To Aryana

“Baby out 1:50pm. It’s a girl,” echoed by the obstetrician who delivered you via C-section. I let out a sigh of relief when the last part of your body was pulled out gently by our medical team. But wait, maybe I was wrong in relinquishing that sigh sooner because I heard no cry and saw no movement from your body.

 And then there’s another problem. You are missing two of your limbs, Aryana. Perhaps a congenital anomaly uncommon to full term babies like you. But first things first, and that is your airway. I kept in mind that your breathing is my priority and the rest, we’ll just have to deal with later. Together with your neonatologist, we rushed you to the cord dressing area and established a clear airway for you. I rubbed your back, an intervention used to stimulate a cry from newborns. I wasn’t very successful with that. All I heard was grunting…but that was better than no cry at all.

“Ready for intubation,” said Dr. Tin. She was about to place the laryngoscope in your mouth when suddenly, you let out a laborious cry. It wasn’t blatant, but any cry from you would be very much acknowledged. Be proud Aryana, you just saved yourself from manual ventilation.

But the battle isn’t done yet. I now have to face the dilemma of your absent limbs. Yet what can I do? I am a  nurse, not a miracle worker. But rather than focus on what I am  incapable of doing, I turned to what I am empowered to do. I spoke with your father and shared with him your brief and honest situation. Of course it’s your doctor’s job on filling your family with pathologic explanation. The technicalities of your case are left to her, while my job is to provide your family with words of comfort. For me, that is an even harder task because anyone can explain the physiologic deficiency of your body, but to say “it’s going to be alright” to a family who’s already dismayed by the outurn of events is a crucial toil. Giving words of encouragement to them is like watering an already dead plant. Useless and disappointing.

But you are my priority Aryana, your family comes second. And as I am writing you this letter, you were already discharged from the hospital. I wish to tell you a lot of things,  but know that you are much too young to understand. I’ll say it anyway for I don’t want to let time pass with words left unsaid.

Baby Aryana, you are a gift from God. You are His masterpiece regardless of how you look like. What you lack doesn’t define who you are. You may not become a famous runway model, but maybe in time you’ll discover some talents with your hands. Perhaps become a painter, or a writer like me. The world is harsh, so be strong. Remember, you have to be brave with your life so others can be brave with theirs. Be an inspiration.

You are a blessing, Aryana. Please never forget that.

Sincerely yours,

Your NICU nurse.


To Christopher

Today is a day for tears, for we have lost you Christopher – our dearest angel in the ward.

Twenty days ago, nobody, not even our best doctors, believed you were going to outlast 24 hours of existence. Who wouldn’t? At the sight of you, even non-medical practitioners could bluntly say you wouldn’t have the strength to make it. But a day had passed and a week had gone by, and you were still fighting.

Gastroschisis. That’s the medical term they used to describe your diagnosis. In my five years of studying the human anatomy, I have never encountered this kind of condition, let alone see one. But the mere appearance of your body could already tell what lies behind your affliction. You were born with a defect in your abdominal wall through which your intestines, both small and large, freely protrude. In lay man’s term Christopher, everyone could see your abdominal contents right outside your body. I took a picture of it and still have it on phone. But I decided not to post it with respect to the departed.

The doctors have already primed your parents on the bleak future you are going to have. But what future? The surgeons said you were too young and ineligible to undergo any extensive procedure. But I figured, if you weren’t here in my country and had been confined in a high-end private hospital, maybe there was hope for you. I see it all the time on TV, babies undergoing medical procedures like conjoined twins being separated, congenital heart defect that are surgically repaired. So why not you, Christopher?

Deep down I know the answer. There’s a reason why you are here in my hospital and not elsewhere. Your parents, they visit you all the time. I remember seeing your father for the first time and he asked me why has the surgeon done nothing for the situation. I told him what every nurse would say. That we are doing everything that we can to keep you still. Your father replied that even if we are just awaiting your demise, the surgeons should still examine you for your daily needs and status. I told him I get what he means and will inform the doctors about it. But the truth is, nobody would ever understand a father’s pain who’s wondering when his son be taken away from him.

First year in nursing class, we are already taught the basic principle of every person’s right to live. But there’s a counterpart for that. That every person be given a right to die in dignity. And though we had already seen death coming, we still did what we had to do. Everyday we would change the sheet of your crib soaked with fluid coming from your body, we refill your dextrose to replace the lost liquid, we change your diapers to at least make you feel a little comfortable, and we even transfused blood twice even though I don’t see the point of it all. We treated you as if you had a remaining hope.

I feel shame for the doctors who didn’t have the means to cure you; who didn’t take the time to check up on you. But then I realized there are also other dying patients in the hospital. They must have been busy saving the lives of those whom they know have greater chances of living. And so we might not have given you the gift of life, I hope you should know that we had given you a decent death. An extension of your life is beyond our command, but you had 20 days of being with us Christopher. And that is a miracle itself.

Sincerely yours,

Your NICU nurse.

To John Paul

Today marks your 5th day in the hospital.

Yesterday, while we were doing our usual nursing rounds, I couldn’t help but smile at the sight of your condition. You were a far cry from the state that I had admitted you. I could still remember how you looked that day: pale and paper-thin. And even if the ER nurse didn’t mention your diagnosis, I could  tell you were suffering from Pulmonary Tuberculosis. You got it from your mother, I heard. It confounded me that it was your Aunt and Uncle who brought you to the hospital. But it only took a few minutes of nurse-patient interaction to find out both your parents are already dead.

