Reflections from the NICU, by Thomas Verstynen, Public Administration Graduate student, NM LEND

February 19, 2008

Thomas Verstynen, Public Administration Graduate student, NM LEND

Billy-Ruben? What is that?

Sounds like some sort of promotional sandwich you could order from Applebees.

I sat in my seat, surrounded by numerous healthcare students and professionals, each of them brilliant in their own fields, perplexed by the term that was just thrown into the discussion. I looked up and made eye contact with Joan Bradley, one of the nursing faculty for the New Mexico LEND program. Even though I desperately tried to conceal it, I knew she could tell that I was confused.

"Do you know what that term means," she asked gently.

As a graduate student in Public Administration I have found that one of the difficulties I have during our weekly discussions is the medical jargon that is used so commonly. Between biliruben, balcofen, and myocardial infarction, I feel like I am playing Scrabble and it is my turn to change the letters I have before me into actual English.

I shook my head. Joan went on to explain that bilirubin results from the breakdown of hemoglobin. The condition often leads to jaundice when bilirubin accumulates in the blood at an abnormal level. Unfortunately, the condition occurs in many premature babies which leads me back to the discussion we were having that Friday afternoon.

As part of our curriculum for the New Mexico LEND, each of us has to visit the Neonatal Intensive Care Unit, NICU, at the University of New Mexico Hospital. With much of the group being nurses, doctors, and other types of health personnel, many of them had already visited the NICU. They knew what they would encounter. While I felt like I had a good idea of what I would come across, nothing prepared me for what I would see, what I would feel, and what I would walk away with after my experience.

As I got dressed on that Wednesday morning, I thought a lot about something that happened last summer. In June 2007 two of my best friends had their first baby girl. On the morning of June 13^th, I received the call that my friend was going into labor. My girlfriend and I rushed down to the hospital to meet with other friends and family. Doing about eighty miles per hour on the freeway, I remember telling my girlfriend how crazy it would be to have a baby of my own. Barely being able to take care of myself, I couldn't imagine taking care of another human being at this point in my life.

We arrived at the hospital and visited with my two friends, an anxious husband and wife, until her doctor kicked us out. My girlfriend, myself, and our mutual friend waited outside the door during the entire birthing process. To be honest, I wanted to wait down the hall in the waiting room so I didn't have to hear anything but the other two wanted to be right outside the door so they could be the first ones to see this baby. After about thirty minutes and only a couple of low screams later, their daughter was finally brought into the world. We were allowed back into the room. My best friend, an ex-Marine, held his tiny daughter in his gigantic arms while his wife was taking a well-deserved rest. After a couple of minutes, he handed her to me. I had never held a baby that young before but once she was in my arms, a conflicting feeling came over me. Knowing that I was holding something so fragile in my arms, I became tense. At that moment, all my concentration was on this tiny human being and nothing else. Every movement she made, I responded immediately by making sure she was always held tightly. To this day, my friend always hand me their baby to watch me squirm, fearing her head might fall off if I don't always hold it for her. However, at the same time I was feeling nervous, an overwhelming calm set in as well. Between work, school, and everything else in between, this tiny little thing had the power to push away everything that didn't matter. I didn't want to let her go but knew she had to be passed back to mom and dad.

I came back to the hospital that afternoon, helping relatives, grabbing food for everybody, and hoping to hold the baby as much as possible. In fact, as I left the hospital I was so caught up in everything that happened that afternoon that I accidentally used a service elevator and got stuck for fifteen minutes earning me the title, "Uncle Elevator." Luckily, a janitor was able to open the door and I took the stairs the rest of the way.

My two friends managed to create one of the most beautiful babies I have ever seen. She's very healthy, smiles all the time, and is progressing very well. Every time I think about having a child, I can only hope that the baby I have ends up like their little one. I thought about their daughter, my pseudo-niece, the whole morning before I visited the NICU. I knew the babies I was going to see were not going to be healthy like she was. I knew they were not going to be as big as she was. Walking on the overpass that leads to UNMH, those were the only two things that I did know.

The NICU of UNMH is located in the Pavilion, a brand new state of the art building that has greatly expanded the capacity of the hospital. However, before I went to the NICU, I had to meet with Monica Aragon, social worker and former LEND trainee, my guide for the next couple of hours. I met up with Monica in the ambulatory building. Looking a little frazzled, she came into the waiting room of the Pediatrics Department.

Even though she was probably having one of the busiest mornings she managed a gentle smile, letting me know that I would be in good hands for the rest of the morning. Managing the maze that must be like every hospital, Monica led me to a brand new lobby where she offered me a cup of coffee. Considering that I had already two cups to make sure that I would be awake that day, I denied.

Monica sat me down and prepared me for what I was going to see that day: premature babies, babies addicted to drugs, and babies with other sorts of defects. She explained the different machines to me and the sounds I would hear. She told me about the different people I would be seeing: the doctors, the nurses, the techs, the medical students and, of course, the families. She finally explained that this particular day was a very somber one for the entire department. A couple weeks before, a baby had been born with Trisomy 18: a chromosomal disorder that happens during gestation and is 95% fatal. The parents, two young professionals, had decided that they wanted to wait for family and friends to throw a party in honor of their baby. In a rare decision, the hospital allowed the family to have a party on one of the patios in the back of the hospital. After the party, the parents would bring their baby back to the NICU and end life support.

