And the Wall Comes Tumbling Down - Part 1

“On morals, I know only that what is moral is what you feel good after and what is immoral is what you feel bad after.” 

—Ernest Hemingway—

I walked into the NICU terrified.  The babies looked so very sick, attached to ventilators, feeding tubes, IVs, you name it.  They were dwarfed by the machines surrounding them.  For the most part they laid quietly in their isolettes, their parents hovering over them itching to hold them close.  Back then we had never heard of kangaroo care and thought it best to keep the babies warm in the isolettes.  Every morning when I entered the unit my day would start with a report given to me by the night nurse for my one or, at the most, two charges.  It was a long, involved report since our babies had a lot going on with them.  The meds were teensy doses, and all of the equipment we used was tiny in comparison to what I had used in nursing school with all of my adult patients.  It took a little getting used to.  

I started the job in an NICU (Neonatal Intensive Care Unit) right out of nursing school.  I was only 21. I wanted to be in an exciting part of nursing.  I wanted to have intense experiences.  I wanted to feel important. So I chose NICU.  Every day I took care of very very sick new little babies.  Having not been a mother yet, I didn’t fully understand the intense emotions of the parents and I could keep a certain emotional distance from the babies themselves.   It was a challenging job and I loved it!  I learned more in the first 6 months at that job than I learned in the entire four years of nursing school.  Everything I learned in nursing school came together for me for the first time.  I felt competent as a nurse.  I knew there was still a lot I didn’t know, a lot to learn, but I was feeling better every day about my skills.  

We had a variety of nurses in that unit.  Most were very compassionate but there was a common thread that I began to notice and that was the gallows humor that many of the nurses used to deal with the emotional turmoil they often found themselves in with these difficult situations, including the death of some of our babies.  When I first heard the jokes some of the docs and nurses made I thought them horrible people but I soon discovered in fact it was everyone’s way of coping with the stress that we so often experienced on a day to day basis;  little babies being subjected to painful procedures, the daily touch and go condition of our patients, the angst of the new parents, the hopelessness of some of the cases, the unusual and rare conditions that were brought to our hospital, the responsibility that we all shouldered for these little tiny beings where one tiny error could be the difference between life and death.   The other coping mechanism I noticed was an invisible wall put up by many of the docs and nurses that disallowed any true emotion to be shown, shared or even felt.  A closing of a door that I was concerned could never again be opened.    

One day we heard that a 26 weeker was coming to our unit.  We had never been able to save any baby under 28 weeks.  We all asked why?  Why were they sending this baby to our unit when we all knew he wouldn’t make it through the night?  

Little Paul arrived along with his hopeful parents and we set to work to do everything we could.  We were afraid we wouldn’t be able to keep him warm enough in the isolette so we covered him with foil to keep the heat in.  We questioned every procedure that we did to weigh the benefits against the risks.  Every time we opened the isolette to do anything we felt we were risking his life.  

And we all questioned why we would work so tirelessly trying to save a 26 weeker’s life, knowing full well he wasn’t going to make it.  Why are we even giving these parents hope?  Why are we putting this baby through all of these sometimes painful procedures knowing in the end he was going to die?   Couldn’t we just put him in his mother’s arms and let him die peacefully?  We were told that caring for him as if he would live would help us learn what to do with the next 26 weeker.    Was that right?  Was it right to put Paul and his parents through this so that we might learn something from it?  Perhaps it was, if it gave the next 26 weeker a better chance.  None of us knew the answer.  Paul died 72 hours later.  

I watched as babies whose parents came in every day die and babies whose parents had abandoned them live only to be put in foster care.   Sometimes we did everything we could for a baby - went way above and beyond to save his life, knowing full well that the life he would have would be one of severe and crippling disabilities. 

Because we were a teaching hospital we allowed inexperienced residents to do spinals, IV’s, and central lines on babies so they could learn.  Sometimes we had to play deaf to the babies’ cries as these procedures were performed because they were too little for us to give them anything for pain.   I saw incompetent physicians make bad decisions which prolonged a baby’s stay and I saw egotistical physicians who would not admit when they made a mistake.  

During that year I saw more and learned more about myself and my values and the world at large than any other time in my life.  

I was raised with certain truths – life is good, bad things don’t happen to good people, babies don’t die, there is a God and he protects the weak, people will act responsibly and ethically when it comes to others’ lives.  All of these beliefs I had acquired during my childhood and young adulthood were held into question that year.  Life wasn’t always good, bad things do happen to good people and sometimes bad people get things they don’t deserve, babies do die and God isn’t always around to protect the weak.  The ethical issues were overwhelming at times. I drank a lot that year . . .  I remember one night in particular when I had gone out for a night of heavy drinking after a particularly stressful day at work. A couple of hours after going to bed I woke up throwing up and cursing the babies. “Those damn babies” I was saying outloud between heaves to no one in particular, “Look what they are doing to me. Damn you babies!!” It was definitely a wake up call.

By the time I was in my twenties, I had many beliefs and values, most of them taught to me by my parents or what little life experience I had accumulated in my white upper middle class neighborhood growing up.  Picture a tall brick wall and each brick is one of those truths, one of those beliefs.  When I had an experience like I had in the NICU, it felt like someone had just driven right through my wall and toppled it.  There are bricks everywhere and my first thought is “Oh my gosh, what do I do? How am I going to stack all of those bricks up again?”  Then, I realize that some of those bricks are of no use to me anymore.  Some of those bricks are broken and I cannot keep them in my wall.  So, I very carefully pick up each brick and I take a good long look at it and I have to decide if it should be tossed aside or put back into my wall.  And as I do this, I very slowly rebuild that wall, discarding some of what I thought were truths.  But now my wall is stronger because I have gotten rid of the faulty bricks, the ones that don’t hold up to my day to day life.  I now believe more strongly in my wall because it is a wall that I built for myself.

I think, that throughout my life this wall has been adjusted according to my experiences but only a few times in my life did that entire wall come down, a time when I was in an unusual and intense circumstance that brought all of my values and beliefs into question.