Sunday, February 18, 2007

I hate to float

I'm a NICU nurse. I like my relatively controlled environment. Yes, I know many of you think I'm totally certifiable for that preference. I hate to float, as in to another unit. Something always happens to make me very sorry I've left the relative safety of the NICU.

Most recently, it was the pediatric unit and the 6 week old with an admission diagnosis of ALTE - apparent life threatening event. According to the mom, baby simply turned blue for no obvious reason. Only as Dr. House says, everyone lies.

The mom insisted that the baby was not feeding when the episode occurred, so the baby got the inevitable big deal workup for ALTE - cultures, LP, various scans and studies.

We all had our doubts about the mom's story, but they grew as the shift progressed.

8 pm: Charge nurse walked into the room and found mom feeding the baby -- baby was lying in the crib, mom was standing beside the crib holding the bottle. Charge nurse instructed mom to sit in a chair, handed her the baby and explained WHY feeding a 6 week old infant who is lying in his crib puts him at risk for choking episodes - which tend to make the baby turn blue and experience the above mentioned ALTE. Mom appeared to listen and finished feeding the baby while holding him.

Midnight: I walked into the room and again found mom feeding the baby in the crib - standing beside the bed, only this time she'd propped the bottle and was standing beside the crib watching the baby. I removed the bottle from the baby's mouth and went over the whole explanation about choking and ALTE's (mom still denied that baby was eating when said event occurred). Mom picked up baby, sat in chair, finished feeding without incident.

12:30 am: The pediatric resident stopped in to see how things were going. I updated her on the situation and documented VERY carefully while the resident went in to have another chat with mom. Social service consult was ordered.

2am: Mother of another patient stopped by the nurses station. She had seen the baby's mom and dad. She said they were relatives and there were some things we really needed to know. Charge nurse and pediatric resident escorted her to a private place for further discussion. Social service consult was ordered.

5am: I opened the door of the patient/parent bathroom on the floor (no locks, no response to knocking). Baby's father was pink, breathing, and sound asleep seated on the toilet. I closed the door and left.

5:30: I entered the baby's room again. Mom was snoring gently in the bed on one side of the room. Baby was lying in the crib, sucking on a bottle of formula. I removed the bottle from the baby's mouth, quickly assessed him to make sure he was OK, and took a deep breath to compose myself. Then I moved over to the mother's side and said:


Mom regained consciousness with a start. I explained, none too gently, that her baby could easily have died if she was in the habit of feeding him this way at home. She insisted that the baby's father must have propped the bottle. From the bathroom. Right.

If the mom had admitted to her unsafe feeding practices, the baby could have been observed and much of the uncomfortable and expensive workup would have been unnecessary. What was she thinking!


Shinga said...

Cliches becume cliches because they are so frequently true. Well observed and well caught.

Regards - Shinga

Anonymous said...

She wasn't thinking...because she was never taught how to think. She is one of many from this generation that has always been allowed to "do her own thing". A phrase from another time; yet it is coming back to haunt us. We are reaping the fruits of the 60's. If your grandparents and parents never instructed their children; in the interest of allowing "my children to develop their own personalities", then you will get these types of uneducated individuals.
So look at this female genome as the leading indicator of the next generation.

Judy said...

Actually, I think she (correctly) surmised that someone would explain to her that what she'd done put the baby in jeopardy. Since she had managed not to kill her other 2 children feeding them this way, she didn't intend to change her practices for us. I suspect that she also had figured out that child protective services would be involved if she admitted to her unsafe practices. Maybe, maybe not, but they were certainly involved once we caught her in the act.

Bryan said...

This make want to scream. Clark has a post on the cursed ALTE over at unintelligent design.

Judy said...

I read his post. In fact, that was what reminded me of this particular event. His experience of ALTE is much more typical than this one.

I remember feeding my second child shortly after bringing him home from the hospital only to have him choke and turn blue when my letdown exceeded his ability to swallow. Most new moms would probably have dialed 911. I did the NICU nurse/mom thing and got out my stethoscope before I fed him the next time. It took him a couple of days to figure things out and we didn't make any trips to the ER, but I can understand why people panic. Not admitting that the baby was eating when it happened I don't understand.

Flea said...

Oh man! You need a hospitalization to work up shitty parenting? We are in very bad trouble indeed.



mcewen said...

As Judy said - the 'let down' waterfall/choking can be a bit of a surprise to the uninitiated. Sad to think that 'education' hasn't improved in the last couple of decades.
Best wishes

Karen said...

It always amazes me that children from these families even live to adulthood! And yet the overly cautious parents turn their back for one second and tragedy occurs.

Ninotchka said...

got out my stethoscope before I fed him the next time

Okay, I am a neonatal naif... please tell me - what did you do with the stethoscope?

Your blog is fascinating. Thanks for sharing it with the masses (eg, me).

Judy said...

Thanks for the question, and I should probably turn this into a whole post sometime, along with other things I never told my pediatrician.

NICU nurses can imagine far worse problems than the average mom. My second child, as I suspected, just couldn't swallow as fast as my milk was letting down. The same thing can happen when the baby sucks on a bottle faster than s/he can swallow and it's scary, especially to an inexperienced new mom.

I was making sure that a gap between his swallowing ability and my letdown was the only problem. I was checking to make sure his heartrate didn't drop to a dangerously low level and that he hadn't aspirated (inhaled) any milk.

I also checked to be sure he didn't have a murmur (might indicate a congenital heart defect) and that his lungs sounded clear (I was worried about a leak between the trachea and the esophagus). I really didn't think there was anything serious wrong, because he looked just fine between feedings.

Ninotchka said...

Ahhh. That makes sense, thanks!