Yesterday was International Nurses Day. Against the backdrop of months of stalled pay negotiations, Roxie Mohebbi, a former Auckland ICU nurse, wrote this journal entry based on some of her toughest shifts.
This story discusses infant mortality and babies in medical distress. Please take care.
17.00: My timer is set for 45 minutes. I’m not sure if I can actually sleep. The tiny ocean in the pit of my stomach has started to swell. My GP is really nice. He wears Kathmandu fleeces and Merrell sneakers and does his best to give me a full 15 minutes when I visit. He calls it anxiety but “it’s more complicated than that”, I tell him. I wasn’t actually going to crash my car on the motorway to get out of my shift, I just thought how nice it would be to have an excuse for not having to go into work for at least a few days. It’s fine, I have thought of lots of different scenarios – not just the car one. No, I’m not a danger. I’m just scared of unintentionally killing a baby.
17.55: I can’t justify pressing snooze again, I have to make lunch and my scrubs still aren’t dry. I’m trying to take salads because by 4am all the sugar from carbohydrates starts to wear off and I get the shakes and I won’t be able to sleep once I get home. I’m doing roast vegetable and feta today, it makes me look like I have my shit together in the staff room and sometimes that’s the difference between Kelly patronising me all shift or not.
19.35: We don’t usually make them share rooms. It must be bad tonight. Not sure how I can sign off my safety checks when there is only one medical gas outlet on the wall. And two babies needing medical gas. I haven’t even had a handover for my two other patients yet and the day nurse is definitely being passive aggressive at this point. It feels like she’s transmitting some obscenities in Morse code with the pen clicking going on. She is doing an extra shift though, and has a 18-month-old baby at home who she hasn’t seen awake in four days. Sometimes I wonder if they ever forget their mums’ faces for a minute. Surely babies don’t have good long-term memory yet.
20.15: Two on hourly feeds and the other two on two-hourly. In nursing school they romanticised ICU by telling us it was one-on-one nurse-to-patient care. Sometimes one-on-two if it was busy. Four definitely isn’t normal. I don’t think? I’m trying to not think about it. Four sets of mums at home, probably awake too, wondering if their baby is going to be alive by the time the moon goes down. I might call and see if any of them are up to coming in for the night. Why does breast milk take so long to defrost?
22.40: I haven’t been down to see Benji yet. I can’t believe he’s still here, to be honest. Plus I already said goodbye last week at the end of my stretch and did my crying on the way home in the car. Which is unusual, because I can’t really cry any more. Death has made itself very comfortable in the living room of my psyche. He kind of feels like a landlord around here. Usually gives notice but sometimes turns up unannounced and drunk demanding rent a week early. OK, I know that doesn’t actually happen and I’m being dramatic but honestly, it’s hard to process how normal death has become for me. And I haven’t even been a nurse for a whole year yet.
23.45: I’ve spotted Kelly. She’s giving someone a lecture about wearing earrings. My stomach starts turning again. In the real world I would never take Kelly’s shit. But she’s put me on three weeks of 12 hour night shifts Friday to Sunday for sending an email to HOD about how unsafe our staffing numbers are. I’m pretty sure my relationship is ending and with these rosters I won’t even get a chance to see him to try and save it. I might take lunch early.
23.50: My vegetables have gone flaccid and soggy. I should’ve left the lid off while they cooled but Auckland traffic is hell at the best of times. I think nursing has turned me into a boomer. I’m OK with that. What I am not OK with is how hungry I am and how unappetising my only food option is right now.
23.52: Half a mouthful of wet feta later and the red emergency sign lights up. It’s kind of an absurd moment, objectively. A baby is out in the ward having a life-threatening event, and the nurses in the staff room let out a unified groan anticipating the phone ringing if it’s someone’s patient. Turns out I’ve been saved from having to force feed myself this salad.
23.57: My 39-weeker in bed 11 with Pierre Robin’s is aspirating again. She does this on the hour, almost to the second. It’s fine – she usually comes right with a quick suction and a bump of her oxygen. But her 28-week-old neighbour has decided to come to the party with a brady. He’s little and on CPAP with HR at 95 and dropping by the minute.
23.58: I’ve left the corner of the suction in on low and run over to the little fella to check his CPAP prongs. Hopefully it’s a line issue and he will bounce back once the flow resumes.
