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Brighter Tomorrows Story Contest 2017 Award Recipient

Nursing, In Joy and Sorrow

Andrea Crane, BSN RN
Porter, Texas

Winner ImageOn my first day with Noah, I stood there, taking it all in. I was being given a rare glimpse into the miracle of life. I was actually watching a baby grow, just as if he were still snuggled within the comforting boundaries of his mother's belly, still listening to the peaceful lub-dub of his mother's heart. I was his nurse on the day his mother would hold him for the first time, and my heart leapt with excitement! I cupped him in my hands, noting how his friable chest wall bent beneath my fingers. I gathered all his wires and tubes, and placed him on his mother's chest, watching as time stood still for her. He clung to her, and she to him. They needed each other - a beautiful symbiosis.

Noah was growing, and my heart was growing invested, too. He was a thriving micropreemie, until early one morning, when NEC would ravage his little body. He would never tolerate feeds, taxing his liver to the point of failure. He would never again breathe without a ventilator, and his heart would severely weaken over time. Even still, we pressed on with the hope that Noah would one day leave for home. I recall placing Noah in a swing for the first time - breathing tube, wires, drains, and all - watching his eyes grow wide as he explored his new surroundings with the fervor of a healthy baby.

Then, just before Noah was to turn five months, the burden of his condition became too much to bear, and his body shut down. At the start of my shift, Noah was not himself. He was cold, weak, and his eyes vacant. We would spend the next three days keeping Noah alive with everything we had. His parents were painfully aware that their precious son's light was fading, too soon. Noah's heart had failed him. When it became clear that Noah would not survive the day, his parents tearfully agreed to turn off his monitors and help him spend his last hours comfortable and surrounded by love. I took Noah out of his bed, and for the last time, gave him over to his mother. As I watched him take his last breaths, I realized that my role in Noah's life had come full circle. I had been both the first and the last person to ever place him on his mother's chest. My heart ached with his.

Noah changed me, helping me to realize the privilege that is nursing, even in joy and sorrow. Our task lists are long, and we often forget to slow down and enjoy, to marvel at our patients' strength. For to admire the toes of a one-pound micropreemie, to place a fragile infant on his mommy's chest for the first time, to care for a little one after they have gone from this life - to do each of these is to be blessed immensely.

Read the other contest entries

Twins to Twins! Mother bonds with nurse and staff.

Greensboro, North Carolina

I work as an NNP at Women's Hospital of Greensboro which is part of the Cone Health system in central NC. As in most NICU's, we see many, many sets of twins admitted to our unit.
After attending deliveries and caring for 25 week twins in January 2017, I came to realize a pretty unique situation happening with a particular mother and one of our nurses.

Although there are many details about how this occurred, this mother of 25 week twins discovered that one of our nurses also has twins. Even though the nurse's twins were not as premature, this mother quickly bonded with this nurse Annie (assumed name). Mom always had the biggest smile when her boys were doing well AND when Annie was there.

At only a few weeks of life, I came to update mom one day and found the most touching scene- she's kangarooing both boys together! When I asked her how they liked that, she said A (Kashius) wiggles & sometimes pushes his arms out at B (Kashmir), but they eventually settle down and sleep. They were on their best behavior on the day of the photos! I am not sure if Annie started this with her, but know she was their nurse this day. Our NICU Nursing Director was on the unit this day, and I sought her help in obtaining consent and taking pictures with our unit's iPad.

Sharing commonalities with someone brings them closer to us. In this situation, I do not think too much was shared, but just enough to help this mom be a little more at ease with having really small babies in the NICU. When our unit began to burst at the seams and this mom was approached about transferring to a Level II unit near her home, she shook her head side to side and said "But they don't have an Annie!". She was not ready to leave the comfort of the unit where the twins had been for 2 months or to leave the staff at Women's.

I will very proudly say this mother has provided all breastmilk to these twins since the beginning and visits them daily (unless of course she is ill herself). Their only complication has been both needed eye surgery, but they are thriving and will soon go home! As a NICU nurse for 18 + years, there are some families that make an impact on us and this is one superb example.

I am just a nurse

Diana Kimbal, BSN RNC-NIC
Reston, Virginia

I am just a nurse.
I am not a doctor.
I am not a manager.
I work my twelve-hour shifts.

I assess my babies hourly.
I do my 5 Rights.
I start IVs.
I teach Mom and Dad.

I am not a story-teller.
I am not a writer.
I do not have grand, glorious NICU stories.
But, I have my NICU stories—

The story of my first day working in a NICU.
I gave a newborn his first bath!
The story when I first saw a 24-weeker.
I stood in the back with a mix of helplessness and awe.
The story when my first baby We coded goes home!
Inspiration. Pride. Hope. Humility.
The story when I first watched a baby die.
The wail of her mother piercing my ears.

