Open letter to the President of the United States

Mr. President,
The recent decision by your administration to proceed with the violation of the First Amendment rights of millions of American citizens offends me. Your administration dares to ignore the very clear words and intent of our founders by demanding that faith-based employers ignore their conscience and the doctrines of their faith BECAUSE YOU SAY SO.

Mr. President, this will not happen. those of us who believe that we are not permitted by our God to participate in sterilization, abortion, and contraception by paying for it will simply not obey your orders. We choose to obey our God.

Furthermore, I believe that you will find that many who disagree with us as regards sterilization, abortion, and contraception will agree that the First Amendment prohibits the government of the United States from making such demands. They are wise enough to know that they cannot simply ignore this violation of the First Amendment then whine when their rights are trampled.

In case you have forgotten, the First Amendment states:

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

You are doubtless aware of the hundreds of thousands of citizens who marched on Washington in support of Life last Monday. That was nothing compared to the numbers of people who are angry about this assault on our First Amendment rights. We vote. We campaign. We will not tolerate this.

Give blood! Somebody else needs it more than you do.

We've been going through a lot of blood in the NICU lately. It's been crazy busy and the babies are smaller and sicker than usual. Packed cells, platelets, sometimes back-to-back transfusions. It's amazing how much blood a 500 gram (little over a pound) baby can use over the course of a week. They only need it by teaspoonfuls, but they need it frequently. Fortunately, the blood bank can split the units so we can get several transfusions from one unit of packed red blood cells.

Packed red blood cells are the oxygen-carrying component of blood. One donor gives about 500 ml of blood in a donation. Something less than half of that is red blood cells. Most of the plasma (liquid portion) of the blood is removed so we can give more red blood cells in a smaller volume. This is done for both adults and children, but our babies are very fluid-sensitive, so we especially need packed cells for them.

Platelets are important in clot formation. Not enough platelets and the baby is at higher risk of intraventricular hemorrhage (bleeding into the brain) as well as excessive blood loss from minor injuries (like heel sticks for blood draws). We only use single-donor platelet units collected by apheresis (collection by way of a machine which removes the platelets and returns the rest of the blood to the donor).

Our blood bank reserves a unit of packed cells for each baby who needs a transfusion. They do the same thing with platelet units. The baby may get one transfusion, or several, from that one unit. It helps to limit the number of donors to which each baby is exposed. Our micro-preemies (under 750 grams) are still exposed to several donors in their first weeks of life.

We are grateful to every one of those donors. Nearly all of the blood donors are type O, Rh negative donors. With platelets, matching isn't so sensitive, so nearly any blood type can be used. However, all of them must be negative for viruses which are harmless to most adults, but which most of us have experienced, making us good donors for other adults, but not OK for babies or those whose immune systems are failing. CMV (cytomegalovirus) in particular is potentially lethal to newborns - or others with weakened immune systems. When you need O negative, CMV negative, blood, you're talking about a pretty small donor pool. Those people may find that their local blood bank is calling them every 8 weeks to make another donation.

Blood donations are down in general, but historically, they drop even lower around holidays when the need can be great. If you can make a little free time this week - or next, make an appointment with your local Red Cross or hospital volunteer donor blood collection center.

Been told you can't donate blood? Ask again. Some reasons for declining your blood will never change, but some policies have -- fairly recently. For example, cancer survivors who are in good health - even those who had chemo - are often accepted as blood donors. Those who had lymphoma or leukemia still can't donate, but many of the rest of us are being welcomed back to the donor rolls.

Celebration of Life

In the last seven days, I have attended 3 funerals. The first was for a friend's mother. She wasn't a young woman and had been ill for some time. She nearly died several times last year and while her family felt blessed to have the additional time with her, she will be sorely missed. Her sons spoke of her love for her children and grandchildren. They wept freely as they celebrated her transition from this life to the next.

The second funeral was for a 93 year old friend whom I was privileged to know for nearly 33 years. She was an inspiration to us all. She was always charitable - even when offering needed corrections. She seemed tireless and when something was needed, she was there before anyone thought to ask. I will miss her, as will her family, but we all know she is enjoying a well-deserved reward.

