Challenge Accepted!

Friday, the 13th of all days to be a NICU nurse in a level 3...and I accepted my challenge with a brave face.

 I woke up just before I had to stroll into work for my long weekend. I'm usually still groggy on my first day back from a lovely, long stretch of off days. I wasn't looking forward to this particular weekend simply because it was the annual NICU lake trip and since it was my required weekend to work, I had no one to switch days with me so I could go. I guess the lake is more favorable given the choice to work or spend the weekend with some crazy NICU nurses! Not only that, but my hubby was on his way to watch the Green Bay Packers in Wisconsin, ANOTHER trip I missed because of the lake trip. Oh well, there were babies that needed to be taken care of and there will always be more lake trips and football games. 

I glanced at the assignment sheet. Next to my name was written, 25 weeker, Vent 1:1, 5. Which meant this infant requires one on one care because of how critical it is. An infant on a 5 status basically means put your big girl pants on, pull your bootstraps up and get to work! I was given a lengthy report, and began to feel overwhelmed with the sheer amount of information being given. "Wow," I thought. "I'm in for it." 

My fave patients are the micropreemies. I've always said that I liked the sick ones. They really are great experience for new nurses and you become stronger in so many ways. This baby was sick. So sick, that it had been coded a couple times but was able to remain stable on the ventilator after  successful resuscitation efforts. This little one was on so many medications. It's MAR was 6 pages long and was given everything from meds to keep it's BP up to meds that stopped seizures and meds for sedation. The infant also needed constant monitoring of blood gasses and labs, so those had to be drawn constantly and pending lab results the infant needed blood products and IV fluid changes. The infant also had physical characteristics that made the docs suspect something was genetically wrong. I never left the bedside and this was only my first day of three. 

Three days per week may not seem like a lot for people outside of the healthcare field. But in those three days nurses work 12 + hours per day and if you're lucky you get to sit down for a 30 minute lunch. 

Day 2 and day 3 were just as busy as the first day. I would go home after a long shift, utterly exhausted, using all my efforts to simply keep this baby alive and comfortable by suctioning, repositioning the ET tube and the infant, all while being as delicate as possible. For the parents, as mentioned in an older post, I'm a stickler for a clean incubator! But with this there were so many wires and equipment that it was hard for me to organize it all. Not only that, but there was so much going on with the actual patient that my bed organization was the last thing on my priority list. But I managed a clean "office"area :) (That's what I call my incubators). 

I would go home after my shifts and my mind would race and race. I couldn't turn off the questions about this baby and I kept thinking what would happen when I returned? Would  it still be alive? Have I done all I could as a nurse? So many thoughts were present and I couldn't get answers unless I was at work which made me almost not want to leave the unit! I was anxious when I got home because I became so involved with this baby. I a was mentally rooting for her to live and I, to do everything I could. It was like we were a little team, working together. I would make a simple change and she would tell me if it was working for her by her vital signs. lab values and activity and I would adjust things accordingly. In a very short time I became involved quickly, telling her, "With all this work I've done for you, you owe me to live, girl." I wanted to see her months from now go home with her family. 

Monday morning I gave report and left the NICU around 0730. I arrived home around 0800 and got ready for bed. I was exhausted and glad to have the day off. Still, those questions lingered, preventing me from falling asleep so I watched TV for a bit and slowly drifted off into a much needed dreamland on my living room couch. 

About an hour later, I awoke with a startle thinking I was still at work. I took myself up to my bed and attempted to fall back asleep but my mind wouldn't let me. 1400 rolled around and I was still staring at the ceiling. Somewhere between those times, I took a bath to try and relax but my mind was overpowering every attempt to just simply close my eyes. I was too anxious and all I wanted to do was get back to work and see what was going on with that baby. I even tried Facebook chatting with my sister until I got a text message from a co-worker, "Parents decided to withdraw care on your baby today. " "Head ultrasound came back with a grade 4 headbleed." Now I REALLY wasn't going to sleep. 

The infant passed that Monday morning as soon as they withdrew all care. I don't really need to express the sheer disappointment and sadness I felt. For a new NICU nurse, it was a reality check. You can't save them all. I thought, "But we've had plenty of 25 weekers that have gone home." Nothing really bothered me before until now. For some reason, I was truly and deeply affected by this. It was odd for me. I never reacted this way to a patient, even those that have passed. I think it was because of the sheer will for me to help her live. It was the thought that, "We can save her." Sunday night I thought she was smooth sailing. ABGs were the best they had been, I thought they could even D/C her BP meds. She was tolerating care. I thought she was in the clear. But because of the severity of her headbleed, there was nothing we could do further. 

Sad. 

Looking back, this was the best and most challenging experience I've had as a nurse and I'm thankful for it. I had learned new skills that I'd never done before and my confidence has grown despite not being able to save her life. These babies are why we are NICU nurses and I'm grateful for them, good and bad outcomes. I grew as a nurse in those three days and am left with a new appreciation for just being able to live. It sounds cliche, but that baby fought so hard to have what comes easily to others. Life is truly, truly precious. 

Be THANKFUL if you have life today.