00.00: The CPAP is working as it should. He is having a proper bradycardia. HR is at 82 now and his O2 sats are starting to drop. I’m trying to stimulate his system by giving him a rub on his legs and torso. O2 is down to 88%.
00.03: The suctioning isn’t working over the hall. I can probably leave him for 30 seconds in hopes that he will catch up with the stimulation and increase of oxygen. I give bed 11 a proper suction and she corrects back to 90% but is now screaming so she’s bound to go back down if I don’t settle her.
00.04: HR is down to 70bpm now and his alarm is going off. The alarms in the unit are like a menacing orchestra. I can faintly hear them in the shower once I get home. The stimulation isn’t working. I shouldn’t even be in the NICU. I’m still a new grad – I should only have babies who don’t need respiratory supports. Feeders and growers. HR 68.
00.05: They’ll make it my fault in the incident report. Kelly will use her favourite two scapegoat words: time management. HR 65. I need to press the emergency bell. Everyone is down the hall with a really sick 26-weeker. It’s intubated and getting lines put in. HR65. O2 85%. Bed 11 starts desaturating again. She’s sitting at 89%. One more scream and she’ll spiral down. I run over to put her dummy in. She’s got tears falling down the sides of her eyes. Babies cry all the time but when they actually produce tears it feels different. It feels like they’re actually sad, and in pain.
00.06: HR60. I’ve increased his oxygen and am moving his limbs around. He’s not responding. HR60. I press the emergency bell. My cubicle lights up and the red lights start flashing. HR77. He’s coming up. No one comes to help. I rub his chest again. He’s not responding to much. I stand in the hallway and call out for help. No one hears me. Benji is being transferred to the whānau room and the new 26-weeker is unstable.
00.06: The last 30 seconds have gone very slowly. My ears are ringing and my head feels hot. I fainted at the first delivery I assisted. It was incredibly cringe but funny after the fact. This is different. Kelly would love to see me faint during an emergency. Prove she’s right about migrant nurses and their “incompetence”. Even though I trained at Massey and have been in New Zealand for 19 years. Fuck Kelly.
00.07: Bed 11 has downgraded her screams to a whimper. A CNS has finally left the bedside of the sick 26-weeker and is up helping me with the bradycardia. HR96. She shows me how to adjust the neck roll so his airway is better. HR120. I don’t know if it’s my completely blanched face or the tears that have found their way up to the rims of my eyes, but she tells me I did a good job. It makes me uncomfortable. It’s the first time anyone has said that to me after being here for 10 months. And I’ve had sicker babies.
00.15: Shit. My feeds and meds for the other two are behind by 25 minutes now. And I haven’t defrosted more milk.
02.45: I finally almost piss my pants so I force the nurse next to me to take a handover so I can take a five-minute bathroom break. We can’t leave the bedsides so everything has to be handed over and at 3am no one is feeling too chatty. The 10-cent-sized patch has grown to at least a $2 coin by now. The LED lights in the bathroom make my scalp look extra white. Alopecia isn’t really something that affects your “health”, as such. My GP (the nice one in the Merrells) said I should reduce stress. He also suggested injecting my scalp with steroids to try and reduce the hair loss but I could still wake up bald so it might be pointless. Ironically, Kelly told me I had nice hair once. When I first started. I wonder if she’ll notice if I come to work in a wig.
04.10: A new admission. It’s just a sugar baby, they say. Three sets of BSL and it can go back to the wards to be with the mum. I try to protest because I’ve got four patients already when I am supposed to have one. And I’m still trying to catch up from earlier. But the senior nurses are tired and I’m the only new grad on shift. I’m definitely not going to do an extra this week. I say that every time. After tax and student loan it works out to be like $20p/h so I probably will do the extra.
05.30: I catch Benji’s mum in the corridor on my way back from my second attempt at a lunch break. She makes a joke about it being a wild Friday night and then starts crying. I put my hand on her shoulder because boundaries are important but also in nursing school they don’t teach you how to comfort a mother when her baby has just died. Benji’s dad never held him. It was some sort of masculine mechanism of protecting himself from the grief or something. She said Benji finally passed in his arms. I guess babies do have a great memory after all.