IslandRoar

Patients I Can't Forget: Teddy

My first night on pediatrics, a 19 year-old boy coded and died. Unexpectedly and out of the blue.

I'd been a med/surg RN for a year, and because of this experience, I was transferred to Nights on peds after only a week of Day orientation.

One of my patients was a six week-old baby, in to rule-out meningitis. She was fine, to be discharged in the morning. There were no parents staying the night with her, unusual, but not unheard of. No meds, no IV's. Just feed her and change her.

Yet I was freaking out inside. "How often do  I feed her?" I asked the other nurses. I mean, what did I know about a newborn? I was 22.

"Do I wake her up or let her sleep? How do I know when she's eaten enough?"

They smiled reassuringly. "She'll let you know. You'll be fine."

The baby slept on and I tended to my other patients. The night was quiet.

Then Teddy coded.

He'd woken up to pee. But instead, his mother reported, he opened his mouth and out came the blood. For some reason she attempted to catch it in  cups. She thought we might want to test it later, see where it was from.

Teddy was not my patient, but I knew him from my week on day-shift, a fun, sarcastic, 19 year-old kid. He'd been diagnosed with leukemia at age 11, gone into remission, and been fine.

Then, the year before, he'd relapsed. And, although the chemo was helping, it had left him susceptible to a terrible fungal infection in his lungs.

Later, we would find out that the infection had eaten away at his pulmonary artery. Which picked that moment that he'd gotten up to pee to burst.

Because we didn't know this at the time, and didn't realize nothing we did was going to help, we worked on him for almost two hours. Pushing drugs, CPR, hanging blood.

His mother lost it when the nursing supervisor tried to pour the cups of blood down the sink. In her bathrobe, she got on the elevator and disappeared. The nursing supervisor went after her.

I ran to the blood bank, two, three times. Then hovered in the doorway, mostly watching the five, ten, it seemed like a hundred, people working on him.

Until, from somewhere down the long corridor, I heard my six week-old cry. I went to her and, without thinking, changed her diaper, popped open a bottle, and sat down in that dimly-lit room to feed her.

While I was rocking her back to sleep, her father appeared in the doorway. He looked exhausted. "I couldn't get back to sleep," he confessed. "I figured I might as well be here."

I handed her off and went back down the hall. The code was over, time-of-death recorded on the chart. Teddy's mother had reappeared with his father and sister, and they were saying goodbye.

The day nurses slowly drifted in. When my new head-nurse arrived, she put her hand on my shoulder and leaned down close to my ear.

"Welcome to peds," she said.

Working with sick children was like that. Most of them, like that baby, got better and went home. I see their smiling faces, their happy families, as one big blur.

Other kids, fewer, got sicker or died. And even these many years later, I remember every one.

 

Death-Defining

For her Freshman Seminar at college, Daughter #1 is taking a class on death and dying. Because she is just that lighthearted, laugh-a-minute type of girl.

As an assignment, students had to interview a person who has dealt with death as part of their work. D #1 took the easy way out and chose me.

She called me late the other night and grilled me for a half hour about my experiences as an RN working with dying patients. I don't know how she felt about it afterward, since she's about as forthcoming as the CIA, but I found the experience enlightening.

One of the questions was did I feel that working with the dying had changed my attitude about death. I didn't really think I could answer that. See, I started working in a nursing home at 16, long before I'd thought much about death at all. I have to say I'd been pretty sheltered from death; I'd never even been to a funeral.

From that, I was thrust into this world where it was commonplace for at least a couple of patients to die each month, often when I was on duty, and frequently requiring me to do post-mortem care, which basically involves washing and wrapping the body before it's transported to the funeral parlor or morgue.

I continued to work with elderly patients through college and my early days as an RN. Then I moved to pediatrics, where I had to readjust my views toward death to include young people, even children and babies. It was difficult but I considered it a privilege to work with these patients and their families. A blessing even.

