all the lights
a maxiel drabble for my beloved @lilyrizzy Happy Birthday, the world is suhc a wonderful place simply for having you in it. I love you so much.
(contains medical stuff and mpreg [sort of, it’s complicated])
The answer is no. It was ’no’ twenty minutes ago and it’s still a no now.
Daniel doesn’t want to leave. He is not going to leave, that’s what he told them when they asked for the first time, the second time, but the third –
“Sir,” the nurse or midwife or doctor, Daniel doesn’t know, doesn’t care says, having sat down on the chair next to him. “Surgery will take a bit longer still, you are not missing anything by going up to the unit. But you are missing something by stay here. Please, consider.”
What’s there to consider? Daniel doesn’t ask.
He presses his lips together, tilts his face away, fixing his eyes on a spot on the floor. His leg keeps bouncing, his hands clam and sweaty, grasping each other. His heart hasn’t stopped hammering against his ribs for hours. Not since he woke up to Max’s panicked voice, finding blood between his legs.
Days have passed since that moment, but according to the clock, it’s not even been two hours.
“Sir,” the woman says again, brows drawn together when Daniel glances at her.
“Max’s here. So I’m here,” he says tightly, voice feeling rough, unused.
Has he spoken since they took Max from him? Since they wheeled him into the operating room? Since he called Max’s name, desperate, and Max turned his head, skin pale, eyes wide. He’d opened his mouth but the door had shut before he could.
“And your daughters are upstairs,” the woman pushes.
Daniel –grimacing, eyes squeezed shut- nods. “Yeah, well.”
“They need you.”
“Right.”
He shakes his head, lips pinched together.
“They do.”
“For what?” he looks at her again and he can tell she’s taken aback by his cutting tone, but-
She puts her hand on his shoulder, a small, cautious smile on her lips, eyes almost pleading. “You’re their dad. They need you.”
“I’m- Right, yeah. No. I-” He shakes his head again, leg bouncing, heart racing. He can’t fucking look at her. She must think he’s a terrible person and maybe he is. Maybe he’s been a terrible person throughout this entire pregnancy but- “I need to be here. I need – Max.”
He gestures in the direction of the operating room.
They weren’t ready. This wasn’t supposed to happen. So soon. And not like this.
32 weeks, that was the goal. 32 weeks so the babies would be big enough to not- So they’d be stronger. Their lungs, and- And so much. Daniel listened to the doctors, he swears he’d listened, but- They have a calendar at home at the fridge and just the day before yesterday Daniel crossed off the 28 week mark. They only just-
Max had watched from the bed, directing Daniel, handing him the marker, hand on his bump and he’d told Daniel, when Daniel had counted the weeks that were left and only gotten paler, that everything would be okay. That he was excited to meet them. Their girls. And wasn’t Daniel?
But Daniel is a terrible fucking person and all he wanted, all he wants now, is for Max to be okay.
“We can make a new one,” he’d told Max when they first found out, terrified and confused beyond anything. “We just- Max. Max, c’mon. Please.”
He’d wanted an abortion. They’d told them it was safest. That Max- Max’s body wasn’t made for this. He had the parts, yes and none of them fucking knew until- But his body wasn’t fucking meant to do this. It was dangerous. He could die. None of the do doctors, none, none of the experts and specialist-
But Max had wanted to try, hadn’t wanted to make a new baby through surrogacy, or have one by adoption. He’d wanted this. Their miracle baby, growing inside his body against all odds and logic. And Daniel had nodded and said “okay,” and there were moments where he’d thought he could do this, could be a dad. But he was wrong. He was so fucking wrong. He can’t do any of this. There is still blood on his hands and if Max dies-
“Wouldn’t Max want you to at least go see them?” the woman asks voice even gentler now, and fuck, Daniel has to wipe at his eyes again. “When he gets out of surgery, he’ll want to hear how they are doing.”
“You can tell him,” Daniel croaks, tasting salt on his lips.
He doesn’t know shit anyway. Even if he went to see the girls, he- What does he know? Jack shit. He doesn’t- They don’t even have names yet. They couldn’t decide and now-
“He’ll want to hear it from you,” she insists, and she’s right, but-
“He might fucking die,” he says, trying and failing to smile. “He might not ever hear anything I tell him ever fucking again, so-”
“So all the more reason to,” she cuts him off. “Sir, there really is nothing you can do here right now. But you can do this.”
