When they rolled the neonatal transporter carrying the very sick baby onto the unit, Marianne stood ready to admit him. As she carefully lifted him from the transporter onto the warming bed, the usual swarm of nurses, physicians, neonatal practitioners, and respiratory therapists gathered. At first, I stood far to the back. Only a few months out of orientation and still a nervous neophyte, I felt things went better when I stayed out of the way.
This time, however, I ventured close enough to watch. There was something I was curious about.
Marianne always seemed to take the new admissions and the complex cases. It wasn't so much that she volunteered, she just accepted the challenge. The charge nurse always sought her out.
Marianne was a southern belle-short, vivacious, with bobbed blond hair, bright blue eyes, and a warm, cheerleader smile. If you happened to be carrying a very sick baby down the street and you saw her, you wouldn't necessarily run to her first. In the NICU, though, she was tops: tough and smart and resolute.
That's what I was curious about. I believed in the nurse as a sort of comic book hero. Quiet. Decent. Defiant. Proudly independent-the Lone Ranger in scrubs and track shoes. I was determined to fly solo, but I kept getting grounded by reality. No matter how hard I tried, I could only do one thing at a time. I wanted to see how Marianne so deftly handled the barrage of demands in a crisis.
No sooner was the baby on the bed than the physician and the neonatal practitioner started barking orders for medications, drips, equipment, X-rays. They wanted to put in lines. They wanted everything stat. Marianne, in the eye of the storm, smiled calmly. She turned to Jo, "Could you mix my dopamine?" She turned to Irene, "Could you get the amp and gent?" She turned to Anne, the secretary, "Would you please call radiology?" At last she saw me, still lurking in the shadows, but not far enough removed. "Ray, could you bring a pump and make my UAC fluid?" I nodded. Who could resist that smile? But deep down I was angry. Hell, I thought to myself, I'm not learning a damn thing here. We're doing all the work. She's just staying at her patient's bedside, telling everyone else what to do. That's not nursing, that's cheating.
Gradually, I had a revelation: no nurse is a soloist. Once I accepted this, amazing things began to happen. One day I could use every spare minute of my time to help Laurie keep a baby off ECMO; the next, I could call on her to help me get an unstable cardiac admission to the cath lab. I could rush to the intermediate nursery to admit Sherry's baby who got septic; then, when I was confronting the parents with the overwhelming news, she could appear out of nowhere to help soften the blow.
I eventually became a nurse the charge nurse sought. She approached me one evening as I arrived at work. "Baby Angela might not make it through the night," she said. "Do you want to take her?"
Angela was the frailest of premature babies. I had admitted her a month before, when she hadn't been expected to make it out of the delivery room, and I had nursed her through the tenuous first days of her life. As fragile as she was, she radiated life to all who cared for her.
But her immature systems were beginning to fail under the onslaught of treatments. If this was to be her last night, I'd be honored to take her. However, Kim, a young nurse just months out of orientation, spoke up meekly in report. "I've had her two nights in a row. Would you mind if I took her back?"
"Of course not," I answered. "Just call me if you need me."
At two in the morning, the alarm went off. Angela's heart rate hovered in the 80s. She was dusky. Her oxygen saturation and blood pressure levels were sinking ever downward. We all rushed over. Someone brought the crash cart, and we started drawing up meds to prepare for the madhouse of a neonatal code. Then Kim tapped my shoulder. "Ray, the doctor wants me to start dopamine. Can you stay with Angela while I go to mix it?" Her voice trembled, and there was panic in her eyes.
She's afraid Angela's about to die. She's trying to back away so that I'll step in and take over. Deep down, I was angry. Damn it, that's not nursing, that's cheating.
"You're Angela's nurse, she needs you at her side," I snapped, and Kim startled at the sharpness of my tone. "I'll get the dopamine. That's what we're here for, to help you."
Angela survived that episode, although she hadn't long to live. Kim survived as well, looking stronger and more confident as we parted that morning.
Driving home, I pondered our propensity toward cheating. There are many ways to do it. Maybe you've just got to learn how to do it right.