Seasoned NICU nurse who has done it all and seen it all reports to duty for a 12 hour night shift.  Charge nurse:  “You are being floated to the PICU (pediatric intensive care unit) tonight.”         NOOOOOOOOOOOOOOO!

DRAG ME TO HELL

I creep slowly through the halls to get to the PICU, wary of the unknown.  No, I have not received any orientation to this godforsaken unit.  Hell hath no orientation protocols for float RN’s.  I am greeted at the gates unit by Beelzebub, the PICU charge nurse.

“Hi. Welcome to the Hotel California PICU.    You have the fresh heart transplant patient in room 1.  Your charge nurse said you were familiar with this patient because you cared for him pre-transplant.    He needs a blood transfusion, but we were unable to start a peripheral IV.  We knew a NICU nurse was being floated here so we waited for you to start it.  He needed that IV, like yesterday, so please start it now before report.”

This is a trap, but I am commanded to go.  I walk into the room.  Lying on the radiant warmer is a paralyzed and sedated newborn, with arms and legs stretched out as if in sacrifice.  He has more tubes and drips and lines than he has body surface area.  He now needs a peripheral IV from me for a blood transfusion.  His chest is wide open, with only a thin transparent dressing covering his heart.  You can see the tiny new heart beating beneath the dressing.  The tiny heart that was too big to be transplanted in the patient’s even tinier body, but was transplanted anyway.  Gotta keep those transplant statistics up.

The baby’s body is hugely swollen.  He looks like he could burst if I touch him. But,  I do as I am commanded.  I shave part of the infants head, insert a needle into his scalp, and thread a cannula the size of a hair into a vein in his head.  I start the blood transfusion.  For what purpose?  I’m not sure.  I overhear the staff in report say there is no way the surgeons will ever be able to close this infant’s chest again.  He either has to wait for another smaller heart to transplant, or he will be taken off all support.

It will be the parent’s decision.  What kind of decision is that for a parent to make?  It is a hellish decision.

I take care of this baby for the next 12 hours.  I titrate drips, push meds, give that blood transfusion.  The baby lies there, quiet, swollen, motionless.  Except for his  new heart.  It beats on and on, in his open chest, underneath that transparent dressing.

RR