News and Events
A Life with Purpose; December grad Erin Palermo returns to work where she was born
by Amy Quigley
West Virginia University
Alumni Magazine Spring 2006
ERIN PALERMO sees her life's purpose each time she comes to work. She sees it in smiling faces–a chubby, dark haired baby boy in a Pittsburgh Steelers T-shirt, a young man in a tie posing for his senior portrait, and a dancing toddler whose parents have written "Our own little miracle" on a card accompanying her snapshot.
Like the children in these photos, Erin survived a perilous start. Her mother, throughout her life, told her she survived for a reason. As a nursing student at WVU, she discovered that reason: her calling caring for premature infants alongside the medical professionals who saved her own life 29 years earlier.
On Christmas Eve 1976, Teri Palermo went into labor. Under normal circumstances, a holiday birth might be especially joyful, but Mrs. Palermo had good reason to be alarmed. Her baby was not due until March 22. And she knew all too well that babies born too soon often died. She had previously lost a daughter born prematurely.
"There had to be a reason she survived."
- Teri Palermo
She spent that Christmas Eve with her husband Ralph and their young son at Morgantown's old Monongalia General Hospital, where doctors believed they could stop her labor. In the end, they couldn't. Erin Palermo was born that night, weighing two pounds, seven ounces–small enough to cradle in the palms of her mother's hands. The tiny baby was quickly transferred to the WVU Medical Center's Neonatal Intensive Care Unit (NICU), created only the year before.
The doctors caring for Erin wouldn't make any long-term projections.
"The neonatologist would always say 'We are looking for this in the next 24 hours'," Mrs. Palermo remembered. Having lost a baby, she found reassurance in every moment that Erin clung to life.
"I was just happy that she was alive and breathing," she said.
She also took comfort from the excellent care Erin received in the NICU.
"I can't say enough about her health care providers," Mrs. Palermo said. "The technology they were working with was new at that time. Trying to save babies born that early was a relatively new thing.”
Indeed, WVU Hospitals Neonatal Nurse Practitioner Barbara Nightengale remembers Erin as one of the tiniest babies she worked with early in her career as a NICU nurse.
Today, Nightengale said, a baby born at 28 weeks' gestation has nearly as 95 percent chance of surviving, and the NICU treats many babies born much smaller than Erin was at birth. In 1976, however, Erin's chances of surviving without major problems were only about 30 percent, Nightengale said.
The most critical problem Erin faced at birth was Hirschsprung's disease, a congenital disorder affecting the bowel wall that leads to obstruction. The tiny infant needed immediate surgery.
A WVU pediatric surgeon; hired just six months earlier, performed a colostomy–a procedure which creates an opening in the abdominal wall for the elimination of bowel contents. If that surgeon had not been available, Erin's doctors would have been forced to transfer her to a Pittsburgh hospital for the procedure.
Throughout Erin's weeks in the hospital, other complications arose. Mrs. Palermo said the fact that issues developed intermittently, rather than all at once, made them somewhat easier to cope with.
As Erin survived each crisis and her chances of continuing to live became greater, doctors began to talk to the Palermos about Erin's future, and their predictions were gloomy.
"The neurologist began telling us negative things," Mrs. Palermo remembered. "He said she might not walk and that she would have developmental problems because she had endured so many 'assaults to the brain.'"
Erin went home a week before her due date. Ten days later, Mrs. Palermo sensed that something was wrong. Doctors soon discovered that she was suffering from aseptic meningitis, a serious inflammation of the brain's linings.
Thanks to the work of her doctors, she recovered. At the end of one year, she underwent "pull-through" surgery to join the healthy segments of the bowel. Eventually, Erin developed into a bright and healthy child who defied predictions that she would never lead a normal life.
From the time she was very young, she heard from her parents about her miraculous survival and the excellent care she received at WVU's NICU. Her mother told her she survived for a reason.
"She always said, 'There's a purpose for you,'" Erin recalled.
"This is where I belong."
– Erin Palermo
Growing up, Erin displayed empathy toward those in need and loved being around babies and children. Her mother thought Erin might become a teacher but never envisioned her becoming a nurse.
