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This Secret Place: the highs and lows of the NICU

Chances are, if you know this world, you know it all too well. If you've seen into a dimly lit nicu, and heard the symphony of alarms and lullabies, you have probably also felt the deep emotions that happen in these securely locked, detail oriented, seemingly hidden places. The highs are high and the lows are low.

Photo Courtesy of Toronto Public Library; Picture 1975

The joys of that first bath, that first completed bottle, the cries of joy at that first poop (if you know, you know). For the nurse it's a job but it's so much more: you see moms sacrificing their time, sleep, and energy while pumping around the clock, parents asking hard questions, listening to difficult answers, being forced to let go of and grieve the dreams they had of a "normal" pregnancy and a healthy full term baby.

There are doctors who committed years and years of their life to work in such a specialty, dieticians crunching the tiniest of numbers to deliver tailor-made TPNs to the bedside, new nurses facing the uphill battle to learn this new layer of art and science and everything that makes it a subspecialty, respiratory therapists that protect the airway with skill and care, NPs working 24 hour shifts to write orders, and educate as they go, researchers spending hours behind-the-scenes to ensure the bedside care is up-to-date and safe. And this doesn't even touch on the nicu's managers hiring and leading with endless discernment and educators pouring out their time and energy into new hires, and all of the specialized disciplines that contribute to the infant's care. It truly takes a village.

But at the end of the day, the real MVPs are the babies themselves: smiling in their sleep, fighting to breathe, learning to coordinate that new demanded rhythm of suck swallow breathe, earning bravery beads literally or figuratively as they face procedures, surgeries, under the blue hue of a bili light, being woken up to having their tummy measured yet again, and their temperature taken every three hours, facing all these obstacles that they didn't have a say in, they didn't sign up for, but still they carry a distinct bravery (and might I say an unmistakable feistiness?). They show up to fight for another breath, another day, and then there are the days they're faced with more than their bodies can handle- their systems can't keep fighting and they face death far too early.

This is the neonatal intensive care unit, and it's not for the faint of heart. I remember having the privilege of spending time in a level III nicu as a nursing student. I was so green, full of hope and ambition, amazed at the tiny fingers and toes, and the smallest of blood pressure cuffs, and a desire to pour myself out - unjaded, ready to take it all in - and yet the low emotions were real even then, still hearing the sound of alarms echoing in my head while I walked down the sidewalk to my dorm room, or woke in the middle of the night, my heart unsettled, worried. There was a distinct sadness I picked up on, one that lingered with you outside the doors of the hospital wing.

And admittedly, my journey here is still young. My love for the job has increased all the more, and all the while there lies this distinct sadness, an almost constant grieving for the brokenness, the heartache, the undeniable pain that exists on a unit like this. The environment becomes second nature, so much of it - you learn to laugh and smile and be upbeat when it's appropriate, you learn how to place a micro premie in the prone position after a bath with ease, you learn to look and raise alarm at the subtle signs of sepsis, and navigate how to speak with families. You do your best to create an atmosphere of camaraderie, seeking to serve your coworkers even when you're tired, annoyed, or disliked. You advocate for the best care, feeling at times you aren't heard, and some days you make mistakes. It's all part of it. Nursing is one of the hardest things I've signed up for, but also one of the most rewarding, and shaping things I've known in my life. We were made to do hard things.

And even harder than the reality of the nicu, you see the pitfalls and limitations of the medical world, and wonder if we are doing enough. Are we providing enough education and parent autonomy when it comes to drug administration? How can we get ahead of some of these premature births, and educate on prenatal nutrition for moms, and show what smoking and alcohol use in pregnancy looks like on a newborn after birth? What do you begin to tackle first? Every one of these are deserving of at least one person's dedicated life work. You also feel the bewilderment at a healthy pregnancy that goes wrong at that last moment, the helplessness of not being in control.

So in the meantime, you fight to believe in and hold up the dignity of life, that these little ones are made in the image of God, you continue to be amazed at 22-weekers, weighing barely 400 grams, fighting the odds, and not only surviving but thriving. You embrace feeling energized by a good day: knowing that this is time well spent, those days filled with incredible teamwork, hanging new lines like it's second nature, making a bed, getting an admission done in a seamless way, celebrating at even just slightly increased volumes of breastmilk with that new mom, seeing babies hit milestones. This is good and valuable work, necessary work, and a privilege to steward such care.

And at the end of the day, you pray. You pray for preceptors that lead with kindness and care, you pray for professional growth and increased competency in your skills, you pray for protection from burn out. You pray for the grieving family as you walk through a bereavement, you pray for the right words to say. You pray for success in that last attempt at a difficult access. You pray for covid restrictions to be over, so families can be better supported and together. You pray that Jesus would come back, that suffering would end, that His light would shine in these sometimes very dark places. And you pray for joy, for families to go home and enjoy their new baby, you pray that developmental milestones will be reached, and when they're not, you pray for parental and family endurance. You pray for good experiences despite devastating diagnoses. You pray for a new heaven and a new earth, you pray for medicine that continues to advance, and for outcomes to be improved. And you pray with gratitude and for gratitude. For the absolute privilege it is to help a parent hold their baby for the first time, or sometimes for the last time. You pray for renewed sensitivity to the stresses of being a nicu parent, no matter how seasoned they may be or how strong they seem. And you pray for grace, to remember the mercies that God provides every morning, and the One who knows all things, and holds all things in His hand. You pray for belief that He will make all things new, you pray for eyes to see what is good in the world, for a holistic vision of the goodness God is up to in the everyday. You pray for rest.

You pray through these highs and lows. You pray for the nicu.


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