Friday, December 4, 2009
Journey to a Foreign Land - Observations of the NICU
Dylan spent the first 12 days of his life in the Neonatal Intensive Care Unit ("Nick-You") at Crummy Hospital. I still hope to share his birth story in detail, which will involve more about what led to his admission there, but for now, I'll just concentrate on my observations of the NICU itself. For me, it was such a strange, foreign place that initially I knew so little about, and when I could take a deep breath and step back from the care my son was receiving, I found it fascinating.
I suspect there are things most NICUs and hospitals have in common, and others that are particular to "ours." Regardless of the time of day, there were always people milling about outside the hospital entrance. Not infrequently, there were patients in hospital gowns sucking hard on forbidden cigarettes under the flag pole. Other times, when general visiting hours were over at 8:00 p.m., there were family members conferring. Then, we felt a certain privilege, I guess, that because of our son's condition, we were allowed in anytime. Security would slide the doors open and we'd sign in.
There were posters everywhere warning about H1N1 and admonishing us to "gel" frequently. In fact, while we were there, the hospital was restricted to visitors 18 years and older because of the virus.
After several days of riding the elevator up to the fourth floor and down, we determined that climbing the stairs might be the only form of exercise we'd get in awhile. So, we began hoofing it and often arrived a bit winded.
To enter the NICU, we had to buzz at a door along a corridor and announce who was visiting, and then we had to relate (and sometime show a tiny camera) the number on our hospital bands. Only parents and grandparents of patients were allowed in. (V. and I got a chuckle when we announced to the speaker that Dylan's motherS were there to see him.)
Then we entered a world without day or night, without sunshine or weather, absolutely void of nature. The florescent lights were always on. Nurses and therapists and occasionally doctors were buzzing about. And it was always LOUD.
There were probably thirty kids in there, and I'd venture to guess they all had at least three different monitors on them, each of which would bing loudly if its input varied out of a certain range. For example, at one point, Dylan had four different "leads": one each for blood saturation level, heart rate, respiration rate, and body temperature. They were constantly going off - which was always a bit, urm, alarming! Then we learned that if he squiggled just a bit, they'd move off their intended target, thus triggering all the commotion. Though at first we were glad they were there, we came to view the alarms as very annoying.
Immediately upon entering the unit, we had to scrub our hands (to ensure we did it long enough, we were instructed to hum "Happy Birthday"), wipe with paper towel, and then also use antibacterial fluid. Anytime we touched something - our faces, a diaper, each other - we thought might be germy, we repeated the process. We did it so often and habitually that for days after Dylan was discharged, I was still trying to turn on faucets with a foot pedal like the hospital sinks'!
Then we'd nod greetings to various folks as we headed to our son. The unit itself seemed to be divided into different sections, depending on the level and kind of care required. Dylan was with the other "big" kids. It was pretty apparent to us as soon as we saw some of the tiny, tiny babies with all kinds of wires and tubes, that our boy was one of the healthier ones.
For the first eight days or so, he was in an isolette, a contraption we determined must cost much, much more than my car. Its a Plexiglas bassinet with temperature and gas flow and other controls. It can move up and down, be positioned on an incline, has breaks, and various portholes, some for hands, and some for wires and tubes. Most of the kids were placed in these, typically with little "sheepskins" designed to help prevent bed sores.
Initially, Dylan was in a more open isolette, so that there was easier access to him for various procedures and monitoring. We came to see the day he was moved to the "glass box" as a sign of good improvement. And ultimately, a few days before being discharged, they moved him to a simple clear plastic tub because he didn't need any more of the bells and whistles. (In fact, they even moved him off the unit into Pediatrics where we got to spend two very uncomfortable nights on a big lounge chair with him in his private room.)
Lucky for us, his isolette was positioned close to the one window in the big room that made the unit visible from the corridor. The day after our son was born, there was a crowd of non-parental relatives gathered, pressing their noses against the glass, hoping to catch a glimpse of the wee one.
Upon arrival at Dylan's isolette, we'd learn who was looking after him. This NICU ran on 12 hour shifts, and visitors were allowed anytime except during the shift change, between 6:30 and 7:30 both in the morning and in the evening. (We came to understand that they often did the more complex or uncomfortable procedures during the shift changes too, likely so the visitors wouldn't get in the way.)
For some reason, the same nurse was rarely assigned to the same patient during the same time period. M. speculated that this might be intentional, to avoid inappropriate bonding between staff, patients, and family members. I don't know if I buy this, because I don't know what the downside would be, but it did seem odd that every day, twice a day, we were introducing ourselves to new personnel.
During our little guy's stay, he must have had twenty different nurses, and (with just one small exception) they were all truly wonderful, warm, caring people. I was going to say "women," but he did have one very good male nurse while he was there, and in fact, one of the three "charge" nurses - the nurse in charge of the unit - was a really nice guy who helped us out once when Dylan was tangled in some cords and the "small exception" above was not paying attention to him.
