A letter to a preemie. I really hadn’t planned on writing about nursing on my blog when I started it. I told myself, that will be one topic I won’t touch on. Like I won’t ever write about make up and fashion, because I’m not good at those things. I didn’t want to write about nursing because I’m not a pro at getting into nursing school or even a pro at NICU nursing. It was a miracle I got into nursing school, got through it and got a job. And it’s a God-thing that I’m even still in nursing! Maybe that will be a story for another day.
But recently, I have felt that I need to write a letter. A letter to my preemies. So here it goes….
A Letter To A Preemie
Good morning little sir,
My name is Stephanie and I’ll be your nurse again today. Remember me? I’ve had you a couple of times. When I walk in and see that I have you as a 1:1, it always makes me a little nervous. Will I have the knowledge and skill to get through the shift today? Will you have a good day or a bad one? I always pray you have a good day.
I get report and find out how you have been doing. The night shift nurse says you had a pretty rough night. Well, today is a new day and I will do my best to make today a little better. But it’s really all up to you, isn’t it? It’s up to your little body to keep fighting, healing and growing. You’re too small though. You were born too early. You don’t have the energy or the body to do this on your own. It’s okay, little one. Everyone here in the NICU, (neonatal intensive care unit) is here to help you.
The first set of cares always takes the longest. I have to assess you, every line, tube and machine that is attached to you. Today, you have a lot of things to assess. I have to make sure the machine that helps you breathe is working properly, and that you are comfortable with the support we are giving you. I’m watching to see if your tubes are all in the right place, doing what they are made to do. I must make sure your IVs and other lines are still good and running the right fluids into you. You need the right nutrition. Not too much and not too little.
Your vital signs are very important, so I have to take your temperature. Then I change your tiny diaper. I know it makes you tired and sometimes it’s too much for your little body to handle. I’m sorry. I do my best to help you conserve energy. The doctor, respiratory therapist and I all have to touch you, move you and examine you.
Then sometimes, I get to feed you! If your tummy is tolerating the feedings, I hook up the tiny amount of continuous feeding. You can’t eat yet so I hook it up to the tube that goes to your tummy. I also get to put your mom’s breast milk on a little q-tip and clean your mouth. You usually like this because you suck on the q-tip. I can tell it makes you happy, because your oxygen numbers go up. After that, I will give you a break. I will wrap you up in the amazing wraps that the hospital provides. I’ll re-position you so you don’t get pressure sores. I will place the tiny piece of cloth that smells like your mom next to your face. And then I will stop touching and moving you, and let you rest.
I sit by your bedside all day. I only leave when I have to go on break. Sometimes I don’t go to break because you are becoming unstable. Your oxygen goes up and down and up and down. I have to give you more oxygen and then I have to give you less. You forget to keep breathing sometimes so I have to go into your isolette and touch you to remind you. The doctor writes orders and we get blood samples often. You have an infection because you have no energy or antibodies to fight it off. We constantly have to monitor your blood to see what your body is doing.
The respiratory therapist (RT) gets a blood gas. That’s to see if our machine that helps you breathe is working as well as we hope. The RT comes back and says it isn’t good. We need to change you to something else. So I help them change it, but you don’t handle it well. Your oxygen drops a lot, your heart rate soars up too high, and your blood pressure drops too low. So we call for help. A lot of people fill in close to your bedside. The RT is helping you breathe by manually giving you breaths through a bag. The doctor comes to give us orders and hopefully figure out what’s happening. The pharmacist comes to help us order medications and get them quickly. More nurses come to help me.
At this point, my heart is probably beating just as fast as yours. I know what to do, but it always makes me nervous. I follow what the doctor is saying. Another nurse is helping to write everything down so I can remember later. Nothing that we try is working, though. Your oxygen isn’t coming up, and neither is your blood pressure. We give you fluids. The fluid should fix your blood pressure, but it doesn’t. The doctor tells us to get the blood pressure medication. The pharmacist works on that. The respiratory therapist is still helping you breathe.
The x-ray tech joins us now to get a picture of your chest. The doctor hopes this shows us the problem. They see with the x-ray what is going on inside your lungs and work to fix it.
We get the blood pressure medication fast, so I check it and hook it up as fast as I can. I know this will help you. It isn’t the first time we have had to do this with you. I start it and wait for it to work, but it doesn’t work fast enough. The doctor says to get another blood pressure medication. That one comes up and I do the same thing, hoping it will work this time. Your tiny heart is still beating too fast, and your oxygen still isn’t the best that it could be. But the doctor has finished her procedure and we hope that fixes things! Another x-ray, another medication, another lab draw. I am still nervous.
My colleagues and I are busy running to get supplies, checking medications, and writing everything down. While I am running around, I am praying that you fight. I pray that God will give you one more day and you get through this. Everyone around the bedside is praying you make it through this. We have you hooked back up to the breathing machine. All of the medications are running. Your blood pressure is slowly starting to rise. Your oxygen is better and in the right range, but the doctor orders more medications and some blood. We have taken a lot of your blood for labs, so sometimes we need to replace it because you can’t make it fast enough. All of us pray that these things will work and help you survive.
Things start to look a little better. You are becoming more stable. It’s 1900 now, so the night shift nurse is coming back in to replace me. I give her report and tell her what happened today. She can see by all the new tubes and medications that you did not have a very good day. She can also tell that you aren’t very stable by all the orders she still has to do for you. So she takes over your care right where I leave off. She will hang the blood, give you medications, and monitor your oxygen just as closely as I have. She will take very good care of you tonight.
Now I have time to chart. It takes me a while since we did so much for you. I stay over an extra hour, but I don’t mind. As I finish my charting and get ready to leave, I hover over your bedside one last time. I hope it won’t be the last time I see you. I pray that you will fight tonight, and that everything we did for you will help you to survive. As I drive home I am pretty sad because I think about the long fight you have ahead of you tonight. When I get home, I eat a little dinner, even though it’s late. I fall into bed because my feet hurt and I have a headache. It was a long day for both of us. I think about you as I close my eyes and pray.
I wake up in the morning ready to go back to work. When I rush into the unit, the first thing I do is look for you. Did you make it? Did you fight? When I see your isolette still in the same spot, I almost cry tears of joy. I am honestly so surprised. It is a miracle! You made it through the night. All the craziness and stress of yesterday is behind you. I am so proud of you little one. You are such a fighter. So I start work, and I pray that today you have a good day.
Your NICU nurse