NICU

The Header Image

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Just a quick story about the header image. It is a panoramic shot of London’s second room in the NICU. This is really the penthouse of the NICU. When we moved from our original pod to this one it felt like going from the ground floor to the fiftieth floor. It’s 1.5 times the size of our first room and it is the only room in the NICU with a whole wall of windows. Our first room had no windows.

I was hesitant when the room opened up and it was first mentioned to us that we could possibly move in there. This was the room that was opposite our first room. I wrote about it in this post. So, you understand my hesitancy.

One of our primary nurses had one stipulation about our move into this room. She said that everyone else that gets that room always ends up pulling the shades and blocking the only flood of natural light the NICU gets. If we were to move in there, we would have to promise her that we would only have the shades down in the morning when the sun is unpleasantly shining straight into the NICU’s eyes. We promised. I got over my initial hesitancy and we made the move, knowing that we had well over a month left in the NICU so why not upgrade for free?

The move was one of the smartest things we did while London was in the NICU. We were there for quite a bit longer than we thought we were going to be. We fell in love with that room, as much as one can fall in love with a hospital room.

Toward the end of London’s NICU stay, there was a leak in the ceiling in London’s room and we had to give it up for just one night while it was fixed. The next morning I came back to the NICU and London was in her temporary room, which was much further back in the NICU. No natural light made it there. Everyone was pale and had a depressed look on their face. At least, that’s the way it seemed after living in the penthouse for so long. I only had to sit with London in that room for 40 minutes, but that was more than enough. I pushed her back to her pod with a nurse and it was like stepping out of a tunnel into a glorious sunny day.

We are so thankful for that upgrade.

Blinded By The Light

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Last night, Kate and I watched some old videos of London in the NICU as we were falling asleep. We did this every night while she was in the NICU. Now, not so much, because we can get out of bed and walk twenty feet to her crib and there she is, sleeping so peacefully. As we scrolled through old photos and videos on our camera roll, we happened upon this one…

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Kate said, “You should write about this picture and the bili lights.”

“Okay,” I said. But it took me a few more minutes to figure out where I could go with a post about this picture. First, I should just tell you about the picture, it is of a very small stuffed animal (beany baby size) wearing the goggles that London wore while she was under the bili lights. We have a couple of these BluBlockers because the nurses thought London was done with the bili lights and then she went back on them after we had taken the first goggles home.

These goggles were addicting to me once they were home because I could, whenever I would pass them in the living room, pick them up and smell them. Their smell transported me back to London’s room. So when these goggles came home, it felt, for the first time, like we had brought a little bit of London home with us. Before bed I would inhale deeply from the goggles. When I got downstairs in the morning I would take another hit from the goggles. It’s starting to sound like I’m talking about a bong, but that’s entirely appropriate because the smell of these goggles made me relax, they transported me to another place, and I was at peace.

Sadly, the goggles eventually lost their scent of newborn London. Unfortunately, one can’t take that smell and store it away in a NICU keepsakes box where the goggles now rest.

Every one of the fifteen weeks London was in the NICU, I took a load of her laundry home. And every time I was about to put her clothes in the washer I smelled them, although with clothes I had to carefully select where I was going to plunge my nose. Then I threw them into the washer. By the way, do you know how many preemie outfits you can fit in a modern washer? I’ll save you the calculation: a lot.

Smell was and still is an essential way to connect to your baby, especially if they are in an isolette. Even before we were discharged from Kate’s room at the hospital the nurses had us wearing receiving blankets in our shirts as we slept. Whenever we were next at London’s side, the nurses took the blankets from us and placed them near her head or wrapped her up in them. The blankets were supposed to familiarize London with her parents’ smell.

I liked to think of her taking a deep inhale from the receiving blanket before she fell asleep in her hot and humid isolette. And again, in the morning, taking a deep breath and catching a hint of mom or dad in the air so a part of us was always with her.

