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To this day, Susan Scott is convinced that Maria Coussens saved the life of Susan’s baby Max. The now healthy 6-month-old spent his first three months of life as a tiny and sick premature infant in the Neonatal Intensive Care Unit at University Children’s Hospital, UCI Medical Center in Orange. Coussens was assigned as his primary care nurse during most of Max’s hospitalization. Yet, she is more than a chapter in Max’s book of life; rather, like most of the nurses who work this wing, she is the glue that holds the fragile pages together. Each of the days Coussens worked her 12-hour shift, she lovingly and carefully looked after Max. She monitored his breathing machines, his vital signs and his medications. She held him, fed him, changed his diapers and told him how cute he was, as if he were her own child. Like most of the other premature infants in the NICU, Max was born too early to survive on his own. A full-term baby arrives between 37 and 40 weeks of gestation. Max was born at 28 weeks and 1 pound, 9 1/2 ounces, about the weight of three large peaches. But he ended up in the right place: UCI Medical Center’s NICU (pronounced nick-you) provides unique care for high-risk pregnant moms and their premature babies, so-called Level 3 care combining comprehensive perinatal (labor and delivery) and neonatal care. Dr. Jack Sills, a UCI neonatologist, is a specialist in caring for high-risk newborns. “Having everyone in one place” (is an advantage), he says in talking about specialists who can address multiple pregnancy and birthing issues. “Outcome and survival require a coordinated team effort.” The key? “We want to get them home as perfect as possible.” One day, when Coussens returned to work after a five-day vacation, she sensed something was wrong with Max. His breathing was more labored and he didn’t seem right. “I said, ‘This is not the same baby.’ That day I was pretty frantic. I was in everyone’s faces that day. Because I knew him, I could see it sooner. You can see subtle changes it would take someone else longer to see,” says Coussens, 52, a Lake Forest resident who has worked in UCI Medical Center’s NICU for almost 29 years - nearly her entire career. When the doctors, nurses and other medical experts at the hospital decided to operate on Max the following day, they discovered a tissue growth in the baby’s trachea. It was blocking 75-80% of his airway. The tissue was removed and he immediately improved. “I think the nurses make all the difference and Maria really did save Max’s life,” says Max’s mom, a fifth-grade teacher from Long Beach who visited her son every day in the hospital. Scott even stayed at a nearby Doubletree Hotel for a month to be closer to her baby. The NICU is a place that will only get busier (it will be expanded and moved to UCI Medical Center’s new hospital, projected for completion in late 2008). Premature births are up. Improved fertility treatments often produce multiples, who have a higher risk of premature birth. Each day, more than 1,300 preemies are born in the United States. A new National Center for Health Statistics report notes an increase of more than 30% since tracking began in 1981. The key is to get high-risk mothers to keep their babies in the womb for as long as possible. As one nurse points out, “Every day we get out of a pregnancy is one more day in a pregnancy.” UCI perinatologist Dr. Manuel Porto is a specialist in managing complicated pregnancies. “Delaying delivery from 23 weeks to 26 weeks, that’s literally the difference between life and death.” Then the real work begins. While more than 90% of babies born under 2 pounds now survive, imagine the challenges to a life that should still be enjoying weeks of comfort and protection inside mom. This is where those medical experts closest to these tiny miracles the nurses step in. Earning the respect Coussens would say she was just doing her job as Max’s advocate, but this hospital makes sure its baby nurses are listened to. The NICU uses a successful method of caring for patients: A small number of nurses is assigned as the primary caretaker during a baby’s entire hospital stay. This allows them to become more in tune to their patients and the slightest changes in their conditions. It also makes for whole careers. In a world in which workers are constantly changing job sites and professions, one of the many constants here is that few nurses ever change out. And in a profession universally revered, they are among the best of the best. Dr. Larissa Isterabadi, a third-year pediatric resident working in the NICU this past summer, said these nurses are intelligent and quick learners. “They