He can’t. He really, really can’t. Every step he takes makes him feel more sick. He’s lead through a corridor. A door, another door, another corridor. There are signs and numbers and he can’t read any of them, can’t look at the pictures on the walls a t the people they pass, not that there are many. It’s still- The sun hasn’t even risen yet, it’s not-
“Congratulations, c’mon in,” a woman, smaller than the one before says, kind smile on her lips, paired with her words it feels almost mocking though.
He stares at her and right, they are in front of a door, two names written on colorful cards.
Verstappen 1, Verstappen 2.
“What-” he says, gesturing to the cards.
“Oh, because there weren’t names yet. Or have you picked?” the woman says.
Her name tag ready Hailey, Daniel can’t remember if she told him or when he’s been handed over to her, his head is still spinning and he’s pretty sure he might throw up.
“We- No. We hadn’t- We thought we still had time, I-“
“That’s okay, don’t worry,” she says, offering another smile. “Lots of parents haven’t decided on names yet when it’s baby time. Even if it’s full term pregnancies. Just tell us when you know, yes? Now.” Her smile widens a little. “Would you like to meet your daughters?”
“Just- I need to go back downstairs?” he says, turning to look where- but he doesn’t know. Which direction was he- How is he going to get back? He doesn’t-
There’s the nurses’ station right there, eyes on him, whispers.
“Well, how about we just go in and I introduce you, yeah?” Hailey says, unperturbed. “Now, I need you to take off all jewellery on your arms and hands. Watches, bracelets, rings – that includes wedding rings. Then please wash your hands very thoroughly at the sink and then when your hands are dry disinfect them. This is very important you need to do that every time you come here. No exceptions. We also need to talk quietly. No loud noises in this room please.”
He nods.
She opens the door.
“So, the girls are doing well,” Hailey says, as they walk up to the first of the – the incubators. The lights are dim in the room, but there’s still some sort of blanket over it, but she removes it and then- “This is number 1. She and her sister both need some help breathing still, which is to be expected at 28 weeks. They are also very small for their gestational age, which we assume is due to the conditions, which- Well.”
She smiles, a little awkward now.
The conditions. She means Max’s womb. Max’s hormonal situation. The way the placenta attached, how it couldn’t- Max wasn’t made for this. Or not- Only sort of. Just- It wasn’t ideal. Not for Max or the babies. Just a fucking fuck up from nature and now Daniel is a father and so is Max but Max might die and there is a tiny little creature lying in a plastic box in front of him, stuff strapped to its little face, frail, twig like limbs tucked in close to its body, chest rising and falling so quickly, wires everywhere and-
“So she’s got 725 grams, and her sister is at 680 grams, which-”
“I don’t know what that means, I don’t-” He shakes his head, throat tight, stomach twisting. ��
She’s- His- Their girl. She’s- She’s so fucking small, he doesn’t-
“Oh, 25.57 ounces,” Hailey explains. “That’s her. And our little lady over there, she’s got 23.98.”
“That’s-”Again he shakes his head, having to turn around. “That’s too small. That’s not- No. That’s-”
“That is very small, yes,” Hailey allows. “But, sir. Right now they are doing well and we are monitoring them. “They get some help breathing, but thanks to the RDS prophylaxis your- The mo- Your partner received their lungs are doing pretty well. The girls are both breathing on their own. They received surfactant already. No brain bleeds so far, and-”
“Okay, yeah, I- I gotta go back downstairs,” Daniel cuts in. “I’ve got to- Max- My partner, he is still in surgery, so.”
“Oh.” She blinks. “Oh, sure, yes, but, if you- Well, it would be so incredibly beneficial for your babies to get skin to skin contact? It’s- We call it kangaroo care and-”
Daniel laughs, he can’t help it. It’s a shrill, crazy little sound and before Hailey can say anything there’s a cry.
A tiny, barely there, barely audible cry, coming from behind Daniel. Coming from - her.
