me reflecting on the art of practicing the finest of Fine Arts

Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit? It is one of the Fine Arts: I had almost said, the finest of Fine Arts

~ Florence Nightingale.

A little more than twenty-five years ago this happened.

It’s true we actually shouted “SMEGMA” as the photographer got this shot. New grad nurses, actually nurses in general can be kind of gross, sick and twisty in our humor, especially when tired, hungry, frustrated, grossed out, ready to cry or just about to lose our shit. The reality is posed in proper, starched nursing whites under a 90 something degree hot sun we were just about to lose our shit as it seemed to take forever to get this shot of my graduating class. Kick-ass, rockstar nurses we were all destined to be; but being able to line up and pose together as a group….not so much. So when the photographer directed us to say “cheese“, “SMEGMA” it was.

Literally a week later, two fellow classmates and I entered the NICU as new grad registered nurses. Dressed in the NICU’s pink scrubs, we walked through the double doors shoulder to shoulder to shoulder scared and excited all at once. Our NICU nurse educator ran up to us exclaiming, “Oh good! You’re here. We’re admitting a 27 weaker right now. You need to come and see this.

My first thought as she led the way was she seemed just a little too excited about admitting a baby born 13 weeks too soon. My second thought, as we approached the bedside and as the four caregivers stepped aside so that we could see was what in the world had I got myself into. That baby seemed to be no bigger than my hand. Her skin was translucent. I could see some of her blood vessels. She looked like a broken baby bird that had fallen from her nest.

Just a week later, I picked up her less than 2 pound body and flipped her from her tummy to her back, breathing tube, monitor wires and multiple IV lines all still attached to her impossibly tiny body. “You need to breath.”, my preceptor whispered into my ear…quite possibly the best advice I have ever received from an RN who helped to train and educate me; second only to always, always take a break when offered.

Twenty-five years later, I received a card from that baby girl’s mama that she, Baby Bailey, was expecting her first child.

Yeah, that seals it. I’m one of the old nurses.

Twenty-five years of always doing what I love to do…taking care of the tiny humans and their mommies, daddies, brothers, sisters and grandparents. Lots of babies. So many babies. So much love. So much laughter. So many tears. Learning so much…always learning…always….as one does when one is practicing one of the finest of Fine Arts. Always appreciating the opportunity to do what I love…enjoying the grateful hugs from a mommy and daddy as we together pack up their baby to finally go home from the NICU after literally weeks and weeks and then only a few hours later hugging a tearful mama who is literally experiencing the worst day of her life as she hears that her baby is dying.

Twenty five years. Some days are worse. Some days are better. Some days are frustrating and exhausting. But rewarding, exhilarating and wonderful all the same. Some days are hard….horribly hard. But most days are good…the goodest of good which literally saves you from the most heartbreaking, pain-filled days. Then years later receiving a card like Bailey’s mama sent me reminds me again the good my practice has done because Bailey is soon going to be a mommy. That, my friends is indeed Fine Art, Fine Art that I can lay claim to as is each and every tiny, mighty human and their families I have had the privilege to lay hands upon for over the last twenty five years in the NICU. Here’s to many more years, for as long as my mind, my heart, my eyes and my body allows me to.

parenting NICU style

Wa-ay back when I was a nursing student, one of my professors shared a cautionary tale about patients and medical abbreviations. A nurse, preparing to assess her patient, sets down her clipboard. While she is carefully assessing her patient, the patient spies his name on her clipboard with the word “SOB” next to it. What followed, the professor shared, was more than awkward for nurse and patient.

In case you didn’t already know, “SOB” is a medical abbreviation for shortness of breath. The nurse’s patient had emphysema and indeed was struggling with shortness of breath. He might have also been an SoB too…then again, he might have been an all around nice guy. Who knows?

There were many takeaways for us to learn from that scenario that the professor shared. For me, the biggest one was to not let my patients or loved ones see my shift notes. I keep them in my pocket.

This lesson came to mind the other day while reading through one of the micropreemie parenting forums I participate in. A parent shared her frustration of over-hearing her baby’s nurse share with the nurse taking over her baby’s care that she had been crying. Not understanding what that had to do with anything, she vented that they should not be worried about her because their job is to take care of her baby. Who cares if she was crying? The NICU nurse in me wanted to comment as to why the nurses might have been talking about her during their hand-off report. The NICU parent in me knew that she just needed to vent because for many micropreemie parents, there are few, if any, safe places to vent off some of the tears, fears, pain, frustrations and anger that is life as a parent in the NICU.

