A journey through the NICU

My alarm blares long before the sun is up, and my thoughts immediately race to the babies I work with. “Are they ok? How was their surgery yesterday? I need to check on their parents ASAP”. As I drag myself out of bed—definitely NOT a morning person—I start the usual routine to get ready for work: wash my face, eat some breakfast, make coffee (jk, my hubs does that, and makes my lunch too—I’m spoiled), and walk the dog. My commute is rough. Drive—train—walk—shuttle—hospital.

Of course now, I mask up before leaving the house and it doesn’t come off until I’m home. As I pass my COVID screening and badge in to work, my brain is already in go-mode. I might see a former patient of mine waiting for an outpatient visit and get to have a joyful reunion on my way to my desk. Occasionally I run into a colleague before I’ve even sat down, and we run through our shared patients, making plans to co-treat for the day. Once I make it to my desk, I always try to take a deep breath before logging in, because once I do…I never know how my day will go.

How it started…

We could have orders on 10 new babies that our team needs to evaluate today. I could find out that we lost a baby overnight. There is sure to be an email from leadership about the COVID emergency situation of the day.

After calling all the nurses, reviewing all the charts, and figuring out who needs to be seen and when (based on care times in the NICU, procedures, transfer schedules, feeding times, and nap routines), I hit the floors with my bag o’tricks in hand. I carry an extra binky in every size, standardized assessment forms, parent handouts, my card to share contact info, a few toys, and straps and velcro in case of a last-minute project.

As I enter the NICU, all the chaos of the day falls away. It has to, because this work requires my all. Any external noise (monitors beeping, codes being called overhead, doctors discussing cases in rounds) is drowned out, as my focus lies only with the families and babies in the unit.

All the chart reviewing I did first thing in the morning are in the back of my mind, guiding my treatment decisions with every baby. I scrub in, taking off my rings and watch for sanitary precautions, and take a moment to center myself before I step into the first patient room. Because I know that when I place my hands on that baby, I’m holding somebody’s whole world.

*Gotta have hands clear of any jewelry and scrub in up to the forearms before entering the NICU—keep those germs away from growing immune systems!*

Every time I enter a patient’s room, I’m fully present, grounded, and aware of the significance of this moment. In intensive care, no moment is promised, no moment is easy. Things like what you did this weekend and what vacation you’re planning no longer matter when babies are critically ill in the NICU.

What matters is the stability of their vital signs right now, the procedures baby has coming up, the specialists they need to see, the cares baby did or did not tolerate. What matters is the tiny life I hold in my hands, and the families I get to support through therapy.

*This babe is getting* *phototherapy to treat hyperbilirubinemia, also called jaundice.*

How it’s going…

Working in the NICU is an honor and a privilege that I do not take lightly. It takes specialized skills and lots of training. It requires acceptance from families and providers alike. I get to work alongside the best in the game. NICU nurses are literal superheros, and I mean that from the heart. The neonatologists, pulmonologists, audiologists, feeding therapists, music therapists, social workers, respiratory therapists, cardiologists, neurologists, geneticists, orthotists, rehab doctors, ENTs, and surgeons I get to work with are experts in their field, and I get to learn from them every day. It’s a beautiful and challenging place to be as a healthcare provider.

Working in the NICU:

-Breaks my heart and cracks it wide open

-Takes me to my lowest lows and makes me feel on top of the world

-Is a challenge and an honor

-Fills me with hope and triggers my fears

-Has left me sobbing in a supply closet and shedding tears of joy

-Leaves me wounded and heals me deeply

Helping babies do baby things, and parents do parent things

As you can see, working in the NICU is intense work. It’s emotional, powerful, and volatile. As a neonatal therapist, I believe my role in the NICU is the best role. I don’t have to make crucial medical decisions. I don’t deliver difficult news about life-changing diagnoses. I don’t administer painful procedures. Instead, I get to help babies do baby things, and help parents do parent things.

I get to delight in each baby’s individual strengths. I tune into baby’s body language and stress cues to learn more about what they are communicating with us. I help parents provide comforting touch, do kangaroo care for the first time, and feel comfortable holding their baby despite multiple lines and tubes. I work on fun developmental skills, like head control, rolling, and sitting. I help baby learn to regulate their state, and take advantage of quiet alert time to focus on learning. I talk about optimal positioning, make splints and wedges, and fight for tummy time no matter what is going on medically. I work to empower parents to advocate for their baby.

And I am constantly in awe of NICU babies and their families. They have taught me more about strength, resilience, and bravery than I ever knew. They have shown me the power of love, hope, and advocacy. And I am honored to get to be a part of their team, their lives, their journey. But as I’ve never had a baby in the NICU myself, I wanted to share some insights and advice from NICU parents themselves. One of the most impactful things a parent ever told me was this: “Of course we are excited to go home. But I’ve realized that “home” is wherever my baby is safe—and right now, that’s in the NICU”.

Soak up these words of wisdom, and know that you’re never alone. You’ve got this, and I’ve got you.

nicu reel.gif — *Thanks to all the parents who sent in their photos and advice to help all the other NICU families out there*

TL;DR

Walking you through a day in the NICU, starting with a long commute, COVID protocols, and masking up, of course.
Getting ready for the day includes collaborating with colleagues, taking new orders, chart reviewing, calling nurses, and making sure my bag is ready to hit the floors.
Entering the NICU requires clean hands, scrubbing in, and centering my head and heart.
Working in the NICU is intense, challenging, and beautiful work.
I’ve learned so much from the incredible families I’ve worked with—see the reel for advice and insights from NICU families themselves!