Looking for advice on dealing with the hard parts of the job

Gompers, BSN, RN · Nov 2, 2005

The first one is usually the hardest. We've all been there before, and you are not alone. Whenever I lose a baby, I just try and remind myself that we are not miracle workers, and that not every baby can be saved. These kids can be so sick, SOOOOOO SICK. I don't think people who've never been in a level III or IV NICU can imagine how critical these babies can be. Sometimes they're just too sick and even though the life support we provide is top notch, their bodies just aren't compatible with life anymore. Especially with preemies and sepsis - plus I'm guessing NEC as well, since you mentioned the repogle? Come on, if he was so septic that he passed away, there must have been so much internal damage and necrosis inside of him. NEC is just the worst. I've seen it take a grower-feeder's life in less than 12 hours.

We can't regrow bowels. We can't repair brains. We just can't fix everything.

Think of how many sick babies you've cared for that recovered and are at home with their families. Really, compared to other ICUs, NICUs have pretty darn good success rates. These babies are so resiliant, it's amazing to see how they recover sometimes. Just remarkable! And it's wonderful to be a part of that, to watch that baby go home all pink and chubby, and think, "My gosh, I once spent 12 hours pushing blood products into that baby while we did every single lifesaving measure in the book..."

You did everything you could. Everybody did. It's normal to want to throw it all away after a shift like that. We're only human. But just rememeber that you love taking care of those babies and that you have played a part in so many little lives already. It never does get easier, losing a baby on your shift or a baby you were close to. And it shouldn't get easier. What's easy about watching a baby die??? But eventually you just have to move on, keep going, and remember that the work we do saves so many babies that wouldn't have had a chance 20 years ago.

Take care of yourself, okay? This is a good place to come and vent when you need to.

{{{{{{{{{{{ HUG }}}}}}}}}}.

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cswain12000 · Nov 3, 2005

And I always think of the ones who have died as angels who have come to teach us lessons that only they can teach...I have seen many tiny babies touch hundreds of people in their short time here on earth. I feel just as privileged working with a family whose baby is leaving this world as I do caring for the babies who do well and go home.

Each and every life has a purpose for being a part of this world-no matter how long or short their time here. Some just accomplish their purpose much quicker and get to go "home" much earlier than others of us.

I know I am most profoundly touched by the babies who die.

babynurselsa, RN · Nov 3, 2005

It took me some time to understand that death was not always the worst thing that can happen. Or that we just can't fix everything.

I have seen babies that we have done soooo much because we could. This was not always in the best interest of the baby. When they have bilateral GrIV head bleeds and NEC to the point that their bellies have actually opened up. 1 or 3 chest tubes...etc I think you get the picture.

It is hard when you have one that was seemingly doing so well, they can change so very fast.

Take comfort in that you did your best and did all that you could for the little guy. I know today it just doesn't seem like enough, but I am sure that his poor parents will remember how hard that you guys worked for this little one.

Deidre Shiobhan · Nov 3, 2005

Do not be disheartened, I've past expereiences like this too. In fact I was nursing this 30weeker yesterday who's IVH grade 4 bilaterally, severely oedematous and not responsive at all. He's literally brain dead and the condition is definitely irreversible. We've spoken to the parents and they are definite about not withdrawing care and want us to go all out to save the baby and they know very well all the consequences! The medical team know the outcome and that the baby's suffering but what can we do! We've breached on the topic of not giving adrenaline to the baby to the parents should the baby crash again, well the dad agree but still want to go on with the " normal " resuscitation. Anyway the baby started to go bradycardic yesterday.

We don't know how long the baby's life will last. We just go on till nature take its course and GOD brings the baby back.

It's not easy to see your child die and that's why the parents are still hoping for a miracle. Whatever it is we have to be very supportive and do not let emotion take over you job. Sometimes you may ask yourself - Why are we doing so much when there's no hope at all? Yes it's hopeless to us but to the parents as long as there's a chance, they'll want to go on. It's very painful to lost a family member especially your own child.

Be strong and don't give up. I love neonatology and I'm sure you too. Going through all these experiences will definitely make you a stronger and better person. GOD BLESSED :saint:

babynurselsa, RN · Nov 3, 2005

I can understand the dilema that parents face. I would never wish the decision to withdraw supprt from your child on anyone. I think sometimes they demand everything be done or they stall in making a decision secretly hoping that either a miracle or the inevitable will occur so they do not HAVE to make that decision.

Though on the other hand as a nurse I knwo how draining and disheartening it becomes performing painful, invasive intervention after intervention on a baby that I know full well I am not going to change the end outcome of.

I find less discomfort in doing things when I feel like I am HELPING the baby.

Fortunately we send more home than we don't. Those victories help take some of the sting out of the ones that we cannot save.

I have a picture over by my front door right now of a little critter that I worked my hiney off keeping alive. He is about 3 months younger than my own 4 year old. I saw his momm recently and she gave me a current pic. It is one of my treasures, as is the thank you card I recieved from a mom of a 24 weeker that didn't make it.

suzanneuthscsa · Jan 2, 2006

Thank you for caring so much about the babies that don't make it. I am the mother of two preemies, one of them a 24 wkr who weighed under a pound. I always felt most comfortable if the nurse on duty was really emotionally connected to him. There was one in particular and we remain in touch to this day. He struggled so much, but his outcome was wonderful. We were spared any IVH's and NEC which are two biggies, but he did almost succomb to a huge pneumothorax. He was on the oscillator off and on for three weeks and had three different chest tubes, plus two femoral cut-downs. That was really rough, but today he is happy, healthy, active and minus the near sightedness and lazy eye problems, and a little BPD, but he is perfect. So remember this little angel who touched your life and be proud of your compassionate nature that allows you to care so deeply. That is what makes you perfect for the NICU. I am in nursing school to follow the same path and in my opinion, if the death of an innocent baby stops making you want to throw in the towel, it is time to switch to a different unit because you are their temporary mother or father, advocating for their interests, encouraging their successes, and comforting their families in the most difficult periods of their lives. My advice to you is to get in touch with a NICU survivor and get an update. It will get your courage back up to strength and remind you of why you chose this profession and why even the babies who don't make it are important. They pave the road for many more to survive and thrive. If we never push the limits of technology, then technology will never advance.

Suzanne

nursechick182, BSN, RN · Jan 12, 2006

I try to remind myself that some babies are just better off in Heaven, not here hooked up to lines and intubated and in pain and such.