend had a baby a number of months back, but her baby was stillborn. The most devastating thing in the world... to lose a child... I'm convinced. She was at work yesterday. We talked a lot, since I too have had a stillborn son. And Mother's Day for her, just a painful reminder that her arms are empty.
3. Apparently, I'm the queen of finding infants who need a blood transfusion. And it is amazing how a tiny amount of blood help those tinies perk right back up.
4. No matter the day, I still love my job.
1. Getting a handprint that looks like a handprint of a baby is extremely difficult! Babies like to ball their little hands up the minute you put it down on the paper. And trying to explain to a tiny that we're making their mommy a cute Mother's Day card does nothing to help the situation. So sorry, hospital, for the amount of printing paper I went through. But the cards did turn out super cute and a tiny handprint makes every mother tear up.
2. Sometimes Mother's Day sucks. My friend had a baby a number of months back, but her baby was stillborn. The most devastating thing in the world... to lose a child... I'm convinced. She was at work yesterday. We talked a lot, since I too have had a stillborn son. And Mother's Day for her, just a painful reminder that her arms are empty.
3. Apparently, I'm the queen of finding infants who need a blood transfusion. And it is amazing how a tiny amount of blood help those tinies perk right back up.
4. No matter the day, I still love my job.
Saturday, May 11, 2013
Funny of the Day
If you have a 9lb, full term healthy and strong baby boy and tell me you had no idea you were pregnant I'm going to wonder what you put those kicks off on all that time. Perhaps you normally have gas the size of a 9lb baby?
Thursday, May 9, 2013
Different Types of Moms
Obviously, we see a lot of mom's in the NICU. It is a place created to care for infants... so they all must in turn have a mom somewhere, right? As Mother's Day is approaching in the US this week I was thinking about the different types of moms we have in the unit. Please note, this is in no way to say one mom is better or worse than another... just observation. I've given them titles because, well, honestly... that is what I call them in my head.
The Crunchy Mom
She had a birth plan that was specific to the minute and it has all been thrown out the window because the NICU is never in the birth plan. She didn't want her child to have any medications (even the eye oinment to fight any infection acquired during birth or Vitamin K shot that is really needed to help promote natural clotting of the blood) and now her child is hooked to an IV being pumped full of antibiotics and fluids. She only wanted to breastfeed and never allow her child to take a bottle, but the child is too sick to eat anything by mouth, so we have put a tube down his throat to give him milk that way. And although we support breastfeeding completely, she isn't getting any milk yet due to the stress of the situation and that makes her more stressed and now we have to give her child formula. Another chemical being forced on her baby in her mind. She hates that we use disposable diapers. She hates that she cannot hold her infant all the time. She hates that she has to leave the unit at times to allow us to do a procedure. She hates us. Period. We, as the nurses and doctors and staff of this unit, are completely destroying her first few days with her child and it is our fault.
These moms aren't bad. They are just angry and usually take it out on us. We get that. We roll our eyes sometimes and soldier through. We explain the way things work. We overly explain all the monitors and tubes and wires and bed and ventilator and everything. It isn't good enough, but we do try. We try to allow her to do as much as possible. And sometimes they end up liking us and sometimes not. But their babies usually get to go home with no lasting ill affects... in our mind anyway.
The Emotional Mom
She sits at the bedside of her infant and sobs. Every time she is in the unit. She cries at every new thing her child does. I'll say, "He pooped for the first time today." And she is bawling. I say, "He got 1mL of formula for the first time." And she is a puddle on the floor. Sometimes these are moms of our micropreemies... the tiniest of the tinies... and I almost understand the overboard emotion. But sometimes these are the moms of our big kids who might be with us a week tops and I don't understand. I guess it is still hard because the NICU isn't the place you want your newborn for any length of time, but I want to introduce these moms to the Steel Moms (see below) and tell them to suck it up sometimes. But they love their babies and are happy and sad at the same time and deal with their emotions by putting them all out there.