As hard as it is to conceive of, I came to believe some people can live a life filled with more purpose and meaning in 8 or 18 years than others might in well over 80. I'm not saying it ever got any easier to see kids die. But I did start to see age as only one factor (albeit a significant one) in the big picture of death.

Another question Daughter #1 had was whether I thought doctors and nurses viewed death differently.

"Like night and day," I told her.

Generally speaking, physicians have an adversarial relationship with death, even those working with the terminally ill. And that's probably as it should be. Most of us count on our doctors to help us fight like crazy to avoid death.

Nurses, on the other hand, are more often the ones present when death occurs. And while we rarely welcome it, we learn to accept it as an inevitability. Having seen enough of it, we realize it's not always fearsome. And in some cases, when we know it's coming, it can even be poignant and memorable.

Don't misunderstand me. I realize the gaping difference between dealing with death on a professional versus a personal level. For all the dying I've witnessed, I've still been incredibly sheltered from it in my own life so far.

And when that changes, as it obviously will, I can only hope some tiny bit of the strength and courage I have witnessed in those I've cared for might be found within myself.

Spin Cycle: What Are YOU Good At?

 

For this week's Spin we're supposed to post about something we're good at.

Right away I thought of my writing and poetry. So please forgive me if I post a poem as my Spin. I wrote this about working nights as an RN on a pediatric unit, something I did for many years, something I also think I was pretty damned good at.

 

Nights on Pediatrics

One-year-olds with their knees
folded under their chests,
backsides high in metal cribs

shrouded in croup tents
hissing drops of mist.
Toddlers tossing with fever.

Adolescents clawing the sheet in search of
the next decent breath.
Kids with cancer swallow Tylenol

in their sleep while
fat drops of blood fall
from the bag through their veins.

The high-pitched screams of septic babies
blend with the deep-throated moans of sickle cell in
a young adult.

Nights on Peds.
We stroke their hair.
Tuck up covers.

Watch chests rise and fall with sleep,
brows wrinkled in dreams.
It’s all that we can do.

                                            *************************

Now you can go on over to Sprite's Keeper and check out what other bloggers have to say about the things they're good at.

 

 

Patients I Can't Forget

Nancy

Nancy arrived on our pediatric unit a shy, sullen, bone-thin 15 year-old. According to her parents, she'd been coming home from school and lying on the couch for months, saying she did not feel well, and complaining of vague aches and pains. They chalked it up to adolescent moodiness and tried to ignore her, hoping she'd snap out of it.

When that didn't happen, they brought her to the doctor, who ran some tests. The diagnosis was cancer, a tumor in her pelvis that had already metastasized into multiple nearby organs. She was given months, but she lasted almost two years.

Even though she was ill, in many ways Nancy remained a typical teenager. Some days she would hole up in her hospital room, the lights dimmed, buried in a mound of quilts and books, listening to her music and scribbling in her journal, offering only muttered responses to our questions.

Other days she'd "ride" her IV pole up the corridor like it was a skateboard, her head scarf off and bald scalp glowing. She'd visit the younger patients on the unit and talk our ears off as we tried to chart, then race back to her room and proceed with some redecorating project she'd just thought up that instant.

Her parents were older. She had siblings in their 20's. If only they'd taken her to the doctor sooner, some of the nurses whispered.

But I couldn't agree. How could they possibly have known? How often did teenage mood swings mask the symptoms  of cancer? If that were the case, every kid would spend their adolescent years being rushed to the doctor, going through test after test. For nothing.

I didn't have kids when Nancy died. But I've thought of her many times over the years. My kids have to complain an awful lot, and over time, for me to stop and say, okay, maybe there's something specific here we need to rule out or get checked out.

Nancy's cancer was so far along that the odds are it would have made little or no difference  had she been diagnosed a few months earlier . But I like to think knowing her helps me be a little more vigilant, always aware.

After she died, her parents found instructions she'd written in her journal for exactly how she wanted her funeral to be. She wanted certain music played and poems read. She wanted them to dress her in her white track suit, and to use her head scarf instead of her wig, so that she would look like her real self.

I didn't go to her service. But I heard they honored her every request.