I wanted to say “I’m sorry for your loss, John Paul.” But I kept silent. Because you know what, it isn’t really your loss..but your parents’ loss for not knowing such a wonderful son like you. It didn’t take five days for me to conclude that because since our first meeting, you have already shown me admirable traits that not all kids of your generation possess.

You never fail to say “thank you po.” In fact, you were so polite you would often mistakenly call me “Doc.” And you would give me that sheepish smile every time I would  remind you that I am your nurse, not your doctor. I remember, on your first night in the hospital, you were having a fever of 39.7 C. If I didn’t see you shivering in your sleep I wouldn’t have noticed. Because that’s how you were, you would rather endure the discomfort than cause it yourself.

I searched for your doctor to prescribe you with some anti-pyretic drug. But unfortunately that night, your doctor was much needed in the other department. And so I had to do what a registered nurse wasn’t really allowed to do. I calculated the drug dosage base on your body weight and had given you IV paracetamol without a doctor’s order. But don’t worry John Paul because as soon as your doctor came, I informed her of your condition and she had prescribed the same medication with the exact dosage that I had given you.

You had three drugs prescribed for you: Oxacillin, Ceftazadime, and Streptomycin. All these require a skin test prior to the actual giving to check if you were allergic to any of the drugs. Before doing that, I explained how you were going to experience a bit of pain in the process. I would usually do that to prepare the patient for the great discomfort  they’re going to feel, which isn’t really effective considering how kids loathe injectables. But you were different, John Paul. Not a single ache was heard from your mouth nor a slight movement from your body. Not only were you kind, but you were also brave.

Tonight, as I am going on my night duty, I am not sure if I’d still see you. I would have guessed your doctor might have ordered a discharge for you in the morning. But nevertheless, I would be happy. Not because you have lessened my patient count tonight, but because I know all is well with you. You deserve an enjoyable childhood beyond the walls of this hospital..so go forth John Paul. And never come back.

Sincerely yours,

Your Pedia Nurse.

To Rachel

I held you in my arms at 2:35 am. As soon as the ER nurse called your admission, I began my distress. “For standby intubation,” –these are the words most dreaded by any nurse who knows how to read beyond doctor’s orders.  In medical world, that basically translates into “you have a few hours to live.”

Yet I stood there, hoping you were a miracle.

You were breathing heavily, too rapidly, and the oxygen support didn’t seem to be of much sustenance at all. In fact, your O2 Sat was 9 digits low. Again, I began my uneasiness. I laid you under close watch service, on the first bed where I could see you from the nurse’s station.

I’m sorry you had to share a bed with another patient. I couldn’t risk placing you on the farther side of the ward, in case…you know, something bad happens. You need to be attended every hour. You were high-maintenance, and though I had 21 other patients last night, you pretty much consumed my 8-hour shift.

Your chart wasn’t modest of your condition. It read: Pneumonia very severe s/p colostomy 2010, Down Syndrome.  You had, not just one, not just two, but three diagnoses. First problem was that your airway was clogged with mucus, which explains the little oxygen circulating in your body. Second, you weren’t blessed with an orifice on your rectum so in 2010, they had attached a “poo-bag” for you. That, by the way, increased your risk for infection. And third, you were born with chromosomal aberration.

Am I now sounding too technical for you? Don’t worry. You don’t have to understand these things at such a young age. All you had to do was fight your battle. You carry a deadweight much heavier than you can endure but you lay there with your eyes closed, looking tranquil in sleep. Were you dreaming of heaven, Rachel? I guess I will never know.

Your mother was kind, and so is your grandmother. They amenably did what I asked them to do and they never left your side. But at around 4 in the morning, your vitals started deteriorating. Your O2 Sat fluctuated from 90 to 64 to 85. Your heart was pounding for the lack of oxygenated blood, and on top of that, you were having a hyperthermia.

Nebulization every two hours began and we suctioned your secretions after that. Did you feel any bettering? Your vitals expressed no, but only you can best judge what you had felt. Just one more hour and you will be surviving my shift. I put away the emergency cart since you didn’t look like you were going to have a cardiac arrest within my duty. But in the midst of the endorsement, 30 minutes passed my shift, your mother came running and said something I could barely understand. But no words needed for that, because as soon as I saw her face, I knew. I jumped on my feet, grabbed the stethoscope and rushed your way.

When I reached you Rachel, you were no longer gasping for air. I placed the stet on your chest and heard nothing. The pulse oximeter now reads 0 0 – negative for oxygen and negative for pulse rate. I immediately called your physician and while on his way, I grabbed the emergency cart that I just put away. I didn’t notice how malnourished you were until we had to stripped you off your clothing and do chest compression. I could do a mental count, not only of your ribs, but as well as your intercoastal spaces. That’s how skeletal you were. I injected Epi in your system to start the heart pumping, but not even a flutter could be heard. Your O2 was now on full blast, but we were the ones doing the breathing for you.

Last try, another dose of Epi was ordered. But you were still a flat line.

At 7:45 am Rachel, your doctor pronounced you dead. I started returning everything that I had put out for you: the pulse oximeter, the nebulizer, the suction machine, the E-cart, and the O2 tank. None of these equipment were strong enough to fight a much bigger force.

 You fought a hard battle, Rachel. Now it’s time for you to continue living in your dreams.

Sincerely yours,

Your Pedia Nurse