Friday, May 02, 2008
angels + fighters + miracles
It is only by following your deepest instinct that you can lead a rich life, and if you let your fear of consequences prevent you from following your deepest instinct then your life will be safe, expedient, and thin.
Katherine Butler Hathaway
If you have kids or have any you're close to, go find them today. Give them a big hug and tell them you love them. You never know when you might send them off to school and the next time you see them, they'll be in the emergency room in cardiac arrest getting ready to be life-flighted to a hospital better-equipped to handle such a severe pediatric trauma.
After my successful interview yesterday, I was supposed to shadow at the local children's hospital for 3 hours this morning. I was assigned to a tech who is in my nursing program and is getting ready to graduate. She'd been a tech on the PICU for awhile, so I hung out with her as she told me different things she did on the unit.
I was very impressed by the passion and dedication of the entire team on the floor. There was so much support in every area of medicine - a beautiful ratio of nurses, a huge group of respiratory therapists, lots of support staff, all kinds of doctors... the unit is surprisingly thoroughly-supported, and that's exactly the atmosphere in which patient care is optimal.
Tech and I checked on patients, stocked carts, played with babies, and talked to some of the nurses. When we heard of a helicopter coming with a cardiac arrest patient, we immediately went to work stocking the patient room so our team of doctors and nurses could immediately go to work saving the boy's life when he arrived. I calculated his weight in pounds and kilos (the tech didn't know how...) and we printed a trauma sheet for quick reference to common drug dosages for his body weight.
As it turned out, the patient had a history of multiple heart surgeries and left-side problems, and as I later learned, anytime there is congenital left-sided heart issues, it's pretty much a game of growing, surgery, growing, surgery, growing, surgery... until the kid's heart finally gives out.
Anyways, it wasn't hard to miss it when our patient arrived. In came a flood of paramedics and air transport personnel, followed by a hysterical mom. The atmosphere instantly shifted and the whole unit was just intense. As for the patient, we immediately went to work attaching tubes, lines, and wires while the doctor established a sterile field and went to work to insert a central line. We pushed epi and dopamine like it was nobody's business, and every few minutes, I recorded his vitals and various respiratory numbers. This went on for what seemed like an eternity. Radiology ran an echo and some x-rays, more intensivists and a cardiologist came in, and it was determined that there was no saving him.
In medicine, it's so easy to get used to situations in which something scary happens, push the meds, patient responds, body heals, and life moves on. It's really hard to believe it when you're pushing dozens of vials of all of the best drugs into a patient, and yet you watch the monitors read exactly the opposite of what you want them to say. Medicine these days is miraculous and amazing, but it's important to remember that the human body is also a force to be reckoned with.
Whether we wanted it to happen or not, whether it was supposed to happen or not.... it happened. Despite constantly loading our little guy with epi and dopamine as well as bicarb and all kinds of other things, his vitals went all over the place as his pulse-ox steadily decreased. Far-from-normal, stable values aren't usually as serious as all-over-the-place, unstable values. Not only did the monitors tell us what we were afraid to know, but our boy gradually stopped fighting, and a yellow tinge started at his toes and slowly crept over his entire body. The family slowly trickled in, and both Mom and Dad were able to hold him as his little heart stopped beating. Various other friends and family members came in, and when I left about three hours later, Mom was still sobbing and holding her boy in her arms. When do you let go? I don't really know if you ever quite can. Losing a life you've not only fought for, but known and absolutely adored for nine whole years.... don't even try to tell me you know what that would be like.
Meanwhile, across the floor, a little girl died in her parents' arms, and we prepared for another baby girl down the hall to lose her battle later in the day. Three precious children went to heaven, all on a rainy Friday day.
It's an awful thought, but I've heard it so many times from so many medical professionals. Maybe death really does come in threes. Even in peds...
I have to admit I honestly questioned my choice of profession today. I questioned my desire to be on the PICU, and I questioned life in general. Who decided precious, innocent kids should be sick anyways? Definitely not God. But as always, if I confide in the people I love most, talk out my thoughts and feelings, and reprocess all of my emotions, I can usually find my heart's clear voice once again. And I did. And I still want to work on this floor.
So today was very, very hard. Very sobering, very shaking, very sad. But the good news about pediatric losses?? These little kiddos go become angels. There is no doubt that after their last struggle of a breath, they are in heaven. They're so beautiful and innocent, and for some of them, heaven is a lot better than any life they could face here on earth. Sure, the hearts left behind are broken, established family dynamics are forced through rigorous adaptations, and such tiny people are missed so very greatly. But as we say on the floor, they are going home. Not home, but home-home. Up there kind of home.
As for us nurses? We are human. The pain of loss resonates in our hearts, but we are not afraid to grieve and cry beside our precious hurting families. Sometimes just being there is the best thing we could ever offer, far greater than any amount of nursing education or medical knowledge could reach.
The best nurses though, the ones who are destined for this type of work, know how to ground themselves. We know how to channel our grief as fuel to comfort the families. We draw strength knowing that we do work miracles on a daily basis, and it just so happens that sometimes life has other plans. We have to focus on the fact that kids are resilient, and the knowledge that many of the sickest, weakest kids are the hardest, strongest fighters. We reason that for every soul that goes, there's quite a few more that are going to win their battles and grow up to see more than just childhood.
Like the little guy who kicked my butt at Connect Four about, ohhhh five or six times?? Yep, a little fighter who could have been dead two days ago but is now sitting up, smiling, telling me that the Cavs better win tonight.
Like the miracles who come back to the floor and say, "Look at me. You saved my life, and now I'm perfect."
Like those whose families where prepared to watch them go, but because of some unexpected thought of God, survived.
Like me.
I could have been in that PICU at some point in my life, fighting a losing battle. But here I am, still fighting.. just maybe not as hard as the kids in the PICU. We do, however, have one huge thing in common, and because of that, I have strength to go on.
Guess I'm not a big girl then, because today I broke down and cried. All the way home. So maybe big girls cry. Or maybe just nurses. Because in such a profession of the heart, being human is not only okay, but it's critical. So today, I grieved for strangers who I took into my heart. I cried for our lost fighters, our lonely families, and a deep, deep feeling of gratitude that is heavy on my soul.
So love your babies. Love your family. Love your friends. Savor each breath, each moment. I don't care how cliche it sounds, but each second of your life is a true, true gift. Just ask the mom who I'm sure would have given her life to give her son just one more sunny, spring day.
We are truly, truly blessed.
Hi,I read your comment over on Sheyes blog and had to come and read yours, how horrible! I don’t want to imagine how hard it was, life is so strange at times, a parent should never have to live longer than their child….my heart aches for the families, and for you for seeing such sadness.
{hugs}
posted by Lea on May 06, 2008 at 9:58am