I have the story when I wheeled a preemie to the unit doors—
He met his big brother.
I have the story when I said "Stop"—
Too many IV attempts.
I have the story when We named the baby "Jack."
Jack needed a foster family.
I have the story when the mother hugged me, thanked me.
We took a selfie.

I am the one who runs to the bedside when the baby is "spelling."
I am the one making sure he is breathing in between his sucks.
I am the one who ensures he is warm, contained, and safe.
I am the one who cradles him when no one else is with him.

I will pour my whole self into my next twelve-hour shift.
I am a NICU Nurse.

The Fascinating Life of a NICU Nurse in Military Medicine

Sherri L. Lammerding, APRN MSN NNP-BC CNS RNC-NIC
Suffolk, Virginia

As singer-songwriter Johnny Cash once said, "I've been everywhere, man."

My journey as a NICU Nurse began in 2003, at National Naval Medical Center, Bethesda. A prior Hospital Corpsman, I was commissioned into the Navy Nurse Corps that same year and reported to duty as an Ensign. Like most Navy Nurses, I was scared to death to learn my fate as to where I would be working for the next three years. Would it be labor and delivery, telemetry or a medical-surgical unit? I remember that day like it was yesterday. I was to work in the NICU. This was like winning the lottery, unheard of for an Ensign. For me, it was the door to many opportunities and one heck of ride that I will never forget.

Stepping foot into the NICU for the very first time was to say the least overwhelming. Hearing the ventilators, IV pumps and monitors alarming every couple of minutes drove me crazy for the next couple of weeks.
Those were the days of sweat, hard work, long hours and yes tears that provided the clinical and professional foundation that would prepare me for what was to come.

What folks don't realize is a NICU nurse is not just a NICU nurse, they are versatile, compassionate, quick thinkers and adapt to anything thrown their way. I learned this back in 2009, when I was deployed to Afghanistan with the Marines. I was informed that I would be assigned to a shock trauma and forward resuscitation surgical unit, basically an emergency and operating room out in the middle of no where working with big people. How was I supposed to survive? I never worked with adults before. It had to be a mistake. Nope, it was true, I spent the next nine months in the hot deserts of Afghanistan using my critical skills learned in the NICU on adults. What I learned out there was a ventilator is a ventilator, a drip is a drip, and giving blood is giving blood. Big or small people, the dosage and settings might be different but the concepts are the same. I survived those deserts of Afghanistan thanks to my NICU training.

From Afghanistan, my journey took me to Japan as the Department Head for a Maternal Infant Unit. How was I supposed to use my NICU background here? Oh boy, did I draw on my experience as a Level III NICU Nurse. Even though we were a level I facility, neonatal emergencies don't stop coming? Yes, the babies still come a knockin' on your doorstep. There was use for a NICU nurse after all.

In 2015, I earned my degree as a Neonatal Nurse Practitioner and Clinical Nurse Specialist. Afterwards, the Navy sent me back home to Naval Medical Center Portsmouth's NICU doing what I love, which is working with my little infants. Home sweet home.

**The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any agency of the U.S. government**

 NICU – A Journey from Patient to Practitioner: A Letter to My Patient and Words of Reflection and Thanks

Bobby Mele, MS NNP CCRN
Cary, North Carolina

Looking into an isolette, I squint my eyes because of the bright glow coming from your phototherapy light. My head rests on my arm that is splayed across that angled slant of your warmed and humidified home. I try to wrap my mind around the idea of how human life can be sustained in something so small, so vulnerable. Thoughts going through my head of what I could possibly be missing; what we could be doing better, what pathophysiology you just taught me, even about what you will want to do when you grow up? It is after 4am, and we both had a rough night, but I will never let you know that because right here, and now, this is not about me – it is about something so much more. I stand here relating to you because we have more than one thing in common. It's not just the parents that have worried, or the will power to fight, but that I once was in the very same place you are now.

I was once a patient in the NICU at Stony Brook Hospital, the very place my Mom works, the unit where I was once a volunteer in high school, and now, where I will be starting as a Neonatal Nurse Practitioner. When I was younger, I knew babies went there because they were sick, but it is so much more than a place for babies who need care. It is a place where parents smile and talk to their baby, but also shed their tears and leave with anxiety. I saw this very picture just a few hours ago with your parents, because they tried for so long to have you. I bow my head as they say goodnight to you, tell you how much you are loved by not just them, but the rest of your family that came in and out of the unit today. They say "thank you" to me as they walk through the door, but when I say "It is my pleasure," I peacefully question if they truly understand that this is more than just a job to me.

