Children's Hospital has always had dedicated doctors, superior equipment and excellent facilities. But the heart and soul of the hospital may well be its nurses, particularly the ones who staff the neonatal intensive care nursery. My associate, Alexandra B. Stoddard, spent a day with one such nurse recently. Her report:

Tracie Rolle awakens at 5:30 a.m., as usual, and dresses in simple clothes and comfortable shoes, as usual. But she doesn't carry a briefcase or go to a corporate office. Rolle is a nurse in the neonatal intensive care nursery at Children's Hospital, where the sickest young patients fight for life.

When she begins her 12-hour shift at 7 a.m. on Nov. 29, Rolle is assigned as a primary nurse to a baby boy who was born the previous afternoon and was transported from D.C. General Hospital at 5 a.m.

He is called Baby Mays because his mother did not name him. He weighs 1 pound 5 ounces and is three months premature. He probably would not have been born so early, but his mother told doctors at D.C. General that she took cocaine the day before. That can cause the "waters" to break, and that's what happened to Baby Mays's mother.

Rolle checks Baby Mays's vital signs. She makes sure that the lamps above his incubator keep him warm but not hot. She runs hourly tests on the oxygen and carbon dioxide levels in his blood. Because 10 percent of his blood is removed for testing each day, he needs daily transfusions.

Rolle and another nurse will be primarily responsible for the care of Baby Mays until he is discharged. The primary care team approach is used by Children's because it provides consistency for parents as well as for their babies. As the nurses get to know the children better, they are better equipped to treat them.

"You learn what the baby responds to. Each baby responds very differently, even at this early age," Rolle says.

At 9:34 a.m., Rolle hears a loud ringing over one of the incubators. Although alarms sound continually throughout the unit, Rolle says as she rushes past: "That one is real."

This patient is named Baby Frederick. Rolle opens his incubator and begins to pat and shake his small body. One full minute passes as she begs him to breathe.

Suddenly, Baby Frederick does what Rolle asked. By that time, his primary care nurse has returned. Rolle tells her that she gave Baby Frederick extra oxygen. Then she smiles and says, "It's common for them to stop breathing."

The neonatal intensive care nursery at Children's holds as many as 40 babies. According to Rolle, about half of the babies there at any one time are premature, and 30 to 40 percent are from mothers who used drugs.

Rolle says extensive drug use among mothers was one of her hardest adjustments when she came to Children's from the neonatal intensive care staff at the University of Virginia a year and a half ago.

"It's hard not to feel a little angry, as the baby's advocate. I think it's just a matter of your individual values and morals," Rolle says. However, she says that she and the rest of the staff "try not to treat them any different."

After many attempts, Rolle finally reaches the mother of Baby Mays at D.C. General by telephone late in the morning. She introduces herself and explains the baby's condition. She tells the mother that the first 24 to 72 hours are the most dangerous, so the staff is considering Baby Mays "real critical but stable."

If all goes well for Baby Mays, he will probably be at Children's a minimum of three months, or until his mother's due date. But each day will be touch and go.

"It's important to take it day by day. I have to keep reminding the parents of that. A baby like Baby Mays is going to have a lot of ups and downs," Rolle says.

The intensive care nursery at Children's offers 24-hour visitation, a room in which parents can visit privately with their children, a bereavement room and a breast-feeding room, where mothers can hook up to a breast pump and store milk. "We like to have them participate in the care as much as possible so they feel like they have some control over what's happening to their baby,"Rolle says.

No matter how long he lives, Baby Mays will never remember his first days of life. He will not remember his traumatic birth, or how it felt to lie tiny and frail in a plastic box, clinging to the edge of life while Tracie Rolle checked his IV, his blood, his temperature, his urine, his oxygen, his carbon dioxide and many other vital signs.

But if he lives, Baby Mays will owe it to nurses like Rolle.


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