It Takes A Village

Once a week Matt and I put on our dress shoes and make our way up to the 7th floor of the hospital to observe rounds in the Neonatal Intensive Care Unit. The NICU has 65 beds, and is divided into 4 “bays.” We shadow in Bay 1, the 12-bed unit for the infants needing the most intensive care. These babies would not survive without the respirators, antibiotics, surgeries, nutrients, labs, and care we provide for them. They are lucky to be born here because the University of Iowa’s NICU has one of the highest patient survival rates in the country!

For the most part, rounds are straightforward. A herd of about 12 of us (the attending physician, fellows, residents, a dietary specialist, nurses, pharmacy students, respiratory specialists, Matt and me) moves along the U-shaped hall stopping at each room to discuss how each patient did overnight, and their plan for the next few days. The NICU truly is the saying, ‘it takes a village to raise a child,’ put into action. Depending on how crazy the night was, rounds can last anywhere from 1 to 4 hours – let me tell you, it’s a long time to stand! Still, no matter how tired my legs get, I always feel better off than the residents, who usually look pretty tired. They work 12-hour days for 2- or 3-week blocks of time and are in charge of most of the direct patient care and planning. They are impressive!

The discussions about the patients are overflowing with acronyms and jargon that I am unfamiliar with. I have no frame of reference for what changing the feeding volume from 8Q6 to 9Q4 means, what a ventilator PIP setting of 20/7 signifies, or the implications of the number of ribs you can count on a chest x-ray. So what sticks with me from my days in the NICU aren’t the specifics of the infants’ care; what I remember are the impressions and small details: the look of trust in a mother’s eyes as the doctor tells her, “your daughter is in good hands, we will take care of her;” or how unbelievably small a baby can be. Many weigh less than 1.5 lbs at birth and are about 7 inches long (their diapers are made by Pampers, but look like they are for dolls).

There is a continuous low whirring of machines in the NICU. Every patient I’ve seen has been on a respirator and the noise quickly fades into the background. I didn’t realize how accustomed I had become to the sound until a patient only a few hours old was airlifted to our NICU last Friday. He was tiny, pink and cute, squirming and whimpering as the nurses hooked him up to the many monitors. But something was off, and it took me a while to place it. I finally realized it was his crying. None of the infants in the NICU ever make any noise; they can’t because their ventilators control their breathing. Soon one of the residents was intubating the new baby. It made me sad to see his tiny body put into such an awkward and unnatural position - his little chest thrust upward and his head tilted way back as she thrust the tube down his throat. I hated seeing him look so sick and helpless; how could he possibly get better, especially when we were jamming things into him left and right?

During moments like these I try to remember something Dr. Segar, head of the NICU, told a mother on my first day shadowing. Her daughter was 4 days old. Overwhelmed by the implications of what the doctors were saying, she had burst into tears. Dr. Segar put a hand on her arm and said, “Everything we do is going to hurt them, we just try to hurt them as little as possible and one day their body will be able to repair faster than we do damage - that’s when they finally take a turn for the better. Until then they are going to have good days and terrible days, but that’s why we’re here.”