The NICU
Posted Sunday, July 08, 2007 5:54 PM

I love working in the NICU (Newborn ICU). It’s a lot of fun. The nurses are great, the babies are cute, and there’s a nice variety of patients that move through the unit. But one of the most common comments that I get when I tell them I’m working in the NICU is, “it must be so hard to work there.” I don’t see it that way. Granted, it can be very difficult working there. You see so many babies that are so critically ill, that it tears at your emotions. So many of them are barely hanging by a thread, require intensive care and life-saving techniques. They’re on ventilators, heavily sedated, hooked up to machines, and have tubes coming out of every open patch of skin and orifice. And the sad reality is, for the ones that are so sick, some of them do not ever get off the vents or heavy sedation. Personally, the hardest part is watching them lay there and struggle against the ET tubes, knowing that they won’t ever be free of them because the parents want everything done for them. It’s not that I want them to let go, but I hate to see their suffering prolonged. All life is precious, but it is the quality of life that is most important (in my opinion). So it is hard for me to see some of these kids that are not progressing, not getting better, and their parents want everything done. The parents don’t always understand what it takes to keep the child alive or what it will mean for the infant. Sometimes it’s better to just let the baby go. But just as they might not understand what is going on or what the prognosis is, we don’t understand what it means for the parent to keep the child alive. What it comes down to is a difference in values. For me, simply existing isn’t living, and it is hard for me to watch a child with no prognosis or chance to be off a vent, yet kept alive without any quality of life.

But working in the NICU isn’t all sad. Most of the infants do very well and get to go home to their families. They’re amazingly resilient. It’s a matter of helping them get better. Over the weeks, you see them get stronger, gain weight, and learn to bottle feed. The parents come in to hold and feed their children and see the pleasure in their eyes. You can hear the excitement in a mother's voice when she hears her son “graduated” from an isolette to a crib. These are things that overcome the sadness of some of the other children and make the work worth while. And the best part is when you pick up a crying child and they calm and fall asleep in your arms while holding your fingers in their small hands. Actually, the best part is when they’re sleeping quietly in their cribs and stable so that the alarms don’t go off every minute haha And the coolest thing in the NICU is that you can save a life one foot flick and poke at a time

*****

A rookie mistake
Originally posted: January 28, 2007 at 2:47pm

It’s kind of scary sometimes when you think about someone’s life is in your hands when you’re at the hospital. Especially when it’s your turn to give out meds. We’re supposed to check and recheck, and then recheck again. And after you think you were being so careful and meticulous about them, you find out you might have done something wrong. It’s scary to think about making a mistake. The other day I was giving meds. I checked them on the orders, made sure I had the right drug, the right dose, right route, right time and the right patient. Then I checked compatibility because I was giving an IV push, along with hanging other IV piggybacks. And I thought everything looked good. So I gave my meds, my IVs, and my IV push. A little later I went to look up some of my meds for the next round. For whatever reason I went back to the IV meds I gave and checked compatibility again. One of them had “caution: variable” meaning the reactions with the two could potentially be incompatible. It’s a terrifying feeling. Your heart just drops. You feel the blood run from your face. You get nauseous. And then you just wish you didn’t wake up this morning at 545, because sleeping in and missing clinical might be better than accidentally hurting your patient. What do you do? What can you do?

I went to my nurse and I told her what had happened. We checked the IV compatibility on Micromedex and confirmed what I saw. We checked the patient (who was fine, no changes), and then I went to talk to my instructor. I was ready to get sent home, to fail clinical, drop out, and then go back home to figure out what to do with my life. Maybe live on the beach in a grass hut? I know I was exaggerating and thinking too far ahead, but when you’re panicking and unsure of what to do, your mind goes in every direction at once. So when I talked to my instructor, I showed her what I found and waited for judgment. And luckily, the meds were compatible. I didn’t mix meds incorrectly. I didn’t almost hurt my patient. And thankfully, my instructor knew what she was doing and wouldn’t let us make these kinds of mistakes. So as annoying as it might be sometimes to wait to give our meds with our instructor, there are benefits to it. Sometimes it’s necessary. Maybe some people are perfect in everything they do and never make mistakes. I’m not one of those people.

I think sometimes we are driven to do everything so perfectly, that little details need to be exact, and then find ourselves missing something really big because we’re too into the little things. Or maybe it’s the pressure that we put on ourselves to do everything exactly and correctly, that make us miss something so obvious. And as scary as it is, at some point we’ll make a mistake. Hopefully something bad doesn’t come of it. All we can do is try to do our best, not scary ourselves into being the most perfect nurse ever, and make ourselves think about what we’re doing. If you have a question or unsure of something, just go ask. If you don’t feel comfortable doing something, ask someone to help. I was lucky, really really lucky. It could have been a lot worse. But as students, we don’t have all the answers. We’ll make mistakes. And the best thing we can do is learn from them. So if you don’t already know, phenergan doesn’t go with Ringer’s Lactate (my patient had KCL). But make sure to double check!

