Part Three (ii of v): Every Day A Marathon (Tales From the NICU)

August 5, 2013 Comments Off on Part Three (ii of v): Every Day A Marathon (Tales From the NICU)

Howdy Doody Time

“Have you been in here all day?  And haven’t left for a break?  Oh, my – Well, drinks aren’t usually allowed back here, but I’m going to bring you something.”

I’d asked for a drink of water.  I’d come alone that day because Missus was visibly tired and needed rest.  She’d only been released and off bed rest for two days.  It was a week after Lucy was born and she needed rest that day more than Lucy needed her at the hospital.  Her color wasn’t very good and she showed grey beneath the eyes.  She didn’t look herself.  She’d pumped enough milk for the day that Lucy would have plenty.  It wasn’t easy, but I convinced her to stay home and rest all day because there was no telling how long this would last, and that Lucy would need her feeling better in the coming days, weeks?

The nurse, a sweet person whom we never saw again, had been talking with me, assuring me that everyone there cared very much for “these babies” (in the NICU), contrary to the feeling that heaved in my chest at that moment.

I was upset.  Somewhere at the convergence of emotional and exhausted.  I felt that since we’d arrived I’d pissed off or agitated about everyone who had any ownership in the care of our daughter.  The day before, it’d been Supernurse, whom I questioned as to why we hadn’t been sent for when the Doc of the Day was present, us right down the hall.  My mother and Aunt were in the room with Lucy and by the time my Aunt got to us and we got to the room the doctor had moved on.  The daily doctor visits, I explained, were a big deal to us, and since there wasn’t a discernable pattern to their visitation times, a little page or a call to the receptionist, something would have been appreciated.  She had given a stock reply, noting that there were just too many patients and parents to keep track of.  “For better or worse,” her face matter-of-factly said, “that just isn’t what we do here.”

Today it was the respiratory therapist.  A while earlier, Lucy had aspirated water.  She’d coughed suddenly and then upchucked, and out from her mouth and nose spat four or five tablespoons of water; from her lungs or her stomach we weren’t sure. This was new, and had not coincided with a feeding – an unprecedented, unsettling incident that bore looking into, in my view.  This happened in the presence of the Doc of the Day and I wasn’t satisfied with his level of concern, or anyone else’s.  Lucy was absolutely fine, it should be noted, after voiding the water that had somehow accumulated inside of her, and was in no distress whatsoever.  Still, I needed an explanation or at minimum a feigned investigation.

The machine that Lucy’s oxygen ran through to humidify the air mixture (to prevent drying out her nasal passages and causing infection) had been noisier than usual that day.  Its drone was throatier, more gurgled and louder than normal, and there was a lot of visible condensation in the tube.  Her feeding had been decidedly worse than in previous days, which had me on edge.  I’d been watching that tube, asking about it with no good answer provided.  I was even trying to contend that trace amounts of saline might have been creeping up the tube and through her cannula and down her nasal passages and esophagus, and that the water might have been accumulating in her stomach, maybe stunting her appetite (I thought it stood the test of reason at the time).  I was making a second, more vigorous appeal to the doctor on this in light of the aspirating episode, which he thought was cute, I think.

More on my mind was how soon and by what primitive methods Howdy Doody would be out on the sidewalk, stripped of all dignity and collecting unemployment.  While voicing my concerns to the Doc of the Day about the extra condensation moving through the saline pump, he’d asked the nurse to go for the respiratory therapist on duty, humoring me, so that it could be said the machine was checked and functioning properly.  The respiratory therapist, Howdy Doody as I came to call him, came and stood outside the room, leaned his head and neck across the threshold, appearing baffled by the doctor’s request that he have a look at his machine.  We explained about the noise and the condensation and then about Lucy’s aspirating.  He redirected his perturbed gaze from me, to the machine, back to the doctor, nodded as if to thank us for the interruption, and then took his leave of us.

When he left the room my father and I redirected our best WTF?! faces unto Doc-of-the-Day, visibly surprised himself by Howdy Doody’s unmitigated indifference.  My old man didn’t graduate from high school.  He got the GED and went on to nursing school and then dug his way into a perfusion program.  He is a perfusionist, operates a heart and lung machine during open-heart surgery.  Has worked on an even plane with doctors and nurses and surgeons of all caliber his entire life, feels no inferiorities between himself and they, as there are none, and so got there first with the expletives.

“Are you kidding me!  I mean what the hell?  You need to go in there and fire that son of bitch!”

I softly reaffirmed that Howdy Doody’s reaction was a bit dismissive.  Good Cop/Bad Cop.

“A lot dismissive!”

The young doctor assured us that he would have a conversation with Mr. Doody and that a more thorough inspection of the machinery would occur, and that very soon.  My old man left not long after that to beat traffic leaving Austin; I would stay until they booted me out at shift change.

