Walking into Strong’s neonatal
intensive care unit for the first time is overwhelming. It’s eerily quiet
except for the strange, barely audible sounds babies make yawning. The rooms
are dim, even dark in some corners. Incubators not much bigger than a clothes basket
are parked along the walls, many of them completely draped in brightly colored
blankets donated by volunteers.
Inside are the tiniest
of newborns.
The babies who come to
this unit, some only hours old and a few inches long, are in such critical
condition that they require 24-hour care to survive. Most have been born weeks,
sometimes months, premature. One is so small that her father can slip his wedding
band over her hand and up to her shoulder.
Such arrivals bring complications:
the kind that lead to more complications. Some babies have trouble breathing on
their own. Some have gastro-intestinal problems. Some have defective hearts.
And there is always the threat of infection.
Strong’s neonatal ICU
is the only one of its kind in the region. It serves 13 counties — and metro Buffalo and Syracuse, too, if open-heart surgery is needed. The
unit can handle about 70 infants. On the day City was there, there were 48.
The goal for the
medical staff in this unit is getting the newborns to artificially complete the
time they should have spent in their mothers’ womb — developing to the point
where they can breathe without ventilators, digest after feeding, and filter
their own blood. Many of these babies weighed only a pound or less at birth. It
can take weeks for them just to gain another pound. The job is quite literally
getting them to grow.
Lorie Banker, a
neonatal nurse for 26 years, graduated from the University of Rochester. After a few months on another floor at Strong, she decided to give
the neonatal unit a try. It was, she says, one of the best decisions she has ever
made.
Banker and the rest of
the team are used to talking in low whispers. Their movements are measured,
never sudden. And their workspace is adequate, but not large. It can quickly
fill when physicians make rounds.
Computer monitors
hover over the incubators, tracking the vital signs of each baby. Stacks of computer
equipment sit to the side. Wires seem to swarm around the incubators. And in
stark contrast: a small stuffed animal rests on top of one incubator. A blanket
with clowns holding balloons covers another.
The mornings begin
with a plan for every baby: when to start feeding, what adjustments are needed
to the ventilators, what kinds of lab results will be needed for the next day.
This is life as a
nurse in an intensive care unit for newborns, in Banker’s words:
This one came to us from the Finger Lakes.
She was about three months premature. And this little guy was born here. Same
thing, very premature. But they are both doing very well. You can see he is up
to three pounds now. And the little one over there in the corner: she is still
very sick. We have her over in her own little space where it is a little
quieter and darker, so she’ll feel safe and won’t be disturbed. Babies don’t
breathe while they are in the womb. When they are born, that’s when they take
their first breath. She wasn’t able to make that transition, so we have to
support her until she can do it on her own. But she’s improving.
Sometimes it’s not clear cut. Figuring out what’s really
going on is not so easy. It may seem like one thing, but then why isn’t she
responding to this medication? Is something else going on? You’re constantly
checking and rechecking. But most of them do well.
A lot of them haven’t really seen light yet. They’re covered,
because in a sense they are still in the womb.
They have never gone home. They’ve never been on their own.
And that’s our goal: to get them stable enough
so they are well enough to go home for the first time. But until then, this is
their home. Some are here for a week and some are here for several months.
We are on call day and night, in the sense that this unit is
probably the only one in the hospital where parents can come in or call at any
time — 24/7 if they want. If the baby was born in this hospital, the mother
might be just down the hall, which is nice. But if the baby was born in another
hospital or away from the city, the parents are separated from the baby. And it
is very stressful for them.
Some parents are so informed: they call and they clip right
through a series of questions, and they want the answers right there. They know
exactly what they are talking about. They’ll ask about the oxygen rate, what’s the
blood-to-gas ratio, what’s the heart rate, temperature, and so on. Then others
simply want to know if everything is still okay. They need reassurance. They
are concerned with something they have read or heard. One that called a little
while ago is worried that her baby is Down syndrome. The mother that just
called wants to know when we will be taking pictures. It’s just something we
do.
And parents handle it differently — moms are different
than fathers. Mothers have already bonded with their babies. They carried the
child and gave birth. Fathers are often a little more detached, but they are
sometimes even less able to handle the stress. And it’s really difficult to see
them go through this. Imagine being far away and trying to handle something
like this. You have a job. You may have other children. We have to help them
feel secure, that everything that can be done is being done. Everything.
No, it’s not any fun being away from your family in the
middle of the night, working Christmas or Thanksgiving. But that’s nursing. The
best thing I like about this job is that we are the ones who really work with
the babies.
The physicians we work with on a day-to-day basis — they
are really about the numbers, the chemistry. But we are really the hands-on
workers. I could have done so many things over the years, but I just wouldn’t
ever want to give this up. I could have gone back and become a physician’s
assistant, because the tuition is covered for us. Or I could have gone into
administration. It just depends on what path you wanted. But to be honest, a
lot of my friends and girls I started with secretly wish they could have this
job. This is really the best job in the place.
The hardest thing is when you are so busy and you just can’t
do everything to your level of expectation. You want to spend a little more
time with each one of them — whether it’s the mother on the phone or this
baby over here or whatever it happens to be. There just isn’t enough time. You
sometimes feel like you couldn’t possibly spend enough time with these little
sick babies.
And of course the hardest is when you lose one. It doesn’t
happen as often as one might think. We have come so far from the
early days, and we know so much more now than we used to. At
one time, more of these babies wouldn’t make it. There was a time when doctors
didn’t believe these babies felt pain, that they weren’t developed enough to
experience it. And now we know, of course, that isn’t true. They do feel pain.
But it is really heart-wrenching when we know that the baby
is probably not going to make it. And seeing it struggle through that is so
terribly hard on the nurses, on the parents, and, of course, on that little
baby. But you learn how to cope with it.
I live in Geneseo, and it’s about a 30-minute ride home. And
one thing about this is you never ever leave these babies behind. You just
never leave them. But the ride really helps me unwind, and by the time I get
home I’m feeling more relaxed.
One of the things I really enjoy right now is seeing the new
nurses. They come out of orientation, and they are on that floor for the first
time, and let me tell you: it’s really, really scary. There is just so much to
know. And you know you don’t remember it all. I still remember my first day,
and I thought: Oh, please, please don’t give me one with a ventilator. Please,
not on my first day.
This article appears in Jul 19-25, 2006.
