I can't teach people to give a sh*t

Today was Kate and my last day at the NICU. We walked in to a unit with only 10 babies (usually the census is 25-30), and one of the nurses said that the unit was "quiet".  Let me shine all of you that don't work in a hospital- saying the word "quiet" is like the kiss of death- if you even mention the dreaded Q word, your unit will be overrun with codes, admissions, crazy parents, etc.  We made a joke of it with the nurses on the unit, but come a mere 2 hours later, we had a baby who was admitted overnight start dropping their oxygen saturations and having increasing respiratory distress.  Thus started the 2 hour frenzy that indued of GMOs not using a bag/mask correctly and trying to resuscitate an infant with a good heart rate and respiratory drive (the baby was crying around the mask).  The resident "running" the code was fairly lackluster in her approach, and I finally convinced them that the baby was cold and stressed, and that if we gave him a chance to recover his respiratory status might improve. This was before I knew he had a history of meconium aspiration at birth.  So we swaddled him, put a heat lamp on, put his CPAP back on and watched his O2 sats climb back to a normal range.

Hospital streets were still flooded- can't imagine what it looked like yesterday!!

Kate copying Dr. Nelin's signature onto the real completion certificates which Cait failed to print and bring (I brought an older version!)

Aruna, our amazing health sciences coordinator, demonstrating the awards to be handed out a tomorrow night's ceremony

Meanwhile, seeing improvement in the infant, Kate and I went to the lab to talk to the blood bank about their transfusion process, mainly what they use as an anticoagulant, how fresh the blood is, and how the blood is processed (infants need leukocyte reduced, CMV negative blood).  Our reason for this investigation was that we were trying to figure out if the increase in blood products being transfused on the unit was responsible for the increased incidence in bleeding we were seeing.  We found that their practices were sound, apart from having leukocyte reduced blood (which I will investigate soon).  We left feeling confident that we could cross the blood components off our list of suspects.

We also met with Sister Shivani who is head of the labor/delivery ward, and a former graduate of the NICU nurse training program.  She took us on a tour of the unit, and we were able to see a vaginal delivery.  In some ways the birth was similar to the system I saw in Sweden where there was a bed without stirrups, mom laboring and delivered by a midwife, and was soon up and walking.  Just a little less comfortable :-)  We watched as the nurse did the normal processes with the infant (weighing, apgar scores, vitamin K injection, and basic assessment).  We were able to ask Shivani a lot of questions regarding the processes being done in labor/delivery, such as the testing of moms for Group B Beta Strep (GBBS) bacteria, using antibiotics for prolonged rupture of membranes/maternal fever/chorioamnionitis, and the cleansing of the perineum before vaginal delivery.  We found that there is no routine screening for GBBS because the lab doesn't have the equipment to run such a test, they do use antibiotics, and they cleanse the perineum with salon.  Why this is important is  because when Kate was digging through the death records the other day, we noticed that many of the infants were dying on day of life 2-3, which generally indicates a perinatal or labor/delivery sepsis, not something the infant acquired from the NICU.  Not to say we are perfect, because there is a lot of improvement needed in the area of infection control in the NICU, but it was interesting to see how we may be able to address some concerns in L&D that may help improve outcomes to infant mortality.

Cait and Shivani

The triage area of the labor delivery room

The Guyanese are very resourceful!  

After our meeting, Kate and I peeked our heads in the unit to check on our friend from the morning.  They were actively coding the infant.  And by they I mean 1 resident, 1 GMO, and about 5 other GMOs standing around to observe but not helping retrieve supplies. One of our nurses, Susan, was leading the nursing charge, and she had another nurse, Cindy, from the previous class helping her, but until the senior resident, Dr. Sara Singh, took charge on the unit, there was a bunch of standing around with people who were not proactive in helping the infant or at least finding the resources to help (if Sara hadn't walked into the unit to ask a question, the infant would have continued to not have any help).  She walked in, said "why is this baby blue?  Why is he cold?  What are we doing?" and the chain of events in a code situation finally took place.

No nurses were harmed in the taking of this picture....because they weren't allowed near the infant

One of the senior nurses completing documentation

Dr. Sara Singh and Nurse Susan Sankar

As Kate, Nar, Alma, and I were debriefing the day at El Dorado Inn (where Kate and I are now calling home, as we had to move out of project dawn to accommodate a large team from Vanderbuilt), Nar said, "You know, I can teach people to do lots of things, but I can't teach them to give a shit".  A little blunt, but extremely accurate.  I was helping a GMO today with an IV on an infant, and all I did was provide containment and allowed the infant to suck on my finger for comfort, and she was extremely grateful.  I explained the role of containment and stress management in infants and she was very eager to learn.  She gave a shit.  It's so incredibly easy in education to teach people who have an enthusiasm to learn.  Whether or not they learn a procedure on the first try, as long as they are excited to come back the next day and keep learning, that makes all the difference.

Learning opportunity gone well: Cait assists the GMO with calming an infant during IV insertion

Learning opportunity gone wrong: Cait attempts to discuss how to dilute Savlon to clean different types of equipment on the unit, notice that no-one is paying attention except the one GMO who is looking at me like I'm a crazy white girl

The night ended with Kate  and I enjoying some "American" food and guyana beer at the historic Cara Lodge hotel and some late night balcony sitting (and drinking and singing loudly to 90's hip hop and 80's power ballads).  :-)

Cait and Alma, a pediatric nurse from Texas on the balcony at El Dorado Inn