Growing up, the NICU was always present in my childhood. It is the place my Mom came home from every night, sometimes completely exhausted, telling her young children excitedly running around her feet that she had a rough day. Now I can relate to how she felt after her shift, driving home with recent flashbacks of how a simple start to a shift drastically turned so quickly. I never knew until nursing school just how lucky my siblings and I were. Learning about high-risk infants, the statistics, and the life-long detriments that can impact so many aspects of their lives, completely changed the paradigm of how I perceived my life. I learned that twenty-nine week quadruplets didn't present statistically well in the 1990s, and that healthcare professionals questioned the ethics of the very beginning of my life. My family must have anxiously wondered what the future held – would we have a brighter tomorrow?

Days away from graduating from my NNP program, I'm filled with so many thoughts. I think of how I will never be able to truly express sincere gratitude towards those that cared for me. The care I never asked for, but am so thankful for receiving. How could I ever possibly share with my "aunt Deb" (Dr. Debra Sansoucie, EdD, NNP-BC) who resuscitated me in the delivery room, how genuinely beautiful my life is and how words could never thank her enough. Tell her how it feels to think about all that I have learned and will soon be practicing the very art and techniques that she used to save my very own life. How I hope my Mom understands that I would be so incredibly fortunate to be even half of the practitioner that she is. To all of those who gave their helping hands and brilliant minds into my care, I am beyond thankful and words are not enough.

It is now towards the end of my shift, my eyes are calling for a few more sips of coffee. But I reflect on specialty that I have become so fascinated and passionate with, pondering over what else I can do for you. The specialty that I have spent countless hours studying, practicing, and preparing for nights like the one we just shared. The pod is now quiet in the early morning, the only sound coming from your high-frequency ventilator, we remain stationary together in the vibrant glow coming from your bed spot. I continue to stare into your warm isolette and try to comprehend if there is any other way I can help you. I hope someday you learn that you are cared for, that your life, even so premature, is unfathomably magnificent. The sun is now breaking over the fresh spring horizon of Chapel Hill, North Carolina. I am walking away from the challenging shift we spent together, hoping you will still be there when I come back that evening. Mentally taking steps back, while walking forward into the fresh morning, I only wish you will also have the "brighter tomorrows" that I was miraculously granted the past 25 years.

Malcolm, Small but Mighty

Marie Thomson, RNC
Westland, Michigan

Malcolm was born at 25 weeks, weight of 838GMS, 1# 13.5 oz. He was Mom's third child. Her membranes had ruptured 9 days before, resulting in chorioamnitis, and they treated her with betamethasone to mature her baby's lungs.

Malcolm required intubation at delivery; placed on a ventilator. He received 4 doses of survanta for hyaline membrane disease. Umbilical lines were placed.

A pulmonary hemorrhage occurred on his 2nd day of life. Iced saline helped subside the bleeding. PRBCs were given. He began to "bicycle with his legs", subtle seizure activity. He was given Phenobarbitol and an EEG to confirm. His electrolytes were abnormal, requiring adjustments to his IV fluids. Antibiotics were started. Sedation was given to help him rest. Jaundice was treated with double phototherapy. His Cranial Ultrasound revealed a Grade III bleed. His pupils had become fixed and dilated, the Neonatologist hoped this was from over sedation. Finally, his abdomen had become enlarged with bowel loops and no stools since birth. Serial abdominal xrays were ordered.

Despite all that was going on with Malcolm, his family sat at his bedside everyday with unwavering faith. I had the privilege to work with them at 10 days of age. The parents smiled when they saw me as they remembered me from taking caring of their 4 year old son. This was the 1st, and last day, I cared for Malcolm.

I lowered the giraffe isolette to eye level for better interaction with Malcolm. His mom applied breast milk for oral care. We watched him as he sucked on the q-tip. Mom was so pleased that there was something she could do to make him feel better.

Upon reviewing the abdominal films, the Neonatologist came to the bedside to speak with the parents. He explained that the baby's abdomen had perforated and eminent transfer to CHM would be necessary for treatment.

A Baptism was performed. I made a baby name card along with a golden cross and placed it with the shell that held the holy water for the service. The parents were touched with the simple gesture.

Upon calling report to CHM, they told me that Malcolm may be too small for surgery and may have a drain placed until he grows. I explained what they had told me to the Doctor who relayed the information to the parents, so they would know what to expect.

When CHM Transport Team arrived I bagged Malcolm's personal items including a picture, breast milk and blanket he had been laying on, for his parents. It was greatly appreciated.

On my next day to work, I called Malcolm's mom to inquire how he was. She stated he had surgery and a small hole was placed in the affected bowel. Vaseline gauze covered the area and another surgery was planned in 3-4 months, to reattach the bowel. He had come off of the ventilator and was breathing with a nasal cannula! They were considering feeding him. Great news for this tiny baby!