In the Hand of Dad
Preemie's struggle becomes one nurse's journey with a father.
Sam Bastian, MS, APRN, BC
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I suppose we are expected to welcome challenges in the neonatal ICU and, for the most part, we do, but when I heard that a 27-week preemie with multiple deformities was on the way, all I thought was, "Jeez, I could do without this."
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We were just reaching the hardest and longest stretch of the night shift when the call came—it was going on 4 am—and because I had drawn the short straw, the next patient was to be mine. We immediately started preparing for the baby's arrival. Called respiratory to check the ventilator before connecting it to the bed. Got the pulse oximeter. Drew up meds. Got the warming lamps. Humidified the isolette. Got the stuff for footprints and identification bands. Pulled supplies. More information arrived: the mother was a pediatrician and the father a lawyer. I couldn't think of a worse combination of parents of a high-risk infant. The mom will know how things should progress, and the dad will be ready to sue if they don't go well.
Wallowing in self-pity and dread, I met the Flight for Life transport team. Their report: deformed limbs, difficult to ventilate, umbilical arterial catheter placed but not confirmed by X-ray, vitamin K in, silver nitrite in; pregnancy number seven for this couple, no living children, and the father was following in his car.
In the NICU, we began the dance of a well-rehearsed team. The neonatologist called out orders, and all available nurses ran blood, drew up IV fluids, entered information in the computer, and delivered X-rays. As admitting nurse, I stayed at the bedside, my hands in the isolette with the baby: Push this, draw off that, take some photos for Mom, position for X-ray, adjust the monitors. I hand-bagged intermittently as we tried to adjust the ventilator. The baby didn't seem to like any of the settings. When the respiratory therapist bagged, the baby's hemoglobin desaturated. I stepped in to bag again.
Dad arrived, Scrubbed and brought to the bedside, he stood on one side of the isolette. We exchanged introductions. The baby's name was Joshua, which means, "Jehovah saves." I filled Dad in on what little we knew. "We worry first about the lungs," I said. He nodded. "He's having trouble but we're helping him," I said. We both looked down at Joshua struggling to breathe. His entire body was barely bigger than my hand.
"None of our other babies made it this far," Dad said. "Some of them didn't even take a breath at all."
Joshua's oxygen levels kept dropping when he was placed on the ventilator. Hand-bagging was all that worked. After a while, the neonatologist told the respiratory therapist to relieve me. The pediatric pulmonologist driving to the hospital was at least an hour away. I stepped away from the isolette and the respiratory therapist took over, but when the oxygenation wouldn't stay within an acceptable range, I stepped back in and the level rose again. So there we were, Dad and I, standing two feet apart over his struggling son.
As he held Joshua's hand and stroked him, we talked about what he would like for his son. Joshua weighed only slightly more than a pound. Looking at him in the isolette, I couldn't possibly imagine him as a bouncing baby. His father spoke softly to Joshua: "Hang on buddy, stay with us awhile." After a few moments, I was really aware of only Joshua, his father, and myself in the room. Everyone was waiting for the specialist to arrive to examine Joshua and determine whether he would live. Other staff members asked me whether my hands were tired. Bagging continuously for 20 minutes can be uncomfortable, and I had already been doing it for more than an hour, but my hands weren't tired. Dad and I just continued to talk about how beautiful Joshua was. Yes, there were multiple deformities; his head was enlarged, his limbs twisted, his tiny hands had too many fingers, but we focused on the perfect parts: the delicate ears, the fingernails, and in between bagging, we caught glimpses of a sweet little face.
When my shift was over I didn't leave. I couldn't leave that baby clinging for life and the father clinging to his son. When the specialist arrived, I positioned Joshua for him and stepped out of the way.
Joshua died later that morning.
As I prepared to leave, exhausted and saddened, Dad excused himself from the bedside and called to me. "I want to kiss the hands that gave me time with my son," he said, bringing my hands to his lips.
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