While Monica continued to brief me about the NICU, I began to think about what I would do if I was ever in that family's situation. I was overwhelmed with the grief and anguish that the family must have been going through. I brought myself back to the conversation and tried not to think about what was going on upstairs.

After about 45 minutes of preparation and discussion, Monica finally led me to the NICU.

One of the reasons why I applied to the New Mexico LEND was that I wasn't so sure if I wanted to get into the field of health care policy. I am also very interested in other things such as criminal law, environmental policy, and international relations. I applied to the LEND project to see if health care is something I actually want to be a part of. While I am still undecided with what I will do for the rest of my life, and am predicting I will be for the majority of my life, the NICU experience unquestionably gave me a new perspective on health care policy and how it affects us all. It helped me realize that even I, the lonely bureaucrat, might be able to benefit these babies and their families.

For the next four hours, Monica and her coworkers gave me a tour of the NICU. Most of the babies that I saw were asleep. Through the use of cushions and contraptions, most of them had their bodies manipulated into the fetal position to simulate what it would be like inside the womb. Their undeveloped eyes were covered from the harsh light. Many of their incubators were covered in blankets as to mimic the darkness of the womb. I found myself amazed at how some of the solutions to the problems that these babies encounter are so simple: blankets, blindfolds, and cushions. I saw a little Native American boy with a head full of hair. His motor functions were excellent and he was able to keep eye contact with things that were in front of him. I was happy to hear that he would be going home later that afternoon.In one of the rooms, I came across an abnormally large incubator. In front of it sat a young mother sitting with a middle-aged woman, each of them holding the tiniest of human beings. It turns out the young woman was nineteen and she had another child waiting at home.

Only nineteen and already had three children?

I thought about what I was doing at nineteen. Living in a dorm room that smelled like Ramen noodles, buried in homework, and wearing clothes that hadn't been washed in weeks. Yeah, I definitely wasn't the parenting type back then. I was snapped back to reality when Monica asked if there was anything that they needed. The grandmother asked if there might be any sort of group that could help them with baby supplies such as diapers, clothes, and formula. Monica, ever the source of comfort, replied saying that she would look into it and come back with some information.

I was introduced to bili lights, lights that are used to help infants with jaundice. These blue fluorescent lamps generate specific wavelengths of light that help break down bilirubin into nontoxic water-soluble components that can then be excreted. Every night, when I walk from my class to my car, I pass the Pavilion and see these lights glowing from fourth floor windows. I used to think that these lights were hallways lights or glows from television screens. Now I walk to my car knowing that these lights are taking care of babies that can't take care of themselves just yet. I think about the power of life that is held in the light's wavelengths, penetrating a child's skin to give its body some sort of inclination of hope.

Towards the end of the morning, I came across a mother and a father staring into their baby's incubator. The baby's tiny arms were quivering and his low mumbles indicated to me that he was uncomfortable. Monica's coworker asked the parents questions on how they were doing and if they needed any help but I wasn't paying attention. Even though I am nothing close to a medical professional I knew that something was seriously wrong with this child. His arms were flailing, his head was rocking back and forth, and his mumbles and screams sent chills through my entire body. Later we went online to look at the child's medical records. It turned out that the child was born addicted to methadone. Those parents that I once held sympathy for were now people I held in contempt. Those parents who looked so scared and innocent while their child was suffering an enormous amount of pain were now guilty and punishable in my mind. While in the office, I daydreamed about walking back to the NICU and yelling at the them, telling them what failures they were as parents and as human beings. Before and after my visit at the NICU, Monica told me about these parents and the troubles they went through. She told me how even though they brought this child into the world addicted to drugs they still loved them. At that moment, while I was reading the words "cocaine" and "methadone" on the computer screen, I had a difficult time believing that.

How could somebody say that they love their children and bring them into the world like that?

The only thought that brought me back to the situation was hoping the parents had already suffered enough and that somebody yelling at them, punishing them for their faults was the last thing that is needed in that situation. Somehow in some way, compassion could be the only solution right now.

At the end of the morning, I was handed dozens of pamphlets on organizations around the state that help out families in numerous ways: funding, clothing, work, babysitting, and many other ways. At this moment, I began to think about my role in all of the chaos. My role as the provider of funding. My role as the one who decreases the paperwork for these families. My role as the one who gives them what they need and maybe just a little more. My role as a researcher and educator, examining the social problems that surround these individuals on a day-to-day basis.

I walked out of the hospital that day considering myself a newly educated individual. So many people in my fields talk about these issues, but I, for one brief morning, had the opportunity to experience them. At this point in my life, I consider myself young enough to be that much more naïve in thinking I can change the world. It's a feeling that I never hope I lose and after visiting the NICU, I am comfortable in knowing that many more people like me will grow up because of the professionalism, the care, the courage, and the decency of people like the nurses, the techs, the doctors, and staff I saw that day.