I came across this vignette I wrote many years ago. It is not cheery, and can be difficult to read. The circumstances have been changed to fictionalize the scenario, but those of us in healthcare have come across this situation far too often. I only wish we could help those who need it most. Think of this as an extended poem.
NICU
There’s a baby in the nursery, only 10 days old, the
unfortunate victim of life’s circumstances at his very young age. Once again, like so many others we see, he is
the helpless and innocent victim of multiple events of which he has no
control.
He lays on his back in the NICU
surrounded by a mass of blankets. His
too thin legs are curled under him, the skin falling off in folds. His skin is so dry that it flakes off in
large pieces as if he had lain under the sun for too many hours on a hot
beach. The wires of the heart monitor are
draped across his chest and abdomen.
Wrinkles form around his elbows and his wrists, as well as his lower legs
below the knees. At first, the soft spot
on his head feels large and the skin of his skull is draped over his brain like
a tablecloth. His eyes are sunk into his
face and he truly has the wizened look of a monkey that we sometimes joke about
with the newborn babies. His lips are
dry and cracked. His belly protrudes,
and veins course across his abdomen.
The
cardiorespiratory monitor is set on silent and records the rhythm of his heart
and his breathing which are steady as is his blood pressure. We await the results of his initial labs; amazingly,
his kidneys are functioning ok and his sodium is basically normal. We know he is dehydrated, but we can look
at him and know that; it is obvious. We don’t need the blood tests to tell us that
is so.
He was born to a mother who had
been doing meth during her pregnancy, and although her drug screen was negative
for anything else, she was probably addicted to several substances. He came four weeks early and to a hospital
where they are used to seeing only the wealthy and the white. Despite not feeding terribly well, and despite
the high risk of developing withdrawal in response to the substances his mother ingested, they elected to send him home on day of life
2.
His grandmother offered to take
custody of him as his mother did not have custody of her other two children and
CPS deemed her unworthy of taking him home.
He came to our NICU so dehydrated that he could no longer get up the
energy to cry when they placed the IV in his foot after several attempts in his
scalp and hands. He had copious diarrhea
to the point where his little rectum was prolapsing with every bowel
movement. We know that if he didn’t come
into our hospital within the next 48 hours or so, his kidneys would have failed
and he would have died.
His grandmother
seemed appropriately concerned and stayed with him most every minute of the
days and nights, and yet we couldn’t help but wonder how he got into this
condition.
Did she not recognize that he
had not the energy to cry for his next meal?
Did the meds she used to help her own sleep prevent her from waking and
caring for him in the night?
Why was
she on such a powerful antidepressant and antipsychotic?
Aren’t the sins of the parent reflected in the child and thus the
grandchild?
Had he also been exposed to
toluene, or some other caustic substance in the methamphetamines that had
affected the lining and absorption of his gut?
Was he withdrawing from any of many unknown substances in such a manner
that his mother never had to experience because she would not give up her habit
although she had gladly given up the boy?
Was it his fault that he was born several weeks early partly because he
was malnourished in the womb because of her addiction?
How does that affect the development of his
brain?
How does it affect the
development of his normal emotions?
Are
the days he spends in the NICU really going to be the best days of his life?
We ask these questions far too often as we work caring for
the underserved of our community.
We see
these situations commonly.
And the
people we need to reach the worst are the most unreachable.
We only hope that we can keep some of these
innocent children out of the path of their own destruction.
We also know that more often than not we
cannot and they will end up in the same circumstances themselves someday.