A while later I sat holding Lucy, in the same spot I had occupied the whole day.  Doc of the Day was in the room with me.  I was a mess.  Pissed off, wrung out (I hadn’t left the room all day for food or drink), tired.  I next made the mistake of asking the young doctor for a realistic and honest estimation of how long he thought Lucy would be there.  Weeks.  Months, possibly.  This was the first time anyone had put this to us bluntly, leaving out the caveat that she could dramatically improve overnight and that we could be taking her home tomorrow or the day after that.  I felt like I’d flipped a breaker.  Already I wasn’t functioning at full capacity and it felt like something had been removed from me.  An anger surged in me at the same time. I was upset at nurses and doctors and respiratory therapists and loose communication and mixed signals and at my own gullibility, or inability to prepare myself for the worst while hoping for the best.  A dozen variations of

            “She’s doing reeeally good!  I think she’s going home soon, uh-huh.  Hey, don’t you two go getting too comfortable, now, Mom and Dad, you understand?”                                                                                               replayed in my mind.

 When I’d asked the question, the young doctor was standing guard, I think, to make sure things were cool between him and me.  As said, I wasn’t exactly pleased with his reaction to Lucy’s episode either. When he gave his answer I’d involuntarily grimaced, shut tight the eyes, and my chin hit my chest.  I’d come unplugged. The young doctor now tuned his voice up to empathetic.  He, an unfortunate witness to my subtle undoing, was connected to the situation at hand solely by vocational happenstance.  Time to go to work:

“This is going to be a process.  It isn’t a race, here.  It’s a marathon.  It’s going to take time.  It’ll just be a matter of how much time, and how you’ll spend it here.”

______

He left the room and I cried.  It would be a fiction to try and put myself to anyone as some kind of uberman superhero who weeps not for fear of damnation, but I honestly couldn’t answer, if asked, when I’d last had an honest cry before this one.  I’d teared up some the previous Christmas Eve when we chose to find out Lucy’s gender.  It was an elaborate secret-gender scheme and we mailed the envelope along with $20 to our close family friends.  Asker Her to just go to Target and buy anything obviously Boy or Girl and put in a box and wrap it.  They visited us that Christmas Eve afternoon, He in full-on Santa regalia (on their way to see their own grandchildren) with a big red bag and a gift for every child in the house.  This is one of my favorite memories now.  The room was full of friends and family and children and when the last box was handed to Missus it contained an impossibly soft and artfully ­­­­­­hand-knitted pink baby sweater with hand-painted apple buttons and matching hat, enveloped in pink tissue paper.  It was a joyful day, and the whole business begat a joyful, succinct snivel.  But it wasn’t a cry.  Nothing even close to a cry in quite some time.  Not when Lucy was born; not even when we learned about her heart.

Here, though, IT came.  It was coming up through me no matter what I did or had to say about the timing.  I wasn’t having it at first, and even when it took hold and I was comprehending my defeat I did so grudgingly.  Silently.  This is long, slow, deep, repetitive sighing — all nose, in and out — the lungs working overtime, heaving slowly up and slowly down, to maintain the relative quiet.  No way we were going to prompt someone in the next room to come over and see what was going on.  Were an onlooker to have happened by, I might’ve looked to have been in the throws of some deeply meditative breathing exercise, were it not for the occasional sudden intervals of quick, silent shoulder-shaking; water voiding my eyes, wetting my face.  Wetting Lucy’s face.  While doing this I maintain the presence of mind, fortunately, to silently will hospital staffers away from that door with every stitch of my being, which seemed to work. I think one nurse might’ve approached, observed, and did her best to reroute unnoticed without breaking stride.  Other than that everyone thankfully stayed away for a good fifteen minutes.  Long enough, more or less, to regain composure.

______

And now in walks a guy, I can’t see his face, his back is turned toward me as he goes to rifling through cabinets and drawers.  I’d more or less gathered myself by now, thankfully, although there was still some drying moisture around the eye sockets.

“Did you have any questions in here, or is there anything I can do for you, or . . ?”  The voice sounded helpful, polite.  Familiar.

“Um.  Well.  (I was confused) Are you the respiratory therapist?”  He halfway turns to me and nods, cheerfully.

“Uh-huh!”

I’m very confused.  I got a couple of very brief looks at Howdy Doodie in those earlier moments but hadn’t made an imprint.  His new tone and aspect didn’t compute.

“Are you the same one that was here a little bit ago?”

“Yeah!  Was there something you needed or something I can do, or. . ?”

Suddenly he’s Mr. Helper.  Still about his business, still opening drawers and cabinets, shoving them shut.  His mannerism is brisk, competent.

