Neonatal Step-Down Unit

“You seem traumatized,” said my friend the neonatologist–a pediatrician that takes care of newborn babies.

I was telling the story of my very first rotation decades earlier as a medical resident fresh from medical school. I was assigned to the neonatal step down unit where I was expected to be the doctor. The unit had over a hundred premature babies in little incubator warming containers stretching across a room that seemed as big as a football field, which connected to yet another room with the larger babies in open cribs. Babies are not little adults! Most of the knowledge and skills that I had acquired in medical school was useless here. How was I going to survive this?

I had a supervising attending doctor and a senior resident to supervise me, but at night I was alone with the “blood gas” pager. I have no idea why, but instead of a digital pager, it was a voice pager. The only purpose this seemed to serve was to make the experience more traumatic. When the pager would go off, it would play a static-filled voice message from the person who dialed the phone number. “Call 1234. <crackle, hiss, pop> Call 1234.” From a restless sleep, I would wake up to the piercing pager alarm and then listen for the message, switch on the light, dial the number or just get up and go out to the unit to find the nurse. Now here’s the most stressful part: I was the one that had to figure out if the newborn baby required an overnight stay in the ICU or could go back to mom.

I got no sleep. Yes, I could call my supervising doctors if I had a problem, but they had showed me what do during the daylight hours. I had my trusty reference books with all the mathematical calculations needed for any doses of newborn medications. And the saving grace, the nurses taught me the rest of what I needed to know. I wish I could say the process was painless, but being responsible for more than a hundred little lives… it’s just stressful.

I would later find out that the pediatrician that went to the deliveries to assess the babies in distress was also a new intern. The reason that I was so busy that first rotation was that the other new intern was also learning how to identify a sick baby and sending me all the babies for observation. I did a lot of reading while in that unit learning about “Transient Tachypnea of the Newborn” or “TTN,” which is just rapid breathing that resolves on its own and can be normal for many newborns as they get used to using their lungs. How do you tell that from an actual baby in distress? I did a lot of reading.

As I got acclimated, the stress was more manageable. While there was no way to get used to a voice pager that could go off at any time interrupting sleep, I began to enjoy the unit because I knew what I was doing.

My favorite part of that neonatal step-down unit was seeing the “grandmas.” These were volunteers who came to help the premature babies. Many would come for overnight shifts. The nurses would identify a baby that needed a “grandma.” The nurses would put a chair next to the baby’s incubator for the grandma to sit. The nurses would then take the little premature baby out of the incubator, wrap the teeny tiny human snugly in a blanket, carefully adjusting all the monitor wires and fluid lines that came out from the baby like a tangled spider web, and finally place the baby in the seated grandma’s hands. Sometimes, the grandma would even feed the baby, but the main job of the grandma was just to hold the baby.

For the babies that lived in these incubator containers, life is so sparse of human connection. Many of these babies had families that lived far away and could not come frequently. Some of these babies would not be held for days, except for nurses adjusting lines and taking measurements. I remember watching these grandmas intently. As a brand new doctor learning new skills and with all the stresses around me, I appreciated how the simple act of volunteering to hold a baby can mean so much. A thought ran through my head that I will never forget, one day I want to be a “grandma.”