The Steel Mom
She is pure steel. She adores her child and does all she can as we let her. But she never really cries. She smiles when her infant is doing well and sits quietly when he isn't. She listens as we explain what we are doing and nods. She asks appropriate questions and listens to our answers. She isn't chatty. She doesn't really want us to sit at the bedside and hang out with her. She wants to be with her baby. When she brings in vistors (rarely) she is strict with them... more so than even I would be. They cannot touch the baby. They can look, but don't talk over him because he gets stressed out. She understands most of the things we do. I'm sure she has strong emotions, but they aren't obvious to us. She is strength only. This is where they are at this time and there are specific things that need to be done so she does them. Interestingly enough, these are usually moms of our tiniest or sickest. I expect them to be the emotional ones, but more often than not, they are just steel. I usually relate a lot to these moms.
The Long-Term Mom
She has been in the NICU with her baby for a long time. We know her and most of her family by first name. She comes in at the same times almost everyday and we could set our watches by it. We even know when she calls. She knows most of our first names too. She can do the care for her baby better than we can sometimes. She asks about a blood transfusion because her daughter looks really pale and has been having a lot of oxygen desaturations (desats) and she says her last hematocit on the 25th was only 26 then... shouldn't we ask the doctor to order another H&H and see? She has learned the lingo and has researched everything. She comes for rounds everyday and asks the doctors specific and intelligent questions. I almost think that she might be getting a little too used to our unit. Then I realize that was probably me when my daughter was in the unit and probably why I went back to school, got my nursing license and got a job here in the first place.
The Mom Allowing Her Child to Be Adopted
A lot of people in our unit call these moms "birth moms" but I feel it puts too little emphasis on them. These moms did not only give birth to their child and then run away. They are doing a great act of service for their child. I admire these women... even the ones who don't act particularly nice. I think they must be getting a lot of flack for their decision everywhere. I try to make sure they understand that I admire them. That I think they are making a loving decision. I try to allow them to do what feels best to them... holding the infant or not, changing him or not, being in the room with the new mom or not. I've watched a this mom has held her son and cried and said goodbye and she loved him. I've seen the love in her eyes and she places her son in the arms of his new mom.
The Adoptive Mom
This mom is precious. She has waited, prayed, hoped for and worked for this child for ages. She usually adores the first mom too. Which too many nurses forget and try to make the first mom sound bad for "giving up her beautiful baby." But she understands the sacrifice and love that mom as much as this little baby in her arms. She is hopeful but reserved. When asked what the child's name will be after adoption and she gives you the full name including her own last name she breaks down a bit into tears, because, well... she had always wondered if it was possible for her to have a child bear her last name. As she looks into his eyes, she talks about how much love she has for him already. She is over the moon with excitement when waiting period for first mom to change her mind has passed and the infant is officially hers. She has more visitors than anyone because her entire village (so to speak) has hoped and prayed with her for this moment. Discharge day is amazing as the rows of people cheer them down the hall.
The Remorseful Drug Mom
She had a problem with drugs. She knew it. She was trying to get treatment for it. She got pregnant. Now her baby is also withdrawing from these drugs (the legal ones that she was using to come off her first addiction). Her baby is in pain and she knows it stems from when he was in her womb. She doesn't mind us using medications to help him with the withdrawals. She calls when she has to leave to make sure he is ok. She is in the unit to hold him and comfort him through his wild screaming as much as possible. She tries to do what we ask. Even though her decisions put him in our unit, I like this mom. She made mistakes, she knows it, she is trying her best to fix it.
The NOT Remorseful Drug Mom/ The DENIAL Drug Mom
She doesn't believe anything she did caused her child's issues. As he lays in a puddle of his own sweat, screaming his high pitched scream, wildly thrashing and causing scrapes on his face from rubbing on the blankets, and tremoring involuntarily, she tells me not to dare give her child drugs. I should just hold him and he'll calm down. She picks him up to prove it and he continues to scream. He's in pain. She either thinks the drugs she was taking don't affect infants, or she denies drug use at all (though I'm holding the positive on admission drug screen from L&D). Sigh... this is the one mom I simply endure. Thankfully(??)... she rarely if ever comes in after she is discharged from the hospital. She doesn't like to hear his screams I think. And often these children are removed from her care anyway.
