The Neonatal Intensive Care Unit is a War Zone
Posted by realityrounds on August 27, 2009
Am I a soldier or a civilian I do not know. I have always known that the NICU is a terrifying, mind-numbing place of noise, and stress, and death. This coming from me, a seasoned nurse. But to a parent who is sitting at the bedside of their baby, their love, the NICU is a war zone. It is a fight. It is a fight to keep their baby alive. A fight to have a say on how their child is cared for. It is a war of ups and downs and highs and lows. It is a fight of fear versus hope. It is a fight to keep your mind from wandering and drifting off into insanity from the stress.
I know having a baby in the NICU is stressful for parents. I have seen marriages crumble, families face bankruptcy, and parents become physically ill from the stress of the situation. I know these things on an intellectual level, but I have avoided thinking about the emotional aspects of parent’s surviving a NICU experience.
Think about it. There is great hope for the baby to survive. One day the baby is doing great. “What a champ.” -says the primary care nurse. The next day, the baby is being rushed to surgery for necrotizing enterocolitis, a condition unique to preemies, where their intestines essentially start to die. One minute you feel safe and confident, the next you are planning a funeral. But your baby survives. You sit at the bedside and watch as painful after painful procedure is performed on you child. (I can not see my kids get a simple immunization. Imagine a lumbar puncture). You watch and listen as other parents babies suffer and face medical emergencies day in and day out. Is my baby next? You can not sleep, waiting for the middle of the night phone call telling you to come to the hospital. Even when your baby is doing well, you worry. Will this last?
The NICU is a war zone. Studies have shown parent’s who have survived the experience to suffer from Post Traumatic Stress Disorder. I can see why. Those of us who work in the NICU tend to focus all of our time and energy on saving the baby’s life. That is our main focus. The parent’s can be a casuality to that. The last thing we would want to do is send home a fragile newborn to a fragile parent. Work needs to be done.
RR
Allison said
Wow. So evocative. I don’t think I could do what you do. As a parent and a nurse the mind shies away. These decisions are difficult enough with adult and geriatric patients. Caregivers/parents are under extreme stress in both situations, but the nicu experience seems like a sealed world that parents can have no experience with, with the tiny babies so vulnerable to problems they could never have heard of. Thank you.
Rahel said
Although I am educated and logical and knew that they were doing their jobs, my emotional perception of things like, arterial blood gas draws on my dehydrated, cyanotic baby, was that they were torturing her. And I think the lizard/monkey/primitive part of my brain recorded it that way, that when they would poke her and the monitors would all go off as her heart went well over 200 and her sats dropped down through the 70s and her respirations stopped from the sheer terror of it all, that they were killing her. And so that primitive part of my brain has taken a long time to learn to trust again.
I have an incredible amount of respect for people in your field, FTR, just talking about those emotional reactions which are so especially acute right after childbirth.
My daughter had a serious congenital heart defect at birth and I recall a moment where I was just watching them work on her and part of me got up and walked out into the hallway and called back to my body, “come on, you don’t have to stay there and worry about all that, this isn’t REALLY your life, let’s go home.” Classic trauma dissociation. She is ok now, she was ok a lot sooner than I was in fact. It took a long, long time.
“We are young, heartache to heartache we stand,
No promises, no demands,
Love is a battlefield.”
realityrounds said
Rahel,
I see where you are coming from. I do not know how you managed to survive intact from your NICU experience. You are a strong woman and mom. I feel sick when my kids need something as benign as an immunization. When my daughter was 9 months old the pediatrician thought her liver was enlarged and we had to go in for a liver scan. I thought I was losing my mind. I am so glad your daughter is thriving, and I hope you and your family will heal just as fast.
RR
Frosty said
Right on, RR. There is work that needs to be done. I think that the work begins with adequate staffing in many places.
I’ve only been at this a little while. In my fourth year, my technical and organizational skills are not yet at their peaks. But I think there’s a reason why we focus on the physical needs: because there just isn’t time to get it all done. Even though we recognize the prevalence of medical error and even though customer service is a new priority in nursing, there are still units where it’s okay to assign a high-frequency baby with two nipple feeders, because “two of those are really easy babies.”
Ideally, the nurse should never have to choose between starting the pressors and explaining the pressors. Many of us, however, work in far-from-ideal worlds. It’s not that we’re lazy, or that we can’t recognize the emotional suffering. It’s just that we’re unfairly forced to prioritize. As a former NICU baby who grew up listening to stories about the ups and downs of dealing with a serious medical condition, I know all too well how important the medical and psychosocial aspects are. It just kills me that I so often leave work feeling like the job wasn’t completed.
Anne said
Reality Rounds,
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I just hope the work that gets done in this area is not mass drugging of parents with NICU experiences. Kind of like the Mothers’ Act and prenatal PPD screening, I fear that’s where this will go.
