Sunday, October 10, 2010

Hard day at work

So last night at work, at about 1 o'clock in the morning, I went to the delivery (and resuscitation) of a 26 week old baby. He was exactly 5 days farther along than my little girl. And he did not do well. And it was difficult.

I knew that it was bound to happen. As my pregnancy progressed toward the point where my baby was viable I knew that it was only time until I attended the delivery of or took care of a patient that was the same gestational age as my baby. And that just that in and of itself would be hard. It was.

We got him stabilized and we'll see where it goes from here. But it started how it always starts with extremely premature babies. It will be a few days before we know how his brain is affected from the delivery and resuscitation. It will be several hours before we know how/if his kidneys are working. He will be unable to "eat" for several days to weeks and until then we will deliver protein, fats, electrolyte and the rest of his nutrition via IV fluids. When he is fed, it will be through a feeding tube inserted in his mouth that goes to his stomach because he is too little to know how to eat by mouth (that will come later). And he already has several issues pretty typical of a baby delivered this early (extreme hypotension, respiratory distress requiring a ventilator, etc).

Like I said, this is all pretty typical of babies delivered at this gestational age. And they are all a waiting game to see 'just how bad" it will be. I hate to say it like that, but for these babies it seems to be that we expect the worst and hope for the best. Rather than be hopeful in the beginning and simply brace for the worst. We try to be realistic with parents but most can not take much in at this point. This usually has come as a huge shock and they are mourning the loss of their "normal, healthy" baby. Some are realistic, some are very anxious, some refuse to accept the truth of the reality that their premature baby has been born into. And they are all finding their way through a world they know nothing about.

Except me. I know. And I can't decide if that makes it less scary or infinitely more so.

Last night, I resuscitated this baby. I took him back to the NICU and placed umbilical lines into a very small umbilical cord with even smaller blood vessels. I prayed, for his sake, that they went in smoothly and were in proper position so that we had the access that this baby will so desperately need in the coming days and weeks. They did. (Score!) I looked at his xrays, wrote orders for medications, made changes to his IV fluids and followed his labs.

And the whole time I thought of my daughter. I willed her to stay put. To grow and get stronger. I want so desperately for things to go right for her. And it's not that all of the babies that I take care of don't deserve this. Unfortunately, some babies just don't get it. But how could I not want the best for my daughter? How could I do what I do every day and not wish and hope with all my heart that she doesn't have to be put through that? Isn't that what makes a parent? Wanting the best for your child?

So even though I knew last night would eventually come, it was still hard. It made me think thoughts I've been trying to suppress for a long time. It put my worst fears for my child right in front of my face. And this morning I couldn't wait to go home, with my child still healthy in my belly and get some sleep.



  1. uggghhhh that is sooo scary! Mine is 26 weeks and 2 days today and although I am happy that there is a chance of survival at this point, all these dangers make me totallllllly paranoid. Here's to healthy full-term babies and positive thinking then!

  2. Oh Layne, that must be so difficult for you to go through, but how lucky that family is to have someone who will care so fiercly for their child. I hope all works out, and that you take of yourself too!