Mind the Hierarchy

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Here’s a pro tip for doctors from someone with no formal medical training:

When you are a resident, regardless of what year you are, introduce yourself as such when you are greeting parents of a 26-week preemie (or any other person in the hospital). Do not say, “Hi, I’m the neonatologist,” as if you are the attending when I can clearly read the giant block letters on your name tag that spell out, “R E S I D E N T.”

Important reasons for identifying yourself as a resident, in no particular order, are:

1. If you’re not a great doctor and you introduce yourself as the neonatologist we are going to assume, at the very least, that you are a fellow or maybe even an attending. And then we will be frightened because if you’re the fellow, then who the hell is the resident and are they next to my baby and, if so, can they please step away from her right now.

2. It’s nice of patients or parents of patients to know your resident status. We will actually give you a little slack (some of us will) because we know you are in an intense three-year period pursuing specialization in your desired field of study.

3. If you say something we disagree with or want to challenge (for example, ordering up another chest X-ray), it’s important for us to know you are the resident so we can communicate to you that we want the fellow’s opinion as well or that we want the attending in on this decision.

4. In rounds, don’t forget that you are the resident. You may be high on your horse, but remember, there are nurses in this circle that have been taking care of preemies since before you were born. There’s also a hierarchy. If a fellow is challenging your idea and nurses are backing up that fellow and the attending is sitting nearby not saying anything, that should really clue you in to the fact that the attending approves of what is happening.

5. You earn your title. Attending. Fellow. Resident. Intern. Clerk. Sub-I. So let us know exactly where in this hierarchy you reside. It’ll be best for all of us.

Daddy Kangaroo Care

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The best thing a dad can do for his baby in the NICU is kangaroo care. Mom’s got the breast milk covered, so dad needs to, again, man up, take his shirt off (or unbutton the shirt until it’s open), grab his baby, and sit in a chair for a few hours. When kangaroo care was explained to me, it was emphasized that the most beneficial kangaroo care is skin-t0-skin and that some dads are a little hesitant about taking their shirt off to do this. This was not the only time I heard of machismo getting in the way of taking care of a baby. (That is a whole other topic that I would like to address in later posts.)

After two weeks of London’s life, we were allowed to do kangaroo care with her. Of course, mom got the honors, but I worked my kangaroo care in when Kate had to hook up to the breast pump.

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For the next couple of weeks London was small enough to tuck into Kate’s shirt. I thought that was the cutest. The two of them were so happy together during kangaroo care. I could not stop smiling whenever I would look at them. It was such a peaceful scene that I too could fall asleep even though I had been drinking iced coffee since I got up.

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The most challenging part about kangaroo care is the management of the tubes and wires when you are moving from isolette to recliner. Once the transfer is complete, you get to enjoy the easiest part about kangaroo care, falling asleep.

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Not the sharpest picture, but look at Kate, my sweet Kate. Whatever was happening that day with London, as soon as she got on mom’s chest she was doing better and every single time Kate looked like she was having the time of her life. Beaming. So proud.

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I did not always take my shirt off when I held London, especially toward the end because we would be switching so often between reading and sleeping on my chest. This was the day of London’s discharge from the NICU. Getting ready that morning at home, I grabbed this purple t-shirt, knowing I had worn it the night London was born, and now the day London came home. I still think of that every time I reach for this shirt in my closet.

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A lot of aspiring writers ask professional writers how they do the work they do? What do you start with? And a common response is, “Butt in chair.” The time to write was not while London was in the NICU, but it was the time to do the most important job I will ever have, which still required my “butt in chair.” This was my view for 109 days, I could not leave it the day of her discharge from the NICU without taking a point-of-view picture. Looking at it now takes me right back to that pod, from where we left the hospital together for the first time.

