Pediatrics pt. 2

My second day in clinical I was placed on the neonatal ICU. My day started out much like many 

previous clinical days - with me wandering around lost and then asking random people questions 

in hope to (end goal) find the nurse I was placed with before change of shift happened. After 

finding the list, identifying my nurse as someone named “Autumn”, and then being told Autumn 

wasn’t coming in today. A very tall thin woman dressed entirely in pink scrubs led me to the 

charge nurse's office - I felt like a small primate scurrying along behind a graceful giraffe as we 

forged through the Sahara (the NICU) in search of the allusive watering hole (charge nurse). 

Here, I was assigned to Jeanie an older Filipino nurse who along with letting me give all her 

meds, prime her pump, and insert a G-tube, also had me do yoga with her mid shift and later 

on made me practice NCLEX questions when there was nothing for me to do. All in all a fun 

and proactive day that sped along (not unlike the gait of the pink giraffe).

Her one patient was a 3 week-old infant, there due to multiple congenital abnormalities. The 

baby’s heart beat irregularly and would shoot up to the 200s range. My patient was a preemie 

being and my phrase for that day in the NICU had to be “so tiny” as I found myself exclaiming 

it over and over again when I was first orienting to the NICU. I had to start suppressing the 

urge to point out the minuscule blood pressure cuff and dainty little G-Tube and IV ports that 

seemed almost as if for dolls. With the nurse I did the assessments and vital signs, done every 

hour, gave cardiac and electrolyte meds, suctioned baby’s vent, changed IV tubing, and prepared 

and administered feedings; everything continued to be on this minuscule scale. I will be shocked 

at the size of things when I go back to adult care after this semester of newborn fingers and toes 

and pediatric dosages.

While on the floor my nurse took me to see a baby on ECMO (Extracorporeal membrane 

oxygenation). She pointed out one machine that mechanically filtered the blood, acting in 

place of the kidneys, and another small machine that oxygenated and rhythmically pumped 

the blood back through the body, that one was the heart I had realized after she explained 

it to me. The machines and baby were branded together by a network of clear tubes all full 

of pulsating blood. I found out that this baby had been brain dead for several days and was 

only kept alive by ECMO, ventilator and a plethora of drugs. After talking to parents the 

hospital was ‘withdrawing care’ today. This baby who lay before me, nothing more than a 

deflated balloon animal of an infant, was leaving the world today, or perhaps he had already left.

Later on in the day I was sent to other rooms throughout the NICCU. My nurse would send me 

away with a “go to room so and so there's something cool going on there!” and off I would go, 

entering the room to watch the IV team locate arteries and veins through ultrasound, or assist 

in a blood gas draw. One room the baby's vital signs were dropping rapidly so I just stayed 

and waited, watching as four doctors circulated in and out, charge nurses made 

recommendations, dopamine was discontinued and then quickly reconnected when the baby's 

MAP dropped below 25. The baby pulled through and I got to experience some great 

collaboration by the health care team, tucked away in my forgotten corner of the room. 

In another room I watched and questioned the RTs as they changed trach tube ties on a 6 month 

old’s floppy neck. The baby had a severe heart condition called Tetralogy of Fallot. In the 

background of the RTs chattering to each other and baby a Muslim prayer CD played on repeat. 

My nurse later told me that a baby with that combination of disease rarely ever pulled through 

and if they did they lived their life debilitated, with a terminate trach tube, and severe delays. 

The family had come here all the way from the Middle East seeking treatment .I wondered 

at what point if any would they let “care be withdrawn” after they had made such a journey 

and held onto such hope for their son.

It seemed to me in that NICCU that day that hope could be a dangerous thing to give away 

so liberally - as nurses have a habit of doing. Hope is a great thing and yet ethically there 

was something wrong with the quality of life that I felt we were preserving for both child 

and family by dragging this body of a child through the dawn of infant-hood only to wonder, 

to what end? Developmentally the children were all small but my patient though only 3 weeks 

reacted, cried, and curled up in reaction to his environment. The others I saw puffed up or 

inflated by drugs, simply lay there floppy. A most unusual and unnatural thing for a baby to 

do. I saw pictures of Mary taped to bedsides and the Muslim prayer chants still ring in my 

ears reminding me that humans are denizens of this world and another. That they crave the 

deeper realms of spirituality and cling to them in times of trouble. This too was a picture of 

hope. Hope and spirituality I feel are two vary kindred spirits. They give us a chance to escape 

the now into something that is bigger than us all. I saw how this related to my different patients. 

One father anxiously sat scribbling down notes in a journal while his tiny daughter puffed and 

deflated, almost pulsating, at an alarming rate controlled by a ventilator. Her limbs were cold 

and her body pink. He asked me questions about the care we were providing, wanting exact 

clarification, desiring to get it all down in the notebook. Later on as I cared for a patient across 

the room I caught a glimpse of him smiling at her and reading her something from the book. 

His lingering smile was the smile of a father looking at his perfect daughter. The tubes and 

puffing didn’t change it. He just kept smiling at her. Later on when changing bedding I asked 

him what her name was. Hope, her name was Hope. 

* Please note names, places, and diagnoses have been changed in order to protect the 

privacy of patients at this hospital.

**Pictured above my very healthy Nephew when he was 3 months old