She-
Daniel turns around and there she is, her little miniature face twisted into a grimace, little mouth quivering and the sound she makes- IT shatters his heart-
“Oh, no, I’m sorry, I’m sorry, love,” he whispers quickly, desperately, hands flying, helpless in front of the plastic wall. “I’m- Shit. What- Just- Because I’m Australian, I was-”
He looks at Hailey, terrified. She needs to do something, she needs- His little girl is crying. She’s crying and she’s just so small.
“It’s okay, you just startled her,” Hailey says softly. “The loud noise. It’s okay. We’ll just- You know she is still adapting. She’s not- We always say they need a little bit, to truly arrive, you know? To the world? Everything is so much for them. The noise, the light, everything. So we try our best to shield them, but positive stimulation is just as important as shielding them from negative one. And part of that is skin to skin. It’s- She needs you, sir. They both do.”
She’s still crying. It’s a pitiful little sound, not like the baby cries Daniel remembers form Isaac or Izzy or Leo.
“But Max-”
“Labor and delivery will call us,” Hailey says. “They’ll inform us and we’ll inform you. I promise. Now, please. It’s really, really so important for your babies. ”
She tells him to take off his shirt. She puts him in a chair that reminds Daniel of a sun lounger except he’s not getting a tan. His heart is beating out of his chest. He’s lying there shirtless and terrified and Hailey and another nurse who introduced herself as Abby hand him tubes and wires and then- then There’s first one baby on his chest and then another. Two tiny little creatures. They tell him to hold him. Put his hands on their backs as they sort out the wires and tubes and everything and his fucking- One of his finger is bigger and longer than each of their legs and their hands-
“Are they- Is this-” This can’t be right. This can’t be- They are too small for him to hold, to lie on his chest and be covered by towels. They fucking- There’s a heating lamp, they need- “Shouldn’t they go back in the boxes?”
„The incubators?“ Abby asks, frowning. “Oh, no, not his is best for them. Skin to skin. With mom. Or dad. It’s the best for them really. Helps them stabilize their temperature and heartrate, breathing, everything.”
“Yeah, but-”
Daniel feels so helpless, useless. He’s just- He’s nothing, no one. He just- They don’t even know him. They grew inside Max, they know him, his heartbeat, his voice, Daniel just-
“They know your voice too,” Hailey says, almost like she’s read his mind. “So you can talk to them quietly. Sooth them if they need it.”
But they don’t. They are both quiet now. Both just there where the nurses put them on Daniel’s chest, bellies down, heads tilted towards each other, little hands on Daniel’s skin, it’s- It might be the most surreal thing Daniel has ever experienced. Three hours ago it was just him and Max in bed together and now he’s alone in a hospital room with their daughters and Max-
“Can you call?” he asks, keeping his voice low, despite its tremble. “Down to- Ask how he’s doing? Max? He-”
“Of course.”
Two hours pass before the door opens again and it’s not just Hailey or Abby, but both of them as well as two other people in scrubs and a bed. A bed with Max inside and a number of things attached. IV pumps and stuff, Daniel thinks, but he has no eyes for any of that. Just Max. Max who seems to barely be able to tilt his head, looking around, looking for-
“Max,” Daniel croaks and on his chest one of the babies splays her fingers, almost making him choke up again. “Maxy, hey. Hi. How-”
“I’m okay,” Max croaks, voice hoarse and barely there, probably because of the tube they had shoved down his throat for surgery.
“He lost a lot of blood,” someone Daniel doesn’t know says. “And we are admitting him to the ICU so this is just for ten minutes tops, I’m sorry, but-”
“Let’s just sort this,” Hailey cuts in, smile on her face.
There’s a flurry of motion then, pushing around of equipment, adjusting tubes, wires, everything and it seems like a whole lot of work but Daniel doesn’t care because by the end of it they have somehow managed to fit Max’s bed next to the chair Daniel is in, the tubes of baby 2 sort of half under Max’s pillow who looks even paler than before, exhausted and only half awake.
“Hi,” he says, and his hand-
“I can’t,” Daniel whispers. It kills him not to reach out, not to take Max’s hand, but. “I got-”
“Oh,” May blinks and then Abby leans over pulling back the towels a bit so Max can see the girls. “They are so little.”
“Yeah.” Daniel nods, but he manages half a smile, tears gathering in his eyes again. “They are. and they’d really like names, I think. And meet their papa.”
