* Name changed for confidentiality
Caitlin was one of identical twins; a beautiful sandy haired, blue eyed little girl. She and her sister had been born at 35 weeks after an uneventful first pregnancy. Although babies born at less than 37 weeks are classed as premature 35 weeks is pretty good going for twins as they are almost always born early.
There were no problems with the delivery although they were born by c-section as one of the twins was breech, again not unusual for twins. Due to being premature they were spending the first week or so of their lives on the neonatal unit in another hospital, just to make sure they were both feeding well before they went home.
Caitlin came to us after becoming unexpectedly and seriously unwell. A problem with her gut was suspected although there was no indication as to why this would have occurred.
I had the privilege to look after her for one day in her short life, the day that she died.
I say privilege because it was; it’s a privilege to look after every baby whether they are critically ill or just needing a bit of extra support, whether they go home or whether the neonatal unit is all they know.
Looking after critically ill babies is something I’m used to. I don’t say this to show off or to sound blasé, it’s just what happens in my job. The longer you work as a neonatal nurse and the more experienced you become the more of your working you spend looking after the sickest babies.
However, I had never looked after a baby when they were dying before although I had cared for them afterwards; removing lines and tubes, washing and dressing them, wrapping them up in white hospital sheets.
I didn’t expect that day to be the first although I knew Caitlin was very sick. That morning I sat down with her parents and the consultant to help explain that, although the surgery to repair the spontaneous rupture of her stomach had been successful, she was still unstable and critically unwell.
I don’t think anyone of us expected her to die.
Even though babies do die on NICU we never get used to it, the longer we work the easier it gets but only up to a point.
It’s never easy when we lose a baby.
After the conversation with the parents things suddenly got very bad very quickly. Caitlin became very difficult to ventilate, even with 100% oxygen we couldn’t get enough into her blood. Even though the surgeons had repaired her stomach her body was shutting down, unable to carry on.
It then became clear that there was nothing more we could do for her.
A few hours after the first discussion we now had to tell the parents that their daughter would die in the next few hours. That even with all our technology we couldn’t save her.
That there’s a limit, even in this day and age as to what we can do.
Her Dad tried to argue, desperate for us to try anything to save his daughter. The daughter who a few days before had been completely well.
Tears silently ran down her Mum’s face, on some level she already knew.
We explained that the ventilator would keep breathing for Caitlin and that it was their decision as to when we removed the breathing tube. We told them that they could take as long as they needed to say goodbye; that Caitlin wasn’t in any pain and that she wasn’t suffering.
That we would support them throughout, that I would stay with them right until the end.
That I would not leave them.
Not even for a moment.
When went back to Caitlin her Dad took one look at her and ran out of the room, unable to look at his daughter and know that she would soon be gone.
I asked Mum if she wanted to bring the other twin in to see her sister but she didn’t want to, wanting to save her other daughter from the worst experience of their lives. I respect her decision as a Mum doing what she thinks is best for both her children but about an hour later something promts me to ask her if she’s sure.
She thinks for a bit and then changes her mind; wanting to give her daughters as much time together as there is left.
The maternity unit brings the twin down and I snuggle her onto a pillow on my lap so that she can be with her parents and her sister but so they can concentrate on Caitlin.
She looks so healthy, so vibrant and alive.
The way Caitlin should look.
I carefully lift Caitlin out of her incubator, taking care not to dislodge the breathing tube. I snuggle the two girls together and I take photographs, dozen of photographs knowing that all Caitlin’s parents will have is five days of memories and these photographs to remember her by.
I turn the flash off the camera and use the zoom so that I don’t disturb the family’s time together.
I take photographs of them together, of the girls, of Caitlin. I focus on her face, her little hands and feet.
Her sister reaches out and clutches her hand.
I have to rest the camera on my arm to stop my hands from shaking.
Over the next few hours Grandparents, Aunts and Uncles, Brothers and Sisters, Nieces and Nephews, Cousins and friends all arrived to meet Caitlin and say goodbye to her at the same time. The room slowly filled with people, grieving and yet trying to stay strong for the parents.
I stay back, still visible to the parents but not part of the family and not wanting to intrude.
People cry quietly and I cry too.
I try not to; it isn’t my pain and it isn’t my grief. I am the professional there to care for Caitlin and the parents.
I can’t stop myself.
I discreetly wipe my tears, making sure that the parents can’t see.
When everyone has arrived, hugged Mum and Dad and held Caitlin’s hand or stroked her face the parents decide they’re ready. The family say goodbye to Caitlin one last time and then one by one they leave.
I sit beside Mum and Dad and their two little girls side by side on a pillow. Caitlin lies still but her sister turns and wriggles towards her, trying to get close, trying to make her sister respond to her.
I continue to take photographs, trying to capture every moment, every memory that I can.
The parents tell me that they’re ready to let Caitlin go.
I fetch the consultant and she comes and quietly sits on the floor beside the little family. I take the twin and cuddle her close, knowing that she will remember none of this but wanting to shield her from her loss, from her parents grief.
From so much sadness when there should only be the joy of welcoming these little girls into the world.
The consultant carefully removes the support for the breathing tube and then the tube itself.
The room is quiet.
The only sound is the little noises made by the other twin.
Mum asks the consultant if Caitlin is gone.
She gently places her stethoscope on Caitlin’s chest and listens for a minute.
My tears fall softly onto the face of their surviving daughter but she doesn’t notice, she’s sleeping.
Mum suddenly looks unsure, she doesn’t know what to do now that Caitlin has died.
I dry my tears and take Caitlin from her. She needs her other daughter now; her warm, pink, living daughter so that her arms don’t ache from the emptiness.
Her living daughter will not make Caitlin’s death easier, having a living child does not diminish the grief.
But she will have a reason to get up in the morning.
I take the little knitted blankets more tightly around Caitlin and I snuggle her back into her incubator.
I don’t want her to get cold.
I quietly say goodbye to the parents.
They don’t need me now.
They need each other and they need their daughter.
I sit in my car and sob.
It’s not the first time I’ve cried today but it’s the first time I’ve been able to let out all my pent up emotions. No one can see me and no one can hear me and I can cry as hard and for as long as I need.
Caitlin would have been one a few weeks after my son was born.
I remember her on the day she was born.
I remember her on the day she died.
I remember her on my bracelet; a tiny silver pair of angel wings.
I remember her parents, her sister and her family.
I remember her.