Not Fun, Placing an NG Tube

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Before our NICU discharge, Kate and I both learned how to insert a nas0-gastric (NG) tube into London. NG tubes are necessary when the baby cannot drink enough milk to thrive. When London was discharged, she was only nippling 25% of her daily volume. The rest was pumped through the NG tube.

We needed to learn how to place it because NG tubes can be easily pulled out by the baby. During her NICU stay, London pulled her tube out several times. So, we had seen it put back in place by the nurses. A nursing student did it one day while we were there watching. I would have been extremely nervous if I had been in her shoes with the parents hovering over me, but she did extremely well, threading the tube up one of London’s nostrils and down, down, down to the stomach.

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At home, with that darned tube snaking out of her and all that orange tape on her face.

When it was time for Kate to practice on London they both did pretty well. When the tube first reached London’s nostril Kate stopped because she was already crying. Nurse Megan and I comforted her and told her she could do this. Kate composed herself and went for it, making it look easy, even though inserting an NG tube in your baby is really one of the worst tasks you can have as a parent of a newborn.

I tried the next day and, again, things went pretty well. Of course, by the time I was finishing up with the tube, London was bawling her eyes out, but regardless of who does this to her and how they do it, by the end, London was always screaming. I suspect most babies respond this way. Luckily, London was always easy to calm down afterward.

The success we had placing the NG tube while London was in the NICU did not follow us home. You can nearly cover your baby’s face with tape trying to hold that NG tube in place and attempting to make it impossible for the baby to get a finger around it and pull, but eventually, that thing is coming out. The first time this happened to us it was already late at night. We were so disappointed we had to do this to London. We let her calm down as we readied a new NG tube, tape, and a little sugar water to distract London from the pain. Kate tried first and I held London down on the bed. Things seemed to be going okay until the tube was a couple inches in and it wasn’t going anywhere. London was awake and bearing down so the tube had nowhere to go. It is agonizing to be in this position. We didn’t know if the tube was going somewhere it wasn’t supposed to be going. We didn’t know if we should push with more force. Meanwhile, London sounded like someone was torturing her.

We regrouped before I tried to place the tube. No luck. Same thing happened. London was bearing down and the tube wasn’t going anywhere. We abandoned that attempt. I was distraught, grabbing a pillow and screaming into it because I just couldn’t stand inflicting that much pain on London, twice, and without any reward.

After an hour of talking about our alternatives (try again in the morning or text one of London’s night nurses to see if they can place the tube if we go to the NICU) we decided it would be best to just go to the NICU. London’s nurses had offered to do this before we left. If we had any problems, let them know, come on by, and they will put in the NG tube.

We arrived at midnight and Windy had set up a little operating room in the NICU’s conference room. She placed the tube like it was no big deal and I tried to pay very close attention to how it worked so well in order to avoid doing this again.

A week or two later, London had pulled the tube again. I tried to recall the night at the NICU and I watched a couple of how-to videos on YouTube. The keys to doing this properly, at least on a baby, seemed to be sleepiness and speed. Don’t try this when your baby is wide awake because they are able to quickly bear down and stop the NG tube from going in. Don’t be slow about it either. By the time your baby figures out what is going on, you want the tube to already be in their stomach or damn near close.

I volunteered for the mission. Kate held London’s arms. Then we paused. We said a little prayer over London, attempting to calm ourselves before we do this again, praying that it would not be a repeat of last time. We finished praying. We took some deep breaths and then I plunged the tip of that NG tube into one of London’s nostrils and it curved downward and kept tunneling its way right down to London’s stomach. What a huge relief it was for all three of us to have that done. In this case though, I think Kate and I were the most relieved. No trip to the NICU tonight, baby.

We did not have to place the NG tube again. A little over a week later we pulled the NG tube ourselves because London was due for a photo shoot. That day she took all her milk by bottle. She looked and still does look amazing without that tube coming out of her nose and all that tape on her face. When I look at pictures from the NG days, I cannot get over how crowded her face looks. We are so happy to have put that phase behind us.