The Foster Mom
Most of these moms are great. She comes in a week or two after the baby has been born and learn about what is needed to care for this child. She has mostly hand-me-down clothes for the infant, but they are clean and well cared for, so it is totally fine. She often has been through this before, so she knows most of our procedures. She is excited... all foster parents seem really excited to get newborns. That isn't usually the case. She can swaddle as well as me. She has had over a 100 children through her home throughout the years. She is seasoned in most drug additions and withdrawal symptoms. She gets attached... almost immediately... you can see it. But she also knows this child isn't her own and she works with the children's mother to learn the care for the baby too. She is sometimes like a grandmother type figure and sometimes young. She is always strong.
The Absentee Mom
She isn't here. Her baby has been here for weeks or even months and she might have visited 5 times. She might say she has transportation issues or other children and no sitter. But she also never calls. We aren't sure why these moms do this, but it is always awkward as we approach discharge and have to call her to force her to come to the hospital and learn to care for her child before she takes him home. We've even been asked, "Don't discharge him on Saturday. I already have plans." Sigh... I really don't understand these moms.
The Mom with Empty Arms
She silently weeps as we place her tiny infant in her arms. Finally he is disconnected from his wires, tubes and monitors. Finally she can see his whole sweet face. He gasps a few more tiny breaths and slips away as she weeps over him. She knows these are the final moments she will be able to hold him, study his face, memorize his features. She brushes her finger lightly across his tiny face and sings a quiet song to him. Sometimes so striking -- "Please don't take my sunshine away." It is only her and her baby in that moment. No one else matters... nothing else matters. She wishes that her love could be strong enough to save him. She wishes that it could be a Disney movie and the tears falling onto his tiny body would revive him. But they cannot. They don't. And she weeps. And she leaves the unit with empty arms... an empty blanket held tightly to her face as she tries to smell his smell one last time. This one, obviously, rips my heart out every time.
That is all I can think of at the moment. As I said, none are really bad (well, perhaps the drug mom who is not remorseful at all). But all are moms. No matter what happens in the end, they will always be mothers. Happy Mother's Day to all!
The Crunchy Mom
She had a birth plan that was specific to the minute and it has all been thrown out the window because the NICU is never in the birth plan. She didn't want her child to have any medications (even the eye oinment to fight any infection acquired during birth or Vitamin K shot that is really needed to help promote natural clotting of the blood) and now her child is hooked to an IV being pumped full of antibiotics and fluids. She only wanted to breastfeed and never allow her child to take a bottle, but the child is too sick to eat anything by mouth, so we have put a tube down his throat to give him milk that way. And although we support breastfeeding completely, she isn't getting any milk yet due to the stress of the situation and that makes her more stressed and now we have to give her child formula. Another chemical being forced on her baby in her mind. She hates that we use disposable diapers. She hates that she cannot hold her infant all the time. She hates that she has to leave the unit at times to allow us to do a procedure. She hates us. Period. We, as the nurses and doctors and staff of this unit, are completely destroying her first few days with her child and it is our fault.
These moms aren't bad. They are just angry and usually take it out on us. We get that. We roll our eyes sometimes and soldier through. We explain the way things work. We overly explain all the monitors and tubes and wires and bed and ventilator and everything. It isn't good enough, but we do try. We try to allow her to do as much as possible. And sometimes they end up liking us and sometimes not. But their babies usually get to go home with no lasting ill affects... in our mind anyway.
The Emotional Mom
She sits at the bedside of her infant and sobs. Every time she is in the unit. She cries at every new thing her child does. I'll say, "He pooped for the first time today." And she is bawling. I say, "He got 1mL of formula for the first time." And she is a puddle on the floor. Sometimes these are moms of our micropreemies... the tiniest of the tinies... and I almost understand the overboard emotion. But sometimes these are the moms of our big kids who might be with us a week tops and I don't understand. I guess it is still hard because the NICU isn't the place you want your newborn for any length of time, but I want to introduce these moms to the Steel Moms (see below) and tell them to suck it up sometimes. But they love their babies and are happy and sad at the same time and deal with their emotions by putting them all out there.
