Strict parameters, unpredictable behavior
James’ Ping-Pong breathing—and the resulting near-constant alarming — didn’t improve over his first few weeks, or even months. His nurses responded quickly, and if repositioning him and turning up his oxygen didn’t work, they saved him with suctioning, a bag valve mask or by calling the crash cart team.
Sometimes when he dipped below set parameters, he would self-correct and begin to breathe again without intervention after about 30 seconds of “mellow yellow” alarming — the mild yellow flashing light and softer ding. Because it happened so often, the alarm was often silenced immediately and only drew attention when it kicked into the shrill red mode.
At the same time, James started setting off false alarms. His micro-preemie skin was so thin that it needed to be moisturized regularly or it would actually tear. But the moisturizer caused his leads to slide off, which triggered a bad signal read and set off another alarm. On top of that, the sweat from his foot made it hard to keep the probe in place; if it wasn’t changed often, his pulse oximeter wouldn’t pick up accurately.
It seemed that whenever his nurse turned away from his incubator to care for another baby, she couldn’t get more than a couple of meters away before James’ alarm sounded, insisting that she turn around. My husband and I joked that James was toying with them by holding his breath to purposefully sound an alarm — a sure sign of his prankish sense of humor.
If James’ alarm went off for too long and his nurse wasn’t nearby, another nurse would usually look over and, more often than not, hit the silence button and see if he self-corrected. Even when the “mellow yellow” warning alarms turned into shrill emergency sounds — which happened every few minutes — it was often either a false alarm or his breathing would pick up. Except for the one time.