Truly, the nurses were wonderful. As the days progressed, we began to observe that, as in other social microcosms, there were different cliques of nurses. While they all worked well and were friendly with each other, when there was a slower moment, or someone was headed off to lunch, we could see where there were stronger bonds. One clique was comprised of the Filipina nurses who sometimes chatted and joked in Tagalog. Another clique was comprised of South Asian nurses, who most often spoke English to each other, but occasionally I overheard another language (Hindi?). One of our favorite nurses - who came to check on Dylan and us often during his stay, many days after she was assigned to him - was from this group. And the third clique was young, mostly blond women from the area around the hospital. Oddly, a number of these nurses were new mothers themselves, so I enjoyed getting some new momma advice from them. Perhaps I am reading too much into it, but it makes me kind of sad that the cliques seem to form around cultural lines.
Oddly, there were just two doctors - pediatricians - who were ever in the unit. One was assigned to Dylan. He certainly seemed dedicated and competent, but he wasn't "warm and fuzzy," and he was rather tight lipped. Since the nurses typically asked us to wait and get medical updates from him and he'd make rounds at different, unpredictable times on different days, many days we wouldn't see him at all. And sometimes we'd see him and delay our departure with the hope that he'd make his way down the row of patients quickly so that we could ply more information from him.
It wasn't just medial personnel with whom we interacted while in the NICU. We also got to know and appreciate some of the other patients' families. There was the very young mother of a tiny baby boy right next to Dylan. She came most days, sometimes with her gangsta looking beau, and sometimes with her very proud mom. She'd hold and feed and coo to her son. Once we saw her waiting at the bus stop in front of the hospital. She'd be taking public transportation to spend time with her precious boy from many months until he is big enough to go home. I was in awe.
There was a loving couple who explained to us that the daughter who was born ten weeks too early was their first, but that he had three from another marriage and that she had two as well. I was so impressed by their dedication. She always showed up with frozen bottles of breast milk. And you should've heard the way he flirted with his little girl! He tickled her feet, talked with and sang to her, and was so excited about her every little improvement. They were so nice about always asking us how Dylan was doing and telling us what a handsome son we have.
There was another nice couple whose son was there for only a few days. We were alarmed to learn that their little boy was named...Dylan. So much for our name being fairly unusual!
I also enjoyed my interaction with a young Sikh couple. I barely spoke with the shy young woman, but her husband was quite affable. He was clearly proud of his son, and after several days of friendly greetings, came over and chatted with me for awhile while I was feeding Dylan. He explained that he had just been in the States for 10 days for the birth, joining his wife who'd been here for the last four months. He and his wife were married just nine months before in Punjab, 14 days after they were introduced by their families. He asked me lots of questions about Americans, which I enjoyed trying to answer. I also told him that his young family was now living in a beautiful state, and I encouraged him to do what he could to travel beyond his new hometown to explore the mountains, beaches, and cities of California.
During our stay, we explained to so many people that we were adopting our son. Regardless of position or culture or connection, they responded enthusiastically.
I've told several people that, as eager as we were to leave the hospital and bring our son home, there were some advantages to his stay there beyond the obvious medical attention he was receiving. For one, it was very helpful to us newbie parents to have experts to show us how to diaper, feed, swaddle, and bath our little guy. It was also reassuring to see the way they handled him - so NOT gingerly. It gave me confidence that he isn't that fragile and that if I was reasonable careful, I wouldn't hurt him. They also advocated "kangaroo care," which we love so much we continue to do today at home. We lay the baby's head near our hearts and hold tight. It's a proven theory that this skin-to-skin contact calms little patients down, speeds development, and improves vital signs.
Having our son in the hospital for the first two weeks actually enabled a fairly soft transition to parenting. It was really nice to be able to leave the hospital, knowing he was receiving excellent care, and go out to a good dinner with a glass of wine or "home" to a full night's sleep.
I wrote earlier that we had hoped he'd be born at Fancy Hospital, but it ended up that he was born at Crummy Hospital. Turns out, we are very grateful he was. Crummy is a county hospital with excellent emergency and acute care facilities. We heard many times from people there and others completely unaffiliated that, because they have so many patients, and so many of them are so seriously ill, our son was at the best NICU in the county.
Indeed, the NICU wasn't pretty. In fact, it was a bit shabby in places. But we had a very positive experience there - well, as positive an experience as having your son in the hospital more than two hours from home could be. I think often of the nurses and other medical staff, the families, and the little bitty patients we interacted with while we were there. What strikes me most is that Dylan was born in this medically advanced country, at a time when his issues could easily be resolved with just a little time and attention. How very fortunate we are.