Our Littlest Patient

RuralNP4KIDS

In my past, that news would not be considered nerve-wracking. This time my adrenaline was pumping as I jumped into the shower. I work in a small rural hospital, on the border of Canada, and we don't have those kinds of deliveries here very often. In fact, there have been none in the six years that I have worked there.

Entering the unit the air is charged with excitement and stress. The nurses and midwife are at the station actively planning the care of the mother and her not yet born infant. When I arrive the charge nurse lets me know that she needs me to be the primary provider for this infant. As I am wondering why she wants me to care for the infant when there is adequate staff another nurse gives me the rundown about the soon to be a mom. Now I find out the real story........" a primiparous teen patient who has had cramping for a week and thought nothing of it. The infant is a 24.2 weeker but doesn't worry a team is coming from the tertiary center and might make it before the delivery. Oh, by the way, she isn't from here and none of the providers know her. We are still waiting for prenatal records." Now I am so stressed it feels as if the sweat is dripping off the ends of my fingers.

I enter the labor room and see a small person in the bed. She is tiny and petite and she is so young. Her skin is as pale as the sheets that surround her and her dark hair accentuates her paleness. All I can think of is my child who is almost her age. Her mother appears to be just a bit older than I am. I introduce myself and attempt to reassure them that we will provide excellent care for the soon to be a couplet. In the meantime, I am praying for guidance for all the nurses and other care providers.

The delivery does not occur as quickly as predicted. The team from the tertiary center arrives and there is not a soul that I am familiar with. Our usual referral center's NICU is closed due to the high census. We spend the morning setting up, collaborating, and teaching each other. The transport team teaches us some of the newest technology and I teach them how to collaborate with a rural physician who does not want to completely give up the care of his patient to them.

Suddenly, during the pushing phase of labor, the infant begins to experience fetal distress. The obstetrician calls for a stat c-section. All that planning goes up in a puff of smoke. We put our contingency plan into action. We got the mother to the OR in record time, 14 minutes from decision to incision.

Standing in the OR, I am waiting for the baby to emerge. Again I find myself praying for the team, mom, and baby. I know we need to act quickly and efficiently. This is the longest 4 minutes of my life. The infant is lifted from the safety of her mother's uterus and is placed in my arms, fragile, blue and limp. As I place her on the warmer all hands start her aggressive resuscitation. She has a heart rate, it's slow, but it is something. She is oxygenated with an Ambu bag but with little effect. Her airway is then invaded by an endotracheal tube. That does the trick. Her color improves, her heart rate and oxygen saturation normalize. We return to the nursery to continue care.

As we exit the surgical area we pass a crowd of family. What can we say? They can see she is tiny. There are six various types of medical personnel accompanying this baby. I imagine that our serious and concentrated body language gives away the gravity of the situation. We do not pause for the family to peek or admire this new life. It is too soon.

We spend the next hour doing all we can to stabilize this little girl for her 40-minute flight to the tertiary center. When we are done she can hardly be seen through all of our interventions. Her father is the only one permitted to come in to see her and touch her. He speaks and she appears to respond. Her heart rate appears more normal. Only her one eye opens and she appears to recognize his voice. He extends his pinky to touch her hand, which is barely the size of a nickel, and she tries to grip it. We are lucky to be able to get a photo of this tender, initial moment.

It is time for her to go. We bring her by her family and let them see her through the protective plexiglass of the transport isolette. She is then taken to the PACU to see her mother, who ironically, is the only person who has not seen her yet. She smiles and thanks to everyone, despite the fact, that she cannot touch her daughter. She cannot reach her from her bed, and the transport team cannot risk opening her protective condo and letting the precious heat out.

We go to the helipad followed by her father and uncle. She is loaded onto the helicopter and is then left in the very capable hands of the transport team. As I return to the unit, I see her father and uncle watching our every move. They appear as two boys, almost men, leaning on one another for support. As she flies away I pray for her next minute, next hour, the next shift and her future.

Our Littlest Patient

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