truly are the babies’ advocate. Typically they are the ones pointing out the gaps in care,” Dr. Isterabadi says. “I don’t mean to sound egotistical,” says Coussens, “but there are kids out there who are alive because we saved them. Even when you can’t save them, there are parents who know someone loved their child for that short period of time.” “A world unto itself” Most parents-to-be dream of having a healthy baby and have never been inside an intensive care unit for babies. Due to a variety of medical conditions, and sometimes for reasons that can’t be explained, about 12% of babies are born pre-term in the United States, and most of them end up in intensive care. At UCI Medical Center, babies born before 34 weeks of gestation are admitted to the 32-bed NICU on the hospital’s second floor. Twins, triplets, and other multiples often are admitted as they tend to be born earlier and smaller than single babies. The last child of Orange County’s first quintuplet births recently went home. And when each of those five children comes back for a visit, they will know this: The NICU is a place unlike any other. A visitor first notices the high-tech equipment keeping the babies alive until they grow larger and stronger. Machines are everywhere. They blink and buzz and beep on and off all day and all night. Sometimes it’s very quiet for a time, with few parents visiting and no alarms ringing. At other times, several alarms go off at once, creating a momentary frenzy of movement as nurses dash to the baby. Usually, however, the nurse is sitting 2 feet away, working on charts or watching the monitors. They keep one-on-one watch as clocks, perched at nearly every corner, monitor not only time, but the advancement of life. Most babies stay in enclosed isolettes and are hooked up to various monitors that continually measure their blood pressure, heart, oxygen level, and respiratory rate. In addition, babies are often connected to lines that feed them medication, nourishment, and intravenous fluids. They may be hooked up to ventilators, medication pumps or suction machines as well. Amid the mass of machines, a closer look reveals many signs of the loving human touch. Each isolette is decorated with a pretty handmade sign that bears the baby’s name and is decorated with flowers, drawings or stickers. The nurses make these signs for every baby. Often, parents have taped on photos of themselves, their other children, or saints. Some isolettes are decorated inside with stuffed animals or Rosary beads. And the nurses talk to the babies as they go about their work. Max’s mother Susan Scott calls the NICU “an amazing place.” “It is a world unto itself. It’s really awe-inspiring to see the nurses do what they do.” Not an everyday job For the nurses, the NICU offers a variety of challenges. One never knows whether a shift will be relatively calm or full of activity. “It can be a quiet place but most of the time it’s a chaotic place. There’s a lot that goes on behind the scenes,” says Donna Grochow, 50, an Irvine resident whose entire 29 years in nursing have been spent in the UCI Medical Center NICU. “Even when it’s quiet in here it’s like the calm before the storm because we get calls from the labor and delivery unit to help with a high-risk delivery or we can get a transport call or a baby can get in distress.” Many parents seem bewildered when they first come in to see their baby. They have no idea what the machines do until a nurse explains. It can be overwhelming, and many parents have what one nurse calls “the deer in the headlights look.” “There’s a lot of machines, that’s the first thing that scares people. You see these little babies with so many lines in them, it’s a lot of equipment,” says nurse Charlyn Chavez, 26, of Chino. Chavez is focusing her career on labor and delivery but is working in the NICU for a couple years to receive additional training on how to save babies in distress. The nurses make it a priority to help parents navigate their way and stay connected to their babies. Many live a long drive away and can’t visit as often as they’d like due to work conflicts or a lack of transportation. So the NICU staff started Project Stay-In-Touch, in which a nurse or staff member phones the parents each morning with an update. “It really makes a difference to the family,” Grochow says. As a night shift supervisor, nurse Aurora Dotson takes on the role of social worker and talks to the parents who often visit about 6 or 7 p.m. Dotson asks how mom and dad are doing, if they found parking OK, how they are coping. “Sometimes it’s hard. You can see parents crying because they have never seen babies like this. Sometimes the parents ask questions like what will we do to care for the baby. We have some parents who just ask, ‘When is my baby going home?’ “Sometimes the parents blame themselves and we’ve had fathers blame their wives.” Throughout the day and night, a host of medical experts filter in and out. Others work behind the scenes. They include the doctors who check on each baby daily, the nurses who care for one or two babies per 12-hour shift, respiratory therapists who monitor the breathing equipment, occupational therapists, dietitians, lactation consultants, pharmacists, social workers, secretaries and others. Most parents just sit quietly by their baby’s bedside, holding the baby if allowed. Esther Moreno of Norwalk came to visit her triplet daughters every day during their month-long stay earlier this summer. The girls were born June 16 at 34 weeks of gestation, a day before their 26-year-old mom was to have a Cesarean section. All three girls were healthy and breathing well but they were still on the small side, weighing 4 pounds, 1 ounce; 3 pounds, 12 ounces; and 3 pounds, 11 ounces. One baby, Alejandra, required medication to clear up a potentially lethal heart ailment. “The nurses here are awesome,” Esther Moreno says as she happily fed her babies and changed their diapers during a visit to the NICU in late June with her 17-year-old sister, Vivian. Growing technology Full-term babies may be admitted to the NICU if they are ill or have a heart defect. But most NICU babies are preemies born as early as 23 weeks. And “micro-preemies” can weigh less than 1 pound. Twenty-nine years ago, when Donna Grochow started working as a NICU nurse, the specialized field of neonatalogy was just emerging. The preemies were bigger, there were fewer multiple births, and babies born weighing less than about 2 pounds, 2 ounces rarely survived. The babies’ average length of stay then was much longer too. Some stayed for a year or more and many suffered lung damage from prolonged use of a ventilator. And the nurses had their choice of just four medications to treat the babies, compared to hundreds of drugs available today. One of America’s most famous premature babies, Patrick, born back East to Jacqueline Kennedy during JFK’s run for a second term in 1963, probably would have survived in today’s medical wonderland. Born six weeks premature, he died two days later of respiratory ailments. As Dr. Frank T. Vertosick Jr. wrote in a New York Times book review in 2000 (“Baby ER: The Heroic Doctors and Nurses Who Perform Medicine’s Tiniest Miracles,” by former Orange County Register reporter Edward Humes): “…the outlook for sick infants is considerably brighter than it was only five or 10 years ago, thanks to breathtaking advances in neonatal science. Salvaging babies born 12 weeks early used to be rare, but now is routine. Babies born 16 weeks ahead of schedule were once abandoned as miscarriages; today, they can be given a fighting chance.” Last year, UCI Medical Center’s NICU admitted 426 babies and their average stay was three weeks. Many preemies stay much longer, however, because they typically cannot breathe, eat, or hold their body temperature on their own until they reach 34 weeks. The NICU is regarded as among the best and most technologically advanced in Orange County, south Los Angeles County and the Inland Empire. Most of the hospitals in those areas do not have a Level 3 NICU. At a Level 3, surgeries can be performed in the NICU instead of an outside operating room, which is preferable because it’s less risky if the baby does not have to be moved. Many premature or sick babies born from cities as far away as Lake Arrowhead and Barstow are brought here by ambulance or helicopter. Home away from home The NICU includes a Nesting Room, where moms can spend the night with their babies at the hospital the night before everyone goes home, and a Lactation Room with breast pumps and freezers for breast milk. The staff encourages moms to pump and store breast milk for their babies. Nurses’ longevity on the job proves they love their work. The experience is vital as there is no room for medical errors. One tiny mistake in medications or one second overlooking a beeping monitor can kill a 2-pound baby. All medications are double-checked by a second nurse before they are administered to a baby. All the extra effort, all the intense attention, is well worth it, these nurses say. And as much as these devoted people love the babies they so carefully look after for so long, there is relief when a magical day comes. Says nurse Dotson: “It feels so good when they go home.” Amy Bentley of Temecula is a regular contributor to OC Family Magazine. |
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