That caveat in mind, however, agreed…parents’ emotional health and confidence in their parenting skills should be kept in mind by all medical professionals treating them or their kids, to the extent possible. Thanks for posting this…as always, you make a great point.
mindexplosion said
I totally agree with that. I think the PICU is similar (even though it isn’t newborns, but when their children who were supposed to be healthy end up in an ICU…it’s the same concept).
Great post!
I’m in nursing school now and stumbled across your blog. I love it! Keep up the writing.
realityrounds said
Thanks! I agree that the PICU can be just as bad.
Adriana said
I came across your website and absolutely love it. I am looking at becoming a nurse. I’ve always had a passion and desire to do it, but never thought I would be “smart” enough. Now that I am older and wiser, I know better.
My daughter was born a micro preemie, 26 2/7 weeks at a 1lb 12 oz. She is 18months old now and doing amazing. I just want to thank all the nurses that took such great care of her and me. It was an emotional rollercoaster. I remember days I would leave and all her stats were prefect, then call in the middle of the night while pumping and she wasn’t doing very well. I would think, how could her status change so quickly. Then I wouldn’t sleep cause I would think was that the last time I would see her alive. That thought crossed my mind ever time I left, would I see her alive again or what if she died while I was not around. The part you wrote about “You watch and listen as other parents babies suffer and face medical emergencies day in and day out. Is my baby next?” that is so true. I would get myself emotionally involved with other families when they had to let their baby go. I would cry for them and their pain, then think about my baby. Everything you said is so true. It is a war zone and you are caught in it. I have had some time to heal but there isn’t a day that goes by I don’t think about it. I have turned my experience into fire and determination on becoming a nurse and helping others. I feel much stronger and empowered by the experience. I thank my daughter everyday for the lessons she has thought me and the strength she has given me. She is a true miracle and blessing.
I do want to give all the NICU nurses a huge thank you. You are all such a angles and thank god for your strength and courage to work with these fragile babies. I don’t know how you do it. Thank you for comforting me when I sat on the chair with my hands in the incubator and cried all day. Thank you for taking such amazing and thorough care of my girl and knowing she was sick before she knew she was getting sick. To all the NICU nurses, thank you for choosing that unit and that path, all the babies and families need you. You will never know how much gratitude and appreciation I have for you. You are my angels.
Chou said
Ah, this is an interesting/painful glimpse into a world that most of us shy away from ever thinking about. Your compassion is needed, thank you.
Kari said
Not sure what to write… the wounds are still so fresh. Even that sounds ridiculous because 3 months ago I brought healthy (other than reflux) twins home from the NICU after an 11 week stay. How can I even talk about wounds with two healthy, nurse around the clock, babies? I don’t know. But I do know this, after 9 years of working in birth… having four other babies of my own (3 at home) and educating and advocating for a variety of families, thoughts of the NICU and birth in general bring complete darkness to my mind. I can’t even go there right now… I’d rather not think about and just pretend that these beautiful twins that I love so much… just dropped from the sky three months ago. I don’t know what the answer is for better caring for parents… but I do know that I am eternally grateful to the handful of nurses that supported me in my daily struggles to parent my babies how I knew best… despite NICU policies and doctors that adamantly disagreed with me. Those nurses acknowledged that these babies were MINE, not the NICU’s, and encouraged me to continue to advocate for my kids. One thing I noticed is that the nurses that were better advocates tended to have been traveling nurses at some point… they knew that the policies in this particular NICU were not the only way to do things and they weren’t afraid of those neonatologists who think they know everything (and have no room for parent or nurse suggestions/ideas). And I hope that the patient advocates (social workers, etc.) are more autonomous at other NICUs b/c at ours, they were afraid to support patients too much or they’d get in trouble with the lead neonatologist… my only allies were a handful of nurses and the dietician!
realityrounds said
Kari,
Thank you so much for your comment. You sound like a fantastic mom! The NICU is traumatic. Period. In your experience, is there anyway to make it less so for a parent? I would appreciate your input.
Melissa D said
Another mom of a premie chiming in to say thank you for doing what you do, and saying what you say.
I’ve read a bunch of your posts now, and you’re so right. My little guy was born very early but otherwise healthy (good size for gestational age, no other medical problems) and sailed through his 70-day NICU stay, so we had a very easy time of it compared to most families with premies – and it was STILL incredibly traumatizing.
I do understand if you need to leave blogging. Who needs to take this nasty garbage from a bunch of mindless, dogma-steeped fanatics who really have no idea what you’re talking about? Especially after a shift of what I’m sure is the hardest job in the world? Either way, thanks so much for writing – and thanks for being a NICU nurse.
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