I knew instantly that Howdy Doody’s presence in that room was owed solely to the young doctor’s request, perhaps demand, that he “go back in there and try to seem professional”.  This happened on day seven or eight of Lucy’s life, our third since she was transferred to St. Elsewhere.  In that week we’d met a handful of respiratory therapists, all of them pros:  friendly, businesslike and inquisitive.  Howdy Doody was not cut from the same cloth as these people.  I’d seen him earlier in the day, in fact.  Walking back from the bathroom, I briefly saw him leaving Lucy’s room.  I asked him if he was the respiratory therapist, figured he was, judging from whatever he had in his hands, I suppose.  I thought it odd that he hadn’t intended to introduce himself at all.  He answered “Yeah,” and kept walking.

I know nothing about Howdy Doody.  Nothing of how he lives his life or of the good works he’s performed during his time here on earth.  I still don’t.  But in that moment, me in my chair, he with his back to me, with his faux-hipster black frame glasses, graying soul patch, balding head and wearing something akin to those loud, baggy pants that even chefs, gym rats and MC Hammer stopped wearing in the nineties, he struck me as the archetypal Austin slacker-turned-grownup.  At least five years my senior, I was wagering.  I’m no teetotaler and may or may not have lived through an embarrassingly late-in-life rockabilly phase (complete with facial hair and permanent ink), but now my mind seethed at the thought of how somewhere in Howdy Doody’s crappy apartment a bass guitar with some kind of decal on it leaned in a corner beneath a Raging Elf gig poster announcing a show at Steamboat.  The old one.  It was tacked to a jaundiced wall in a room with a futon*  where the stale anticipation of another gig one day hung in the inert, musty air.  This clown was tasked with providing infants in an intensive care unit with controlled, adequately mixed and delivered air to breath and his respectable career had become his enabler:  was but a means of paying some bills, filling his bong and otherwise keeping an undead dream on life support.   ( * I once owned a futon for way too long in life.)

[Was there anything I needed or anything he could do, or. . .]

 “Well you’re job for one thing.  I mean it’d be a place to start. . .”

He laughs like I’m joking with him and I go into a slower, more deliberate explanation of what I’d been trying to relate to him earlier. I tell him I’m trying to give the benefit of the doubt, since he wasn’t in the room to observe it for himself.  I’m trying to tell it better this time.  When it’s his turn he gives a canned and tepid explanation of certain elements outside of his control, of the room temperature and the machinery and the nature of compressed oxygen.  While talking, he’s going through the motions of changing out tubing, pure busy work intended to appease the needy bundle of nerves before him in the moment; honor his word to the young doctor that he’d go back in and make an honest effort at appearing competent.  He does not make eye contact.

I caught the tone instantly, wasn’t having it.  I was beyond irked.  I don’t know what I said next, but I’m pretty sure I cut him off, said that he’d done what he’d been told to do and that he could go.  And he did.

_____

And then he walks back in about ten minutes later.  Back to try something different with his machine, do something he hadn’t thought of earlier.  Kicking it up a notch.  I tried to set a new tone.  I explained that, you know, this is a tough place to be, and that we wanted to be on – Good – terms with the people that were charged with the direct care of our daughter when we were not within sight.  And when we were, for that matter.  That we weren’t fussy people, here to pick fights, just. . .

He forgivingly cut me off, relieving me of the necessity of further explanation.  His back was still turned.

“Hey, man, I’ve had kids in the hospital before, believe me, you don’t have to apologize. . .”

“Not apologizing.  Don’t misunderstand.  Given what your job title is and what it is your paid to do, your reaction to what I described to you was not nearly equal to the situation.  And I’ll say the same to other people when I have the chance.”

He, again, laughs along like I’m joking with him.  And then I understand that his laugh is the laughter of derision.  Obviously, I just don’t get it.

I don’t push it.  This is about as close as I get to a confrontation these days.  It’s always behind schedule and generally anticlimactic.  But I don’t engage unless I know that I’m right and that Party B knows that too, and even then rarely.  And anyway pride does funny things to people, blurs the margins, and even when in the wrong and called out most of us will respond with either a dumb face and a plea of ignorance or maybe a little audacious reverse accusation.  Or else it’s artificial laughter intended to mock. It’s all right.  He has a boss.

______

A little later the sweet nurse is back in the room.  Like the doctor before, she is kind of standing watch over me.  She can sense that I’d had the weeping episode and was still, in many ways, upset and out of sorts.  I’m venting about how this keeps happening, me, these confrontations.  She’s trying to put me at ease.  My voice is not itself.  It travels up through a parched gullet and comes out flat, low-volume.  Fatigued.

I ask if there is any possible way I could have just a small drink of water.

“Have you been in here all day?  And haven’t left for a break?  Oh, my – Well, drinks aren’t usually allowed back here, but I’m going to go get  you something.”

She brings me some water.

(Thank you for reading.  Please check back next Monday, August 12, for the next installment.  Please share as you see fit, and also consider making a donation to the NDSS in Lucy’s honor by clicking the Lulu & the Lettuce Patch image on the sidebar.  And thank you.)

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