Inevitably my name comes due, and I see ‘NICU, 12 hrs, sorry” printed next to it on the board.
Intensive care units are staffed according to a “What if a bus crashes into another bus?” rationale, whereby you plan for the worst but don’t always get it. Staff soon become accustomed to being sent elsewhere in the quiet times, on the understanding that they’ll be called back if something bad happens in the world outside. This can lead to an unwholesome wish for disasters. It’s not that we want bad things to happen to little ********, but if they must happen, let them happen on our shift!
I found the NICU eventually, on the top floor. The night nurse gave me a skeptical look as she departed. I knew how she felt. At the sound of the closing of the door, the first alarm went off: Contestant Number One.
Slow heart rate. No problem, intermittent bradycardia is fairly standard in this age group. I watch, ready to provide stimulation if required, while I read up on the baby’s history. Just a couple of days out of the womb. Some swelling and some large spaces in his brain, poor lad. No wonder he’s so irritable. He’s breathing though, and the heart rate comes back up. I see from his notes that he has several infections that might be communicated, so I take extra care with gloves, hand wash, ******* rub.
Contestant Number Two. Only a few hours old this one, a furry-backed marsupial in her plastic incubator pouch. Bottom in the air, nose in the blanket, she has assumed the position. Probably used to being squished by her twin *******, in the next space. After a few minutes of assessment I have her picked as the least likely to cause trouble during the shift, and move on. Wash, glove.
Contestant Number Three, her *******, is a few minutes younger and liable to have this sad fact lorded over him for the rest of his life. He’s connected to a positive pressure blower and humidifier. A blue hat and velcro straps secure the contraption to his nose. A wad of tiny bubbles has oozed from his mouth, which I scoop away with a tissue while I check him over. He was making an awful racket a minute ago, which leads me to doubt that he needs respiratory support at all. Far too vigorous. We’ll get that CPAP off him soon, I decide, and move on. Happy birthday, twins.
By now it’s clear that contestant number one is determined to bust my chops. He wails, high-pitched and reedy, his body wracked with a clean and jerk motion every couple of seconds. I check the usual suspects: nappy, wind, feeding. Time to start this one on some food. It turns out you need to sign for changes in feeding and intravenous fluid administration in this unit, right down to the last fraction of a drop, so that takes a little while to get straightened out. More food, less IV. Wash, glove. Next contestant.
Two is fast becoming my favourite girl, snoozing without a care in the world. Her monitor disagrees: “ALERT! BABY RESPIRATORY RATE ZERO! ALERT! ALERT!” I spend some time convincing the monitor that all is well, changing settings and gently shifting leads. Contestant One interrupts with another bradycardia. The next room’s monitors go off, and I take a few moments to satisfy myself that nothing serious has occurred since the nurse in charge of that room is out for a moment, tag team style.
Contestant Three decides he isn’t receiving enough attention, and starts yelling. Definitely time for that CPAP to come off. The medical round trundles past and gives its collective consent, so I take the wide flexible prongs out of Three’s nostrils and give him a good clean out with the suction, lovely globules of creamy snot oozing up the catheter and out of his airway. He settles down almost straight away and gets on with the important business of breathing, unsupported. I position him carefully, listen to his air entry and watch him breathe for a few minutes. Sometimes these **** can refuse to cooperate and turn blue, at speed.
Contestant One objects to my spending time away from patting his rump by bradying down again, this time into the 50’s. Ok, fine, be that way. I flip him over and change him. Meconium. Blech. He pinks up and I take the opportunity to get some food down his gastric tube, after another hand wash.
Having successfully foxed me, Contestant Three emits a horrible barfing, coughing sound and ****** everywhere. Two seconds to cross the room, another one to undo the side of the incubator and turn him, supporting his head away from the pooling *****. He looks dusky. Great. I call for an assist from a neighbouring room as I am running out of hands. The bedside suction is present but doesn’t look like it’s been used for awhile. Ditto the Ambubag. I get the suction running, fumbling for a catheter in the unfamiliar environment. Deep suction from both nostrils down into the back of his airway, hoping to prevent anything from dribbling down into his fragile new lungs. He seems to have a reasonable cough and gag, which is encouraging. I get some oxygen running through the Ambubag, ignoring the nurse behind me who’s saying something about the trumpet-shaped thing hanging from the back of the incubator. Relax, I won’t pop his lungs. Just want something with a decent mask.
He gets oxygen only until I see his saturations come up above 90, then I back off and let him recover for a bit. Contestant One is screaming his head off, but I figure that’s a healthy enough state of affairs for now and wish him all the best from across the room. Priorities.