*****

Awkward Communication
Originally Posted: October 21, 2006 at 8:34pm

Last week I attended the wedding of my older brother in California. It was a beautiful wedding and I was so excited to get away for a weekend. We had a three day weekend and my brother was nice enough to move the wedding date to accommodate my travel considerations so I didn’t have to leave in the middle of the party to fly somewhere like I did for my oldest brother’s wedding. I like weddings. It’s a celebration of love. And there’s a lot of good free food. I’m always for good free food. But one of the things I hate about weddings, particularly if you’re the youngest unmarried brother of the groom, people are bound to ask you annoying questions like “when are you getting married?” it’s one thing when family asks you that, because that is the eternal question any family member or close family friend will ask anyone unfortunate enough to be single. But what I don’t like is when a complete stranger comes up to you and asks you that question. Of course it’s to be expected, but I find it awkward and a little insulting at times. I don’t know you, and I probably don’t remember your name, and you’re asking a really personal question. It’s rarely, “are you seeing anyone special right now?” no, it’s straight for the jugular, “when are you getting married?!” Is it right to naturally assume someone is coupled? What about those lonely singles out there? What about those who aren’t allowed to get married? Maybe we don’t need a big party or a wedding to celebrate the love that we have for one another. Maybe I’m a little touchy about people asking me about my marriage prospects. For some I replied with “I can’t get married until the laws change” and would smile and watch the confused expression cross their faces and perhaps a dawning of understanding. Most of the time when I was asked by strangers I just said “Not for a long long time” and made a V line for the door. I wouldn’t wait for that look of pity and the condescending “you’ll meet someone someday…” I don’t like having to explain myself all day long, and I shouldn’t have to. Those questions make me feel horrifically awkward, and I’m sure the other person feels just as awkward too. I say we dispense with awkward questions, and not bother trying to talk to complete strangers haha no I’m kidding… for the most part.

But I guess this has been the week of awkward questions. People have been coming out of the woodwork with them, and I’ve been asking them also. I’ve been getting the, “so… you’re a male nursing student… how’s that working out?” and the “so you really wanted to become a nurse, not a doctor?” questions and it gets on my nerves quite a bit. And perhaps I am not the most socially adept person and I might have fallen asleep briefly during some our therapeutic communication lectures, but how do you answer those questions? How do you not get offended by the negative connotations and not want to pull out your hair in frustration. I’ve always tried to not put much stock into what other people think or say about me, but it doesn’t mean I don’t get annoyed or feel awkward. I’m not saying I never put my foot in my mouth and ask awkward questions. My face still becomes red with embarrassment when I’m asking a postpartum woman how her hemorrhoids are doing while she’s laying on her side and exposed with myself and my instructor examining her ‘roids (although I’m thinking that she’d feel more embarrassed than I would be). I still feel my ears get warm and the hairs on the back of my neck rise when I know someone is going to say something that will offend me. But I try not to let it eat away at me. And it still bothers me sometimes when people make ignorant judgments about me or others for the decisions we make for ourselves.

But I guess it’s something I’ll have to learn to deal with and not get too worked up about. People will offend you whether they mean it or not. It’s usually it’s innocent, but unfortunately, it’s part of the job. No one said it would be easy. It takes a really strong person to be a nurse. It takes dedication and discipline, a thick skin and the ability to take the abuse, and the knowledge when to accept it and when not to. And it also takes a strong will to not smack someone when they say something stupid and offensive. We do it because we care. If we were in it for the money, we’d be doing something easier. If we wanted recognition and fame, we would have chosen a more glamorous job. But sometimes the benefits outweigh the difficulties and the headaches. When a patient sincerely thanks you for your help, or when a fellow nurse praises a male going into nursing, then it’s worth the abuse, the irritation and the indignity that sometime follow the job. It’s about being proud of yourself for your work and loving who you are. It makes those hard questions a little less awkward and easier to answer. Maybe I’m still trying to get used to these questions. Maybe someday when someone asks me one of those nurse related questions I won’t get annoyed or feel like I have to explain my choices all the time. And maybe someday when some stranger asks me at a wedding when I will be getting married, maybe I’ll tell them the laws finally changed and that my partner and I have the date for sometime next year.

Sorry folks if this entry was a bit scatterbrained, it’s a scatterbrained time. It’s late, I’m tired, and I like to kill as many birds with one stone. I wanted to celebrate my brothers wedding, send a shout out to the LGBT community at school (I missed the lunch last week because I was too hungry to wait until 1230 to eat and wanted to go to a ER/transplant nursing meeting), talk about some of the difficulties and rewards of nursing, and emphasize the importance of therapeutic communication. We need to learn talk gooder and avoid the awkwardness!