To the editors.
Re: "Confessions of a Baby Saver" [June 15]
The title of this article certainly attracts the reader's immediate attention, however, I must question the motives of a nurse who uses a lay newspaper as the vehicle to air these very complex and sensitive issues.
While there is a kernel of truth behind each issue presented, my concern is the impression the reader (especially the lay reader) is left with--that Neonatal Intensive Care Units are places where babies are tortured mercilessly until they die; and, secondly that hospital staff are more concerned with lawsuits than human life and easing of suffering.
Specifically, I would like to address several points that Ms. Shepard presented:
(1) I find Ms. Shepard's style of writing to be flippant and irreverent, especially in her frequent analogies of babies as non-human, e.g. she describes premature babies as having an "uncanny resemblance to pithed frogs," or refers to them as "creatures," or states that "animals, of course, abandon those of their litter that are not right." She also compares premies to a "broken radio" and states that when they stop breathing, if "you give them a good shake . . . everything starts working again." Ms. Shepard may have thought these were clever and cute analogies, but personally, I found them offensive. I think of the parents of a sick newborn currently in an NICU, and worry that after reading this article, they will wonder if their baby's nurses think of him as an animal.
(2) I must also question Ms. Shepard's motives for becoming an NICU nurse--"I was sick of listening all the time to people with problems, and I was depressed that I could help so few of them. I needed a change. I decided I wanted patients who weren't going to talk to me." (So much for family-centered care!) And even though she felt "disgust and horror" when walking through the NICU, she chose this place to work because of the "desire to learn something completely new" or because of a "sick fascination" or because the hospital was close to home! Not inspiring motives for nursing in any specialty area!
Who should be saved? This, of course, is the million dollar question. If we had crystal balls in the delivery room, the decision would be simple. We'd all like to know who will live or die, or who will live for months at great expense and then die, or who will survive with residual effects or handicapping conditions. Even if we could predict who will have permanent sequelae, who decides which sequelae are severe enough to preclude a "quality life." What I consider to be poor quality of life is probably different from yours or anyone else's. These very same issues occur at all points in the life cycle, and are not restricted to neonates. After all, our society not only does not value children, but has a very negative attitude towards any individual with a handicap or who is not a "productive" member of society. Our value as a human being in this culture is based upon the size and function of our cortex and physical appearance.
In summary, Ms. Shepard presents an emotional and subjective view of the difficult nature of "life" in an NICU, whether for the baby and parents or for the nurses. Her reaction is a common one for NICU nurses after the first or second year. The first year or two are spent eagerly learning and becoming overly optimistic over every new admission. In time, after experiencing the death of one or more babies, it is natural to question why? Why does this happen? Why do we resuscitate very immature or very sick babies? Ms. Shepard partially answers these questions when she cites several examples of babies who appeared to be "hopeless" at birth, yet survived intact. Ms. Shepard does not point out that the majority of NICU admissions survive intact. The most sensational stories that reach the lay press involve a very small minority of infants. Every NICU has had an "Andrew," a beautiful baby who survived for months and then finally died. Ms. Shepard states that Andrew was 12 weeks premature. A 28 week gestation infant is not that immature and has a good chance of survival, although it's certainly at risk for many problems. Some 28 week infants do amazingly well, while others seem to develop every complication. There is no way to know this at birth. Her description of Andrew's last night is very poignant and a situation which most experienced NICU nurses can relate to. While his prolonged hospital course and death are sad, I'm not sure we can automatically draw the conclusion that Andrew's life was without meaning. We may never know the impact of Andrew's life and death on others.
While some aspects of care in the NICU are painful, I'm not sure they are any more painful than hospital care for any other patient. Is starting an IV or drawing blood more painful for a baby than for a toddler or adult? We have come a long way in terms of pain management for the newborn, and what I believe is more gentle, compassionate and developmentally centered care. There is no comparison between NICU nurses and "Nazi doctors," and I find the analogy reprehensible.
The major issues at stake, namely who should be resuscitated, who decides when treatment should be withdrawn, and who pays, need to be dealt with objectively without emotion and sensationalism. These ethical issues affect all age groups, not just the newborn. However, I sincerely doubt that there will ever be cut and dried answers to all these questions. Rather, decisions will continue to be made individually based on the facts of each case. Those of us who have stayed in NICU nursing obviously do not feel the way Ms. Shepard feels. I don't view myself as a "baby torturer," but one who brings knowledge and experience to each baby and attempts to deliver the best and most compassionate care to each baby and his family! I see myself, and every NICU nurse, as an avid patient and family advocate. It is unfortunate that Ms. Shepard did not present NICU nurses this way. I am only grateful that she left NICU nursing.
Mary Beth Malloy, RN, MSN
Loyola University Medical Center