Though Erin said she briefly considered nursing as a career when she was in high school, she too believed her future lay elsewhere. She attended WVU and earned a bachelor's degree in liberal arts and sciences. But after graduating and realizing that her career prospects were limited, she decided to begin her education anew. That's when she decided on nursing as a career.
She kept an open mind about a nursing specialty as she rotated through assignments. When she worked in the NICU, she made her decision.
"After one day there, I said, 'This is where I belong.'"
As a nursing student, she bottle-fed babies almost ready to go home in the NICU's "step-down" unit and helped educate parents about caring for their babies.
She hoped that when she joined the staff of the NlCU full-time this winter, her story would reassure her patients' parents.
As one who has lived through the nightmare of watching their premature infant struggle for life, Teri Palermo is sure that Erin's presence will benefit parents.
"She's going to be an asset to the University," Mrs. Palermo said. "It will be very reassuring to parents to see what can happen–that there can be a positive outcome.”
Nightengale, who will now be working with her former patient, agreed.
"It will mean a lot to parents to realize that their baby's nurse faced some of the same risk factors as their own child," she said. "It's also very emotional for Erin personally to work with these babies and to realize, 'That's what you were.'"
Erin realizes that not all her patients' stories will have endings as happy as her own and that she must, like all medical professionals, find a way to cope with unhappy outcomes.
"It will be a challenge," she admitted. "You have learn to take the bad with the good."
Those who have witnessed Erin's progress in nursing school have no doubt that she is up to the challenge and that she has found the purpose her mother predicted for her.
"She just knows in her heart this is where she's supposed to be," Nightengale said.
That sense of belonging was obvious as Erin showed a visitor around the NICU during finals week, about a month before she would start in the unit as a full-fledged nurse. She laughed with future colleagues about her upcoming Christmas Eve birthday–being born near her due date and celebrating a St. Patrick's Day birthday would have been more fun, she joked.
She walked briskly around the NICU, a large, airy, impeccably clean space. The patients are dwarfed by the computer-screen sized monitors that surround them, and occasional beeping or buzzing from the machinery draws nurses to investigate. Here and there, bluish bili-lights glow above jaundiced babies. Some babies' beds are draped with homemade quilts. Others display teddy bears, Christmas pictures colored s by older siblings, or hand-lettered signs bearing names such as "Morgan" or Colton."
In three acute care pods, each nurse cares for only two babies at a time. They check vital signs every two hours, and perform any other necessary treatments at the same time. The babies here can weigh less than a pound–about the size of a can of soda. The lights are dimmed, the area is kept quiet, and the babies left undisturbed. After all, a nurse points out, these babies should still be in the womb.
In the step-down unit, the babies are bigger, and their parents are learning the skills they will need to safeguard them at home. This means learning infant CPR and, in some cases, how to manage an apnea monitor.
The 34-bed NICU also includes a "swing" unit for transitional patients, a resuscitation room, and an area for babies who just need extra observation to make sure they are feeding and growing properly.
On any one shift, 15 RNs and two nurse practitioners watch over the infants.
When caring for a premature baby, who cannot give voice to its pain, a nurse becomes the baby's advocate. Learning to anticipate a baby's needs and problems is the greatest challenge for a new nurse––especially because, as Erin noted, these babies' tiny bodies are precarious systems, and problems can arise seemingly out of nowhere.
She paused by the bed of a baby boy whose weight is about the same as hers was at birth. His arms and legs are not much bigger than an adult's fingers, and to an observer he looks breathtakingly frail. Smiling at him, Erin said that to those who work with much smaller babies, a two-pound infant looks positively robust. She has to remind herself that in 1976, babies her size were at very high risk, and babies the size of those now in the acute pods simply didn't survive at all.
In the end, survival is success. Seeing former patients become strong, smiling children, like those whose survival is chronicled in the pictures that hang on the wall, is the most rewarding part of working there, several NICU nurses agreed.
When she starts work, Erin said, I she will sometimes stop and think about the people who took care of her and feel proud to be providing the same kind of care to her patients.
She can't wait to see their pictures smiling at her when she comes to work each day.