Baby M and Anne are fictitious names. Teddy is my Jack Russell-Theodore Roosevelt Newmarket Verklan, or Teddy for short.
The alarm clock rings off, ripping me out of a dream. And, for a minute, I am a little disoriented. OK, I have my bearings now. Running down the road with my Jack Russell close on my heels was a dream. Reality is, it's time to get up, hit the shower, put on my scrubs, and head toward the neonatal intensive care unit (NICU). Today is one of those days that I need to remind myself, "Why am I up at 0415 to work at the bedside?" Let us see-it is because I love to teach and conduct research, and really because, I love to look after those critically ill neonates. Somehow, these concepts just do not roll off my tongue very easily at this time of the morning. So, I feed Teddy and get moving-it is just another day.
Nothing eventful happens on the way to work-not much does when you drive 90 miles per hour-things go by too fast for me to notice. There is a group of us that gets to work a little early so that we can sit in the staff lounge and chat while we have coffee, as we get ready to begin the shift. No one has any "exciting" news to share and, according to the gossip, it is the "same old-same old" in the unit. Busy as always, with the census running high. So, what else is new? Just another day.
The charge nurse enters the lounge with the assignment sheet in hand. She has a frown when she tells us that our census is even higher because of a number of admissions during the night and we are short staffed. Again, so what else is new? She sees me and smiles as she says, "Terese, you're here!! You aren't on the schedule for today." As my butt is getting off the chair (because you know that I am outta there...), she says, "Can you stay-we really, really need you. There is a very sick baby on maximal support who isn't expected to survive. I want you to take him. He's a 1:1, and that will really help out staffing." So, I stay because (1) I will need a staffing favor 1 day and (2) I would really like to provide care for the really sick neonate. Just another day.
The patient, Baby M, is kept in an isolation room so as to provide quiet and privacy to him and his family. I am immediately struck as to how many cards and pictures are taped up covering all 4 of the walls (a nurse later that day tells me I should take them down because the Fire Marshall will have a fit). This child and his family have an incredible support network composed of family, friends, and community. The love and hope for this baby's best outcome leaps out from everywhere. Baby M is a 28 weeker, delivered by cesarean section for severe hydrops of unknown etiology. He is 16 days of age, on a high-frequency ventilator, and has numerous intravenous pumps delivering pressors, sedation/analgesia, nutrition/fluids, and medications through his umbilical venous catheter. We typically remove umbilical venous catheters within a week; however, this one was kept because Baby M was never expected to survive for very long. And now, he is so ill and severely anasarcic, finding another intravenous access route really appears impossible.
As I complete my initial physical assessment, his mother comes into the room. She (Anne) and her husband have been staying in one of the care-by-parent rooms on our unit. Anne is very pale, scared-looking, and looks like she has lost a lot of weight. She goes over to the incubator, opens a port hole, and talks very softly to him, telling him how much she loves him, and how there are so many people waiting for him to come home. My eyes are beginning to mist for the first of many times that day. She tells me, as I am sure she has told previous nurses, that she doesn't know what happened in the pregnancy; what was it that she had done wrong or, maybe she had gotten sick and did not know it, and transmitted something to him. She told me of all the laboratory tests that she had undergone before and after the cesarean delivery in an attempt to determine the etiology of the fetal hydrops. It still is a mystery, so she is terrified of trying to have another baby. And, she so much wants this one!! So, with tears splashing down between us, we talk about her pregnancy, etiologies of hydrops, and Baby M's clinical course. And, I try to reinforce that she did nothing wrong, but that message is not getting through all her self-blame.
About mid-morning, Anne's mother comes into the room. She looks familiar and says she knows me, but I can't place from where, nor does she remember. As she hugs me, she tells me how glad she is that I am there, that her daughter has not left the hospital since M was born, and now maybe Anne can leave to get some peace for a while. Anne sits down by the incubator, pulls out a child's bible story, and begins to read to Baby M. He struggles against the edema to barely open his eyes and they move toward the sound of her voice. His entire body is so swollen that he can barely wiggle his fingers and toes. So, we have some more tears as we pray for M (Anne's mother says maybe we met at church when she discovers that I am Catholic too). I asked Anne when was the last time she kissed M-she said she never had, he was so sick and in the incubator. So I popped the canopy and put down the side so that she could lean on the bed and "hold" him and give him some kisses. I gave the grandmother a little nudge and told her to greet her grandson too. Again, she tells me how glad she is that I am there. After a little while, Anne decides that perhaps she can go outside the hospital for a lunch for just a short time.