“Oh,” Max says again. “Hi, babies. It is your papa.”
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Writing about my day yesterday at work and I want to preface it by saying I know some it may come across as judgemental and I don't intend that but I also know some of these beliefs and ethical dilemmas are things many nurses and health care providers experience. Also TW for talk of death
Yesterday was "one of those days" from start to finish. I noticed when I got there one of the dayshift nurses was already there running around and she said she had been there since 615 because the night charge sent an SOS and asked her to come in early.
They told us in huddle that they delivered micropreemie twins and one had done OK and was sent to our bigger level 4 NICU hospital and the other had died. The reality was this baby had needed extensive resescitation and the doctors advised the parents to make them comfort measures only given the severity of the situation. So that baby was staying near their mom instead of coming up to the NICU. The baby was on a vent so was being kept alive ny machines and they werent going to be doing any more measures for them. They also told us downstairs, our L&D unit was busy and there were lots of preemies/multiples/ c-sections.
Things changed kind of quickly though because the twin that was originally downstairs with their mom got transfered to the NICU because the family decided they wanted to do everything to save them. Even though me and my preceptor were first admit, they ultimately had another nurse take this baby because there was another admission coming at the same time that they thought would be a better admission for me.
Here's where I want to be careful with my own judgement and thoughts because I can only imagine being in that position and dealing with all of that (x2), but I also have the perspective of knowing what the quality of life for these babies/kids is when they are kept alive on machines and how much suffering that leads to for them and their families. Everyone wants to save babies and no one will easily throw in the towel for them, especially a NICU team so for them to be saying this baby is suffering and will not have a good quality of life and will ultimately die a painful death speaks volumes. I wish families could and would listen because it's not fair to the poor babies. I also dont fault the families, although its hard to manage as the care team having to do things that feel so ethically wrong, are causing pain and suffering to little babies who dont deserve that.
We do the best we can, but we can't save them all. Severe brain bleeds, HIE, respiratory distress, needing multiple rounds of CPR...the list goes on. That kind of situation will not get better or lead to any quality of life. It's so hard, for everyone involved. This family ultimately wanted to transfer the baby to the level 4 NICU to keep trying to save them. I'm talking extreme measures and surgeries...and so much suffering for a likely awful, painful, extreme outcome.
At the same time we got our admission who was a little older but still a young preemie. They came up and it was immediately a disaster. They ended up intubated, not tolerating the vent well at all and needing umbilical lines all at once. It was pure chaos. I tried to help the most I could but was pretty useless. I mostly observed and tried to learn what I could while staying out of thr way. The only positive was that the team was amazing. We had like 5 to 6 nurses just helping us out, then all the residents, 2 neonatologists, and a few NPs.
The baby was not stable and it was clear they needed to be transferred to the bigger level 4 hospital too. Transport got there relatively quick while the team had to put in a chest tube. We were also giving blood, meds, getting the baby on the right vent and vent settings, placing lines, running fluids. It was about 2.5 hours from the time they got to the unit to when the transport team had to literally run out with them to get to the ambulance. I felt so bad for the father who came up and was watching a lot of the work we (mostly the amazing transport team) was doing and then watched them run out with his baby. I also was so sad for the mother as she was in surgery and recovery and didn't even know they had to transfer the baby.
After it all, my preceptor and I debriefed and she answered all my questions because obviously that was not happening in the moment as we were just trying to keep the baby ok and help the team. We didn't eat lunch until like 4 pm. I felt like I neglected my other babies for a bit but it slowed down and they had families around so that was good.
Things settled for a bit but then another transport team came for the other baby. Then right before shift change we got another admission. At that point there was only one resident left for the day but thankfully this baby was stable enough. So there were like 5 nurses just getting everything done for this baby before nightshift came in. I felt much more useful with this admission as I'm definitely learning the routine with admissions and knowing where and how I can help.
All to say, it was a very difficult emotional and long exhausting day. These days are tough, but can also be envigorating and remind me that I'm where I want to and love being. I think I really like this level of acuity because there's quite a bit of high acuity but it's not crazy all day everyday and there's enough time to snuggle babies, get close to families and do all of the "extra" stuff too. We're getting nitric vents soon so we'll start keeping much sicker babies too.
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