I walk in, the tall, white American wearing gray scrubs. Everyone thinks I am a doctor because the nurses here wear dresses and white caps like British nurses from sixty years ago.
There are metal, wheeled cots in rows. The basket part of the cot rocks gently when pushed. I'm the only one that employs that method of calming the babies. I'm the only one that bothers to calm the babies by any method, for that matter.
There are babies everywhere. The cots are full. The incubators have two or three 1 pound babies each. The plastic lawn chairs are lined up in the aisles, each with a baby in its seat. I'm afraid to sit anywhere.
There are babies in rows on the tables, stashed on both levels of the carts, in corners and on shelves. It would be so easy to forget about one of them. Or ten of them.
There are no blood pressure cuffs, no heart monitors. Three pulse oximeters are in the room, but rarely used. There are a few oxygen attachments on the walls, and tubes sprout from them like a monster with multiplying heads. One tube becomes two, becomes four, becomes eight. 16 liters of oxygen are pumped through them, and the assumption is each baby gets 2 liters. Sometimes we trip over the tubes that lie all over the floor, and I just pray that we discover which baby's oxygen was removed before any permanent consequences arise.
All the tubing and bulb syringes are reused. Every morning on the unit begins by washing them with soap and cold water. "Can I boil them?" I ask. "No. Just wash them." I do as I'm told, using a needle to scrape out any dried gunk from the previous patient inside the nasal cannula.
There is no such thing as giving report. All the nurses have all the patients. At one point I counted 62 babies, with me alone, while everyone else had gone to have tea.
The medical "charts" are just pages stapled together and laid on top of the baby's blanket. They are frequently mixed up, as the patients are all lying together. The medications are given the same way. All meds and flushes are drawn up into syringes, and then each babies' pile of meds is placed on top of their blanket. None of the syringes are labeled. I could be giving saline. I could be giving phenobarbital. I could be giving the neighboring baby's meds.
The IVs are covered in thick white tape. I can't see if the cannula is infiltrated or not. I do my best to check for swelling or leaking under the tape.
Every two hours the mothers come in a long, sore and tired parade. They are all barefoot, as shoes are not allowed on the unit. Even I have to change into special shoes when I arrive. They each carry a small plastic bucket with diapers and a wad of cotton wool, which they wet and use as baby wipes. The baby does not get a diaper change, a feeding, or a change of clothes until the mother comes. Even if they are messy. Even if they have thrown up. Even if the mother has not come in hours.
Some of the babies have feeding tubes. There are no breast pumps. I watch the mothers struggle to hand express their milk into a plastic cup.
They all want my attention at once. It is the perfect scenario for those "prioritization" NCLEX questions.
"Doctor, my baby won't eat."
"Doctor, my baby is very hot."
"Doctor, my baby is throwing up blood."
I'm not a doctor, but they don't know or understand. They just see someone in scrubs, and they take everything I say as literal fact.
Every morning when I show up, I look in the death records first. I count how many died in the night, and if I can remember their faces. I shouldn't do it to myself but I have to know.
I decide to start smiling and greeting the mothers. If nothing else, I can smile. They always look up, startled, at my greeting. They smile and greet me back. I always hope that the baby I'm particularly worried about isn't theirs. I always hope that the mother of that baby will come, so she can see him alive, just in case.
I will never complain about nurse to patient ratios again. I will never take for granted the Code Blue button, or the Code Blue team. I will appreciate the meticulous requirements of electronic charting, frequent vital signs, and alarms on monitors. I will gladly double identify my patients and label their meds.
I will never be the same.
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