1. Theiman, LeAnn LPN

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DECEMBER ARRIVED AND with it, the usual preparations for the holiday season. Our unit, a neonatal ICU (NICU), entered our hospital's holiday decorating contest with enthusiasm. Snowflakes and all, my helper elves and I transformed our workplace according to the theme, "Peace on earth and goodwill to all."


Here in Scottsdale, Arizona, the daytime temperatures had dropped into the 50s and we experienced 3 solid days of rain-our version of a Midwestern snowstorm. The locals agreed that the last and coldest season of the year was upon us. Little did we know that another Winter was about to arrive.


On December 5, during a scheduled Cesarean section for breech presentation, one of our neonatologists was urgently called to the OR. All present were astonished by the baby who'd just been born. Although crying vigorously, this little girl was encased in what appeared to be a thick, glistening layer of her own skin. Her eyes were narrow slits, her arms and legs flexed and contracted. It was as if this precious little girl had been born in a cocoon.


The neonatologist immediately recognized her as a collodion baby* and informed us that the filmlike collodion membrane would undergo desquamation and peel away in several weeks. She assured the parents that although their baby would require special care to prevent complications, chances were good that she would survive and thrive.


The baby's mother received her child with open arms and lovingly named her Winter. Somehow she seemed to know that everything would be all right.


I met Winter in the NICU when she was 3 days old. Approaching her incubator, I was initially shocked at her appearance. In nearly 30 years of nursing experience, I'd never seen a baby like her. After report, I had to step away and take time to compose myself. Several deep breaths later, I began my nurse-patient relationship with Winter, an experience I'll never forget.


A cracking, leathery membrane encased Winter's entire body, down to her fingers and toes. She could move her arms and legs, but her range of motion was limited. The membrane covered her ears and face, but her mouth, ear canals, and nostrils were open and she required no supplemental oxygen. Remarkably, she could suck, swallow, and breathe easily.


Needless to say, her condition required special nursing care. Initially she was kept in an incubator with 90% humidity-more like Florida than Arizona. Nothing could be attached to her skin, not even a skin temperature probe or monitor electrodes. Nor could arterial or venous access be maintained except via a single umbilical catheter.


Winter's care included frequent application of emollients, lubricating eye drops, and daily baths with gentle debridement. Her mother breastfed her around the clock and participated fully in her care, eagerly making suggestions.


After the mother was discharged, she came to the hospital every morning and stayed all day, despite her healing incision and two children at home. She pumped her breasts diligently so that Winter rarely had formula, even during the night.


Winter's dad spent long hours at work but visited in the evening and always told his baby how much he loved her. Grandparents provided support, visiting often and taking care of the children at home.


After that first day, I became attached to Winter and took care of her every shift that I possibly could. Special babies with special families usually attract an entourage of nurses who insist on taking care of them. Winter was no exception. She had her own posse; outsiders never had a chance.


Gradually, Winter started to emerge from her cocoon. Adjusting to our dry desert environment, she was moved to a regular crib. Those beautiful dark eyes that once peered out narrow slits in the membrane became larger.


As she shed the thick leathery skin, fingers and toes emerged. Now she could move her arms and legs more freely and grasp with her hands. Her skin became accustomed to cotton clothing-mostly pink, little baby girl clothing. Soon we'd say goodbye and her medical needs would be provided on an outpatient basis.


Yet in one sense, this baby had been born with everything she really needed. Sure, her unusual condition required NICU care, but she had the one thing that any baby needs- a mother who loved her, believed in her, and knew that everything would be all right.

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When Christmas Eve arrived, it was time to go home. All dressed up in her romper and bonnet, Winter lay in her car seat, ready to go. Her mother gave me a long hug and thanked me for taking care of this special child, for doing so much for them. Tearfully, I hugged her back. Looking into her eyes, I told her that they'd done so much for me. They'd become my inspiration.


Each December, when we're reminded to think of the true spirit of Christmas, I fondly recall Winter's story, one of love and belief, a story of Madonna and child.


-Christine Linton, RN


*The term collodion baby describes a neonate with a shiny, waxy outer layer of skin, known as a collodion membrane. Although the membrane may be a sign of a genetic skin disorder, in about 10% of cases the baby has no further skin problems after the membrane dries and falls away, usually in 2 to 3 weeks. During this time, the baby is vulnerable to infection, dehydration, and hypothermia. The condition isn't painful and care is primarily supportive. [Context Link]