Sorry for being away for a couple of weeks, my duties took me into the Neonatal Intensive Care Unit (NICU). Specifically, a “Level II” NICU, or Special Care Nursery. Unlike the world of the normal newborns that I wrote about before…I’m now in a world where our little patients are dependent on us for everything and it may seem obvious that they need warmth, nutrition, and oxygen. However, what they really need may not be quite as obvious. You see, some of our littlest patients need communication, ways of telling us what is wrong with them, or perhaps as important, what is right with them.

Probably the infants who need this the most are our Neonatal Abstinence Syndrome patients, who are infants, who for one reason or another are withdrawing from narcotics. Because infants constantly need to feed and grow in order to properly develop, it is important to make sure they are under as little stress as possible. An illness that in an adult would be a minor inconvenience can be life threatening to an infant. Withdrawing from narcotics is no exception.

People who are withdrawing from narcotics experience a variety of symptoms that range from effects to their central nervous system to their respiratory or gastrointestinal systems. Adults can tell us about many of these subjective symptoms before they become life threatening; infants, unfortunately don’t have those kind of skills yet. They rely on us to be able to look at them, to be observant, and to “speak” for them.

This requires powers of observation that I don’t think come naturally for most of us. So many of us walk through our days without really noticing the pain of others. I see it in the hospital all the time, where in so many ways we become inured and insulated from the stress of others. We don’t notice the subtle pause, the lack of eye contact, the tremulous voice, the slight shudder, or shy silence that signifies another in distress…we are just too busy and self-involved to really notice.

With our infants withdrawing from narcotics, however, we do not have that luxury. We have to notice. So we have to train for it, scoring our infants for irritability of the central nervous system, the metabolic system, the vasomotor system, the respiratory system, and the gastrointestinal system…scouring them for the subtle signs of distress, scoring them, and then soothing them.

Wouldn’t it be nice if that wasn’t just limited to NICU Nurses and Physicians, patiently observing and caring for a tired stressed little baby that was born with a problem not of their own doing? Wouldn’t it be a little better place if that we could all be a little more observant to the distress of others?