The Steel Mom
She is pure steel. She adores her child and does all she can as we let her. But she never really cries. She smiles when her infant is doing well and sits quietly when he isn't. She listens as we explain what we are doing and nods. She asks appropriate questions and listens to our answers. She isn't chatty. She doesn't really want us to sit at the bedside and hang out with her. She wants to be with her baby. When she brings in vistors (rarely) she is strict with them... more so than even I would be. They cannot touch the baby. They can look, but don't talk over him because he gets stressed out. She understands most of the things we do. I'm sure she has strong emotions, but they aren't obvious to us. She is strength only. This is where they are at this time and there are specific things that need to be done so she does them. Interestingly enough, these are usually moms of our tiniest or sickest. I expect them to be the emotional ones, but more often than not, they are just steel. I usually relate a lot to these moms.
The Long-Term Mom
She has been in the NICU with her baby for a long time. We know her and most of her family by first name. She comes in at the same times almost everyday and we could set our watches by it. We even know when she calls. She knows most of our first names too. She can do the care for her baby better than we can sometimes. She asks about a blood transfusion because her daughter looks really pale and has been having a lot of oxygen desaturations (desats) and she says her last hematocit on the 25th was only 26 then... shouldn't we ask the doctor to order another H&H and see? She has learned the lingo and has researched everything. She comes for rounds everyday and asks the doctors specific and intelligent questions. I almost think that she might be getting a little too used to our unit. Then I realize that was probably me when my daughter was in the unit and probably why I went back to school, got my nursing license and got a job here in the first place.
The Mom Allowing Her Child to Be Adopted
A lot of people in our unit call these moms "birth moms" but I feel it puts too little emphasis on them. These moms did not only give birth to their child and then run away. They are doing a great act of service for their child. I admire these women... even the ones who don't act particularly nice. I think they must be getting a lot of flack for their decision everywhere. I try to make sure they understand that I admire them. That I think they are making a loving decision. I try to allow them to do what feels best to them... holding the infant or not, changing him or not, being in the room with the new mom or not. I've watched a this mom has held her son and cried and said goodbye and she loved him. I've seen the love in her eyes and she places her son in the arms of his new mom.
The Adoptive Mom
This mom is precious. She has waited, prayed, hoped for and worked for this child for ages. She usually adores the first mom too. Which too many nurses forget and try to make the first mom sound bad for "giving up her beautiful baby." But she understands the sacrifice and love that mom as much as this little baby in her arms. She is hopeful but reserved. When asked what the child's name will be after adoption and she gives you the full name including her own last name she breaks down a bit into tears, because, well... she had always wondered if it was possible for her to have a child bear her last name. As she looks into his eyes, she talks about how much love she has for him already. She is over the moon with excitement when waiting period for first mom to change her mind has passed and the infant is officially hers. She has more visitors than anyone because her entire village (so to speak) has hoped and prayed with her for this moment. Discharge day is amazing as the rows of people cheer them down the hall.
The Remorseful Drug Mom
She had a problem with drugs. She knew it. She was trying to get treatment for it. She got pregnant. Now her baby is also withdrawing from these drugs (the legal ones that she was using to come off her first addiction). Her baby is in pain and she knows it stems from when he was in her womb. She doesn't mind us using medications to help him with the withdrawals. She calls when she has to leave to make sure he is ok. She is in the unit to hold him and comfort him through his wild screaming as much as possible. She tries to do what we ask. Even though her decisions put him in our unit, I like this mom. She made mistakes, she knows it, she is trying her best to fix it.