As a parent in the NICU, I know too well that feeling of being watched over, scrutinized even. In the NICU where Daniel was, where I also worked, parents had access to the bedside chart and were more than welcome to look at it. It was not uncommon to see a note or more about Bill or myself visiting Daniel. Weird to be under a microscope and analyzed in that way…especially because we already felt intense pressure from social workers, family and friends who questioned our motives to want to be Daniel’s family. Stir in the fact that a number of my own colleagues were against our plans (and quite vocal about it) and my being called into my manager’s office a couple of times because staff and administration had a number of concerns about my wanting to adopt a patient in the unit because something like this had never happened at that hospital before. “People might think we are ‘giving babies away at Good Sam’!” 

The horror of such a thing! 

Not fun it was.

If only there was a forum like the one I participate in thirteen years ago!

With most NICUs in the US focused on Family-Centered Care and many hospitals keeping an eye on overall patient and family satisfaction, odds are families are going to be right there during change of shift hand-offs and rounds…unlike the “old” days when I was a baby NICU RN and the unit was closed to family visits and calls during change of shift so that we could focus on the hand-off of patient care.

Being a parent in the NICU is hard. Other people seem to know more about your own baby than you do. They tell you when you may touch them, when you can hold them, feed them, change their diaper. You feel guilt that your baby was born early, that you can’t be at their bedside 24/7, that your other children need you, that your husband needs you, that everything else going on in your life is being ignored. You deal with questions…questions all the time as to why the baby was born early, what did YOU do to cause that, what’s going on currently with the baby, why isn’t the doctors and nurses doing what your co-worker’s nephew’s baby had done to her, why aren’t you at the hospital right now, why aren’t you spending time with your other children because they need you too….and on and on and on. Doctors and nurses and staff either seem to act as though you’re not even there or are hovering not giving you just a quiet moment alone with your baby. And god help you if you break down and cry or yell and scream in the NICU, at home, in church, at the school drop-off, in front of your parents or your in-laws.

NICU parents, am I close?

For what it’s worth, speaking as a NICU RN, when we share with colleagues that mom was crying today, or dad keeps asking the same question repeatedly or the family’s only car broke down or almost anything else family-related it is because the care we give is Family-Centered Care. Our role is to care for the baby first but we also are caring for and supporting the family during one of the most stressful times in their lives as a family…until their baby is a moody teenager. It helps the staff to know that mom is having difficulty producing breast milk or that her mother in law doesn’t want to drive her to the NICU anymore or dad just got laid off or little brother is sick with the flu so that we can better address what the family and the baby needs right now…and what they need to be ready for discharge because, god-willing, discharge will happen sooner than a NICU parent can hope to imagine.

What an amazing day that is when your baby is finally free of every single wire, tube and tape that is attached to his body and you pick him up and hold anytime you want to!

It’s a day that every NICU parent and NICU nurse, doctor, respiratory therapist, social worker and unit coordinator looks forward to as well.

Meanwhile, dear fellow NICU parents, cry if you want to, vent away too, but most of all, hang in there. Your journey is just beginning and this right now is preparing you for the weeks, months and years after the NICU.

 

 

for the future important people

This week in my social media:

And one special gem that made me smile and made me cry.

Dr. Carey D. Andrew-Jaja’s joy shines out like a bright beacon in this video. It reminded me of the fact that for the last 25 years I always whisper “happy birthday” to each and every tiny human I have the privilege of greeting on the day that they are born because this day really is a day to celebrate meeting a future important person. Oh, and I am reminded once again that I do have the best job ever shaking the hands of countless important people.

The mother of this one reminded me yesterday that she turned 9 years old. Honestly, it seems like it was yesterday when she and I shook hands for the first time.

 

 

photo dump: the thankful edition

It’s Thanksgiving Day so I’m going to give thanks, as one should on Thanksgiving Day…and every other day.

For Thing 1 and Thing 2, generously provided by my employer and a co-worker who has no use for the 12 pound turkey they handed him as we left work early in the morning last week. Yes, I named them, as I do every year. Deal with it! Meanwhile, Thing 1 and Thing 2 are currently soaking in an icy cold, brine-y bath waiting to be properly roasted.

For bringing sexy back in the way that only Personal Protective Equipment can. This look is hot. No. It really is hot.

The perfect pick-me-up after running 4 miles before you work your 4th 12 hour night shift in a week. Hurray for Snickers and for running and for a busy, busy full NICU which means work!

For kick-ass looking compression socks to wear after running a few miles before working hard on your feet for 12 hours all night long. Oh, and, give thanks for the break relief RN who makes the moment where you get to put your feet up for 20 minutes.