I am sure that the elevator doors had barely closed when a priest popped his head into the room and asked if the mother had been by yet. Apparently, the priest came by at least once a day to check in on the family and bless M. Anne had told him yesterday that she would like to take Communion today and he came prepared to deliver the Sacrament. Finding Anne not there, the priest asked me to tell Anne that he had stopped by and because of prior commitments he would not be able to be back that day. He said a blessing for the baby and then asked me to join him in a prayer for M.
When the priest discovered that I was Catholic, he got very excited and said that he was going to "ordain" me for the day so that I could be the one to give Communion to Anne. I was shocked and quickly declined. From the many times I stumbled over the 2 prayers we said, I thought it was pretty obvious that I wasn't a "good" Catholic!! He was not taking no for an answer. He blessed me and said a prayer. Then, we said the Lord's Prayer together as we held the "host" together. At the end of the prayer, he handed it to me. I must have looked like I was holding a hot potato. I didn't know what to do with it!! Where would I put it? I didn't have a holy place for it-my parents would be horrified if I damaged it in any way. He smiled and told me to put it in my left breast pocket. I'm thinking-you've got to be kidding me!! I told him I couldn't-I didn't have anything to put it in. He continued to smile and said that it didn't need to be placed in anything. That pocket was the perfect place because it was close to my heart. He then proceeded to give me instruction about what to do to give Anne the blessing and what prayers to say. I was still so shaken about having the "host" in my pocket unprotected that I couldn't absorb most of the information he was giving me. As soon as he was out of sight, I ran to find a tissue to wrap the "host" in-I just couldn't leave it in my pocket like that!!
Soon thereafter, Anne and her mother return. Anne looks like she has some color in her face now and I am very glad that she was able to leave for a brief period. Their faces fell, though, when I told them that the priest had come and would not be able to come back. I take a deep breath and tell them that I have the "host" and was "ordained" to give the Sacrament to Anne if she still wants to receive it. Her mother smiles and Anne comes over to me. I confess to her that I forgot about 95% of what I was supposed to do because I was and am so nervous. Anne's mother says it will be just right. The three of us say the Lord's Prayer together. Anne is so devout as she bows her head that I become even more nervous about being able to carry out the ceremony. When we are finished, I pull the tissue from my pocket, unwrap the "host," and offer it to Anne as I say the sacred words. I make the sign of the cross over Anne and then she gives me a huge hug. The three of us are crying again. Anne's mother says, "I knew there was a reason for you to be here today when I saw you this morning." Yup, just another day.
I've gone through several tissues as I relived the emotions of that day. How fortunate we are as perinatal/neonatal nurses to share such deep personal times in our patients' lives!! Once you have their trust, they open up such vulnerabilities that they may only share with you. The bedside nurse should never forget that she or he is the healthcare provider who has the most continual interactions with the parents and that, sometimes, physiological needs become secondary to psychosocial needs. That day reinforced the reason why I became a neonatal nurse and continue to get up before dawn to work in the NICU. And, it also gave me a gentle reminder (well, maybe not so gentle) not to take things for granted. Each day is really what you make it. And, by being there when the patient and family need you, you can make or break their day too. Take a moment to think about all the potential positive (or negative) impacts we may have on our patients each time we are on the floor or in the unit. Yup, just another day.
I hope Anne does have a second pregnancy. There were at least 100 people at Baby M's funeral supporting her and her husband at one of the most difficult times of their lives. I am confident that Anne's family and community will help give her courage to try again; she will be a terrific mother.
Oh gosh, am I staffing again tomorrow? Wonder what awaits me-never again will I have just another day.
-M. Terese Verklan, PhD, CCNS, RNC
University of Texas Health Science Center, at Houston, School of Nursing, Houston