Today's funeral was by far the most difficult. I didn't know the young man who died. I knew his aunt, my sign language teacher. Harry grew up between two cultures. The family of his birth is Deaf (though not all are deaf). He proudly brought legions of hearing friends home and shared his family with them. His death was unexpected and devastating to so many of his friends. Today his mother made us laugh and cry as she shared stories of his life. Her faith that he rests now in the arms of a loving God is her consolation in this time of great grief and an inspiration to all who attended the funeral.

Gianna Jessen Abortion Survivor in Australia Part 2

Gianna Jessen Abortion Survivor in Australia Part 1

Over the years, we've had a few abortion survivors pass through our NICU. A small number I remember.

All were born pre-term.

One young woman came to us in labor prior to 20 weeks. She had gone to another hospital for a prostaglandin abortion. She came to us hoping that her baby could be saved. Clearly she had not had appropriate counseling prior to her procedure. Sadly, there was nothing to be done but deliver her dying baby and console her.

The others were born early in their third trimesters after failed first trimester abortions. They were still very pre-term and only 2 survived their first few months of life. I don't know what happened to them. I hope their mothers were more accepting than Gianna's.

American Sign Language - free class on-line

I've had an interest in American Sign Language (ASL) for a long time. The first time I did anything about it, I had a patient whose parents were deaf. That inspired me to take my first class in ASL.

My second inspiration to learn sign was my oldest child. When he was little he was quite hard of hearing as a result of frequent ear infections. This resulted in expressive language delays. He attended a special pre-school where they taught some basic signs which helped at school and home. Unfortunately, he doesn't remember much sign at all.

The third impetus was my dyslexic middle child. He needed a second language for high school. Being unable to spell in one language is frustrating enough and the spelling used in ASL is English. Off we went in search of sign language classes which would accept a 14 year old. A local Deaf church provided those - along with some wonderfully accepting Deaf friends. We took classes there for several years and became proficient enough to carry on a conversation with any reasonably patient Deaf person. Unfortunately, I lost touch with that group and as a result, lost much of my signing ability.

My youngest son is now high school age and needs a second language. He remembers coming with me to ASL classes and Deaf parties, so he naturally wants to learn ASL. It just makes sense to him. It is also one of the more commonly used languages in this area and not at all uncommon to see people signing in public places here.

In my search for ASL classes that would accept someone his age, I found ASL University. It's a high school/college intro level ASL class in a very structured on-line format with accompanying resources.

I am amazed at how fast the ASL I'd forgotten is coming back through the use of this site -- and how quickly my son is learning expressive and receptive skills. We still want to find a live class, but we won't feel totally lost when we get there.

Hold that position!

Lumbar puncture (LP, spinal tap) is a relatively common procedure in neonatal ICU's. It can be done as part of a sepsis workup - looking for infection. Less commonly it may be done as a way of treating hydrocephalus (excess fluid in the ventricles of the brain) until a shunt can be placed or until a temporary condition causing hydrocephalus resolves. The most common temporary cause of hydrocephalus is interventricular hemorrhage (IVH, Bleeding in the brain). It's been years since we've had a baby with a bleed that severe, though.

More than one physician or nurse practitioner has commented that successful lumbar punctures depend more on the skill of the person positioning the baby than on the skill of the person wielding the needle.

There's more than a little truth in that, but the person doing the tap needs to be able to tell the holder how to adjust the position for best access. The more accurate their directions, the better the position.

There are two basic positions for LP. Sitting and lying on the side. Most of the time, we position the baby on his side with the lower part of the spine curved as much as is practical given the baby's condition and equipment being used. I generally place one hand on the baby's upper back and the other on the back of the upper thighs extending onto the diaper area.

The diaper is pulled down to expose the lower spine, but not so far as to risk fecal contamination. The nurse practitioner or physician cleans the site and places a sterile drape over the lower back. The lumbar area of the spine needs to be curled in order to open the spaces between the vertebrae. This is accomplished by curling the baby's spine from the bottom, keeping the upper part of the spine as straight as possible so as not to interfere with breathing. When I position a baby this way, it is very rare for a nurse practitioner or physician to fail to get a successful tap.

The seated position can be used for less fragile babies and the principle is the same, but hand position is different. The baby needs to be leaning forward with the head supported and lower spine flexed. One hand is placed on each side. I generally have 2 fingers of each hand on the upper back, thumbs under the chin, and pinkies under the knees. My hand size limits the size of babies I can position this way. It's trickier for the holder to learn this position and to keep the baby immobilized while the LP is done.