Be thankful for the 2 hour nap you had after working all night before you take the time to drive your favorite Princess 125 miles in the rain and wind and fog across a couple bridges during drive time Bay Area traffic so that she can attend two hours of Princess training.

It’s totally worth it when she sends you this picture of her being fitted for the wig of her favorite princess, one of a few who she will be portraying. Yes, you can almost hear her squeeing with delight from the only open cafe in the area where you sat and waited during those two hours. Worth it. Totally. So was her telling you how much she loved you and was glad you were driving as you drove across the Richmond-San Rafael Bridge in the 0.25 mile visibility fog.

This card with this name on it which we waited for for 12 years because no matter what the social workers tell you, it isn’t as easy as it should be to get your child’s social security card with his name on it after the adoption is finalized because government agencies can be so frustratingly dumb sometimes. But not Maria at the Manteca Social Security Administration office. Sure it took her several hours to figure a way around the bureaucratic walls but she did it because, as she humbly put it, “there’s always a way around walls.”

Remembering when you said you couldn’t wait for your kid to outgrow his shoes and clothes before they wear out when you see that the shoes that you just got him are too small. Human Growth Hormones, we are so thankful especially when you see your son’s height and weight plotted at <1%ile on the growth chart because look at that, the kid is almost finally plotting on the normal growth chart!

Pretty scarves and jewelry and makeup and clothes that flatter what your mama gave you, no matter what your age is, that you wear for no other reason than because you want to; which has nothing to do with completely unwanted attention from any stranger who imagines that you got all dressed up because you want their attention.

Yeah.

No.

Taking the time to catch part 3 of the 4 part Hunger Games Trilogy with this child of yours because that is what the two of you do together after the husbands and kids are asleep.

Running this for the third holiday season because otherwise you might just murder someone…or at least given them a really big hug with your hands around their neck because it is the holidays and because you like to eat and to drink because it is the holidays and because you like to run…a lot.

Moments of relaxation and the cat who makes you sit still and enjoy them. I plan to do just that today after I run a 10K and get Thing 1 and Thing 2 into the oven.

Happy Thanksgiving y’all!

 

adjusted for prematurity

Yes, today is World Prematurity Day because one in nine babies every day are born much too soon. Check out #WorldPrematurityDay and you shall see hundreds and hundreds of images of babies who literally can fit into your hands wearing diapers no bigger than a saltine cracker and you shall see pictures of some of those same tiny babies as smiling school aged children or teenagers or even adults. My own social media timelines are flooded with images of some co-workers own preemies and friends and the parents of former patients as we recognize the tiniest but mightiest humans we have ever known not necessarily to celebrate but to remind everyone that in spite of amazing strides in Perinatal and Neonatal medicine and nursing care, prematurity still happens and when it happens the adjustments for prematurity happen.

age 1 month/28 weeks adjusted age; 792 grams/1lb 7oz

I remember having to explain way too many times the adjusted age of Daniel during the first few years of his life. How that adjusted age seemed to annoy some as they would sarcastically question if we were going to be using his adjusted age when he was a grown man.

Perhaps.

Maybe.

What do you care?

As he has grown and developed, knowing Daniel’s adjusted age helped so much in understanding this life living on preemie time. It helped to have just a little more patience when he didn’t walk until age 30 months (26 months adjusted age) or when we struggled so mightily with potty training and eating. But the fact of the matter is that after the magical age of 2 or 3, adjusting does not abruptly end. Experience has taught me that these tiny humans carry so much more than the physical scars of needle pokes, TCM burns, healed incisions and chest tube scars. The bright lights, the loud, clanging alarms, the noxious smells, even certain touches remind them of the trauma they survived that was intended to help them survive. PTSD is readily accepted in adults after hospitalization, why would it not be valid for a tiny infant whose brain isn’t even fully developed and spends weeks, months even in an intensive care setting? Just because they can’t articulate it does not mean that it is not real.

The fact of the matter is for this child, this boy, there is always adjustments for his extreme premature birth. Adjustments in how he learns, how he expresses himself, how he eats, how he grows, how he handles noxious stimuli, how he reacts in stressful situations. Adjustments because he is who he is. We have come to learn and understand so much of who this boy is and what he is passionate about just by adjusting. He’ll never stop being an individual who was born 4 months too soon. He will always be that. Today, and every day, we honor that, we celebrate it, we accept it and, yes, we adjust.

I feared because it was too early, I cried because it was too soon. Yet I underestimated the strength in one as small as you. ~ Unknown