The NOT Remorseful Drug Mom/ The DENIAL Drug Mom
She doesn't believe anything she did caused her child's issues. As he lays in a puddle of his own sweat, screaming his high pitched scream, wildly thrashing and causing scrapes on his face from rubbing on the blankets, and tremoring involuntarily, she tells me not to dare give her child drugs. I should just hold him and he'll calm down. She picks him up to prove it and he continues to scream. He's in pain. She either thinks the drugs she was taking don't affect infants, or she denies drug use at all (though I'm holding the positive on admission drug screen from L&D). Sigh... this is the one mom I simply endure. Thankfully(??)... she rarely if ever comes in after she is discharged from the hospital. She doesn't like to hear his screams I think. And often these children are removed from her care anyway.
The Foster Mom
Most of these moms are great. She comes in a week or two after the baby has been born and learn about what is needed to care for this child. She has mostly hand-me-down clothes for the infant, but they are clean and well cared for, so it is totally fine. She often has been through this before, so she knows most of our procedures. She is excited... all foster parents seem really excited to get newborns. That isn't usually the case. She can swaddle as well as me. She has had over a 100 children through her home throughout the years. She is seasoned in most drug additions and withdrawal symptoms. She gets attached... almost immediately... you can see it. But she also knows this child isn't her own and she works with the children's mother to learn the care for the baby too. She is sometimes like a grandmother type figure and sometimes young. She is always strong.
The Absentee Mom
She isn't here. Her baby has been here for weeks or even months and she might have visited 5 times. She might say she has transportation issues or other children and no sitter. But she also never calls. We aren't sure why these moms do this, but it is always awkward as we approach discharge and have to call her to force her to come to the hospital and learn to care for her child before she takes him home. We've even been asked, "Don't discharge him on Saturday. I already have plans." Sigh... I really don't understand these moms.
The Mom with Empty Arms
She silently weeps as we place her tiny infant in her arms. Finally he is disconnected from his wires, tubes and monitors. Finally she can see his whole sweet face. He gasps a few more tiny breaths and slips away as she weeps over him. She knows these are the final moments she will be able to hold him, study his face, memorize his features. She brushes her finger lightly across his tiny face and sings a quiet song to him. Sometimes so striking -- "Please don't take my sunshine away." It is only her and her baby in that moment. No one else matters... nothing else matters. She wishes that her love could be strong enough to save him. She wishes that it could be a Disney movie and the tears falling onto his tiny body would revive him. But they cannot. They don't. And she weeps. And she leaves the unit with empty arms... an empty blanket held tightly to her face as she tries to smell his smell one last time. This one, obviously, rips my heart out every time.
That is all I can think of at the moment. As I said, none are really bad (well, perhaps the drug mom who is not remorseful at all). But all are moms. No matter what happens in the end, they will always be mothers. Happy Mother's Day to all!
Friday, May 3, 2013
Sad and Funny
So the little man from my previous post a while back made the decision for all of us. His lungs got much worse and he died. Now I go to work and I'm sad each time I pass his room. I miss him, but I'm also happy he isn't hurting anymore and there are no more "what ifs" in his life.
On a lighter note though...
One of my patients this week has been a tiny little boy. He is only a few days old and born at 25 weeks. His mom looked at me and said, "Do you believe I smoked with him?"
I stepped back and adjusted my nurse face as best I could and said, "Umm, yeah."
She was smiling and happy as if she was proud of it.
So here is a lesson... if you smoke while pregnant you greatly increase your chances of having an extremely premature baby. Everytime you take a puff, you are killing a bit more of that baby's placenta which causes them to have very low birth weights even if they are born at full term. Don't be proud of yourself if this happens.
On a lighter note though...
One of my patients this week has been a tiny little boy. He is only a few days old and born at 25 weeks. His mom looked at me and said, "Do you believe I smoked with him?"
I stepped back and adjusted my nurse face as best I could and said, "Umm, yeah."
She was smiling and happy as if she was proud of it.
So here is a lesson... if you smoke while pregnant you greatly increase your chances of having an extremely premature baby. Everytime you take a puff, you are killing a bit more of that baby's placenta which causes them to have very low birth weights even if they are born at full term. Don't be proud of yourself if this happens.
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