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Letter to the Editor

NICU Collaboration During the COVID-19 Worldwide Pandemic: A Memory of Gratitude

Marana, Joseph MEd, MSN, RNC-NIC; Manager

Author Information
doi: 10.1097/ANC.0000000000000802
  • Open

Felicidades!” I exclaimed!

And right there, I saw it.

Through the muffled voice of wearing two masks, a distant image through the face shield I was wearing, I saw the look to his daughter. It was nearly imperceptible. It was the slightest hesitation. To stare, and see, his infant for the very first time. In the rush of moment, installing the car seat base in the heat of the afternoon, with his mother-in-law, his infant's nurse, and myself holding the infant in the car seat, along with a few bags of supplies for the infant, he only took a fraction of a second to do it. But right there, in that moment, it felt like time stopped. The air felt heavy, the sounds drowned out to silence, and as I father myself I recognized in his face what this was. It was a look of love.

I have seen it many times before. The first time a father lays his eyes on his newborn infant is always different. It's always new. Usually, it is during or immediately after delivery. It is often without speech. But even if a picture is worth a thousand words, the image every time is indescribable. It is love.

Typically, the birth of an infant, especially in an operating room (OR), is filled with lots of people. Nurses taking care of the mother and nurses taking care of the infant. Nurse practitioners right there to “catch” the infant and wrap in a blanket, obstetricians and their team at the surgical site, and anesthesiologists at the head of the bed. The father anxiously standing by, peering on toes next to neonatologists at the ready. In this particular case, with this specific infant, instead of the father being there, it was me. It was us.

She was the first infant born in our COVID OR, in the specifically built COVID unit. The OR had been equipped and prepared for weeks, if not months, but doctors and nurses, practitioners, and respiratory therapists to develop plans for deliveries just like this one was. We had spent days setting up machines, placing beds, and staging trays and lights. And then we spent days and weeks rearranging and adjusting it all again, as we talked through situations and scenarios. For days, we had mapped out who of our staff was going to be working, who was going to be going to the delivery, who was going to do what, who was going to be where. It was my plan to switch places with the nurse who was supposed to be going, to minimize her risk of exposure and, hopefully, her anxiety. But as the confident and dutiful nurse she has always been, she refused to do anything less than to be right there for the infant. So by the time the COVID-positive mother was brought in, they closed the doors and it was us two. Next to our neonatologist, the 3 of us were the neonatal intensive care unit (NICU) team ready to receive and, if necessary, stabilize and resuscitate this little baby girl.

The room was a flurry of action. With assured confidence and precision, I admired the Labor & Delivery staff who worked quickly and efficiently to make sure everything was set. It was as if they had done this thousands of times before. The thing was they had. Just never like this. In a negative pressure OR, with noisy HEPA filters, a smaller than usual space, and personal protective equipment (PPE) covering our mouths and noses, our eyes, our faces, our hair, bodies, and even shoes, all of us were uniformly protected from any chance of exposure. I remember looking at the mother's face. Calm, eyes closed.

When the infant was born, instead of her father present, it was the physician and myself, alongside her nurse, the first to see her, the first to touch her, the first to talk to her. It was decided that she would be admitted to the NICU. So as I assisted in unplugging and unlocking the enclosed isolette to transport, I couldn't help but recognize that unlike most deliveries, the mother would not get the chance to hold her infant right away. As we exited the room, despite all the other things going on, the Labor & Delivery staff moved poles and carts to clear a path. As we came out of the room, there were more of our team members outside, ready to assist with whatever they could. Our NICU charge nurse took the lead, as we took off and put on more PPE since we were leaving the room. Like this infant's own personal entourage, we walked to the exit of the unit where more NICU nurses and Respiratory Therapy were there to receive the bed, attach our support “shuttle” for additional oxygen and power support, and bring the whole production down to the NICU.

The next few days were new to us. The entire multidisciplinary team worked seamlessly to make sure this mother and family were updated. One of our nurses created a new Skype account for the mother to be able to video call and see her infant using her cell phone. Our nurse practitioners and provider team kept in constant contact to communicate plans for discharge. Social work was involved, all of our managers stayed in touch, and we used a newly purchased car seat to test the infant in, and then give to the family so they would not need to bring one in from home. Our medical director was involved, our neonatal nurse practitioner administrator helped facilitate any needs, and Nursing had the constant resources from our leadership in Maternal Child Health, our director, and even our chief nursing officer.

When the day of discharge came, the whole team worked to coordinate times for pickup, who would be coming into the hospital to meet us, where they would park, where the father would wait. The infant's nurse that day spent the entire shift preparing enough bottles, diapers, discharge information, and even clothing to be as ready to go out into the world as any newborn infant could be. We put on our PPE and together, she and I took the infant down to the emergency department (ED). I coordinated with the manager of the ED, who made sure we had a place to go, and what the best way to go would be, as well as the best route for us and the family. In the humid heat of the afternoon, I stood at the entrance alongside our COVID screeners, ready to meet the father and escort the grandmother in.

I knew it was them when they showed up, the anxious father and his excited mother-in-law. “Hola abuela!” I said, “Me llamo Joe, soy enfermero con to nueva nina!” (Hi grandma! I'm Joe, a nurse with your new baby girl!). As the father waited outside, the nurse and I walked the grandmother through discharge paperwork, and finally gave her the infant to see, hold and now feed, for the very first time. ED nurses and even physicians stopped in their tracks as they walked by, smiling at the beautiful infant in her grandmother's arms. After just a few minutes, it was time to walk out. Back through the corridors, we all exited into the heat. Again, this little infant's own personal entourage. I gave the father the base of the car seat and I could see him struggling, and sweating to get it secured in.

And as he turned, I extended the tiny infant in her car seat toward his waiting arms. “Felicidades!” I exclaimed. And right there, I saw it. In the heat of the outside, rather than the cool of the OR, into his hands instead of ours, this man recognized, and for the briefest of moments, stared at his new daughter for the first time. It doesn't happen often, even for an NICU nurse to be there for both the delivery and also the discharge home, but this time it was me. In the moment that time stopped. In the moment of recognition, as a father myself in the eyes of another father, the look I have seen many times before, but new and amazing each time. It was a look of love.

For all of our planning, our weeks and days and sleepless nights. For our staff who worried but were always there. Through the stress of the world, for our team who demonstrated kindness and deep compassion. Through the endless meetings, the constant e-mails, through the questions and concerns and even through the tears, it was and always is moments like this that remind us of who we are.

Joseph Marana, MEd, MSN, RNC-NIC
Manager
Neonatal Intensive Care Unit & Pediatrics
Mercy Medical Center
Baltimore, Maryland

© 2020 The Author. Published by Wolters Kluwer Health, Inc. on behalf of the National Association of Neonatal Nurses