A Nursey Tale

NSG 416 Maternal Child
Senior Year 

                Let me start by saying that after three years of impatiently waiting for my Maternal Child course, it is not what I expected. I am facing more psychosocial issues than I was prepared for. I am often broken hearted by the children and frustrated by the parents. Yet I have never had a clinical day strike such a deep emotional cord as the story I am about to retell.

                I went to bed Sunday night after a heartfelt prayer that the Lord would use me the following day to help someone. I don’t know why I did that… I wish I could say it was a regular happening but I must admit, it was out of the ordinary for me to pray “Lord, send me just ONE person I can help and I promise I’ll do my best”. Now, having prayed that prayer and seen the Lord use me, I am blatantly terrified to pray it again!!

                I woke up at 3:30am to prepare for my clinical day on the pediatric floor. I purposefully put in my ballerina earrings in case I had a little girl to dote on. Little did I know then, neither of my patients would even be aware of what I looked like let alone what earrings I was wearing… 

                We pulled off campus at 5am with an apple and some peanut butter for breakfast. Clinicals had started by 6:15. I was placed in the Pediatric Intensive Care Unit (PICU).  Because of HIPPA as well as respect for the overall quality of the hospital staff, I will say my nurse’s name was Mary, we had rooms “A and B”, and I will not be using the patients’ real names or tell you the name of the hospital.

                The night nurse reported to the day nurse, “Well, you know A—he’s back again. And B, gosh he’s as cute and cuddly as ever”. She went on to give several key details on room B, never returning the conversation to our patient in A. I was unable to access the charts so I walked into the rooms with only the information given.

Patient B, let’s say Aaron, was a premature baby not yet two months old. Very small. Very cute. And yes, very cuddly. My nurse went into Aaron’s room first to wake him up and get his morning cuddles. He has a very rough home life so I can’t say that her love for Aaron was misplaced, he needed it. His mother was not responsive to his needs and had yet to finish her assigned parenting classes in order to take him home. She was “too busy”. So for Aaron’s sake, I am glad my nurse loved how soft he was.

                *Warning* I will describe what happened professionally but keep in mind, this was a PICU clinical, it will be blunt and hard for some people to read.

As we left Aaron she said, “Alright, let’s get Jackson’s med pass over with”. Jackson was apparently the patient in room A. I decide to walk in alone while she prepared his medications. I found a cluttered room, a TV turned to a monotone news caster, and in the crib was a small little boy with a head somewhat large and a rather short neck. This was Jackson. He had a tracheostomy tube in his neck attached to humidified oxygen and he also had a PEG tube (a tube on his belly leading straight to his stomach) attached to continuous formula. His eyes were rolled back, not focused, and so dilated you could barely tell they were blue. They did not constrict when I shined my pen light. His lips were white with flaky dried skin and his neck was covered with the froth from his own drainage, soaking his gown. He had a wet diaper. His had small writhing movements but nothing coordinated or very big. He couldn’t communicate and didn’t respond to my voice.

            Mary came in and briefly told me Jackson’s story. When he was 9 months old… His mother tried to drown him. She was never charged. His father and two siblings visit regularly but live two hours away. His grandparents come when they can but the drive round trip takes all day. This little boy, sweet precious boy, was a victim. He is now 2 years old. Two. Years. Old. I assisted Mary in mixing his medications and giving them bolus via his PEG tube. She attached a new bag of formula and she left to do her charting. I stayed in the room. Staring at Jackson…
            I couldn’t help it, I cried. I cried and cried. Even now, while writing this, I am crying. Break my heart for what breaks Yours...

His nurse had left the dirty diaper. The froth... The wet gown.

I cried while I changed his diaper and gown. Hooked up suction and cleaned his trach. While I had the suction attached I ran it lightly over his lips. The dead skin came right off. I was looking for signs of the life left inside his sweet body. It was obvious that he did not like to be suctioned; his brow furrowed and his cheeks pinked up. I worked as quickly as possible. I remembered how a little boy in our orphanage liked flashing lights so I tried to see if he could focus like Sammy used to. I held up my pen light and shinned it right above his head onto his pillow and ran my hand back and forth across the beam. At first he didn’t do anything but then his cheeks got flushed again and he got stiff. I stopped flashing the light, he calmed down. He was there… My Jackson was there! I still wanted to find a way to comfort him so I grabbed a bottle of baby lotion and rubbed it into his calloused knees and elbows. I got mouth moisturizer and applied it liberally to his little lips. All the while, I sang. I sang whatever came to mind. Most of them were Khmer worship songs. And when I ran out of songs, I told stories. When I ran out of stories, I prayed out loud. And when I couldn’t do anything else, I cried some more.

The nurse came in later to say that he had not passed a bowel movement in a while and that she was considering an enema. An enema! On a two year old! I understand it can sometimes be necessary, but he wasn’t even on a regular stool softener. We finally decided on a suppository. I inserted it and I could tell the poor guy didn’t like it. I held his hand and rubbed his face. I promise you, he did respond! He calmed down. My touch. My voice. After just 2 hours, calmed him down. While the nurse was in helping with the suppository she noticed that when she administered the formula via PEG tube that she’d never unclamped the tube. So he had been without formula for 2 hours.. I know this is small in the grand scheme of things but still! 

            My nurse went to go give Aaron his bottle so I stayed doing whatever I could for Jackson. I used half the bottle of lotion and his skin was still soaking it up. I was suctioning him whenever he needed it and reapplying the lip moisturizer afterwards. He got red and stiff and I realized he had a bowel movement. Once he was finished I changed his diaper again.

I helped my nurse with Aaron for a bit but only when meds and/or formula were due. He was receiving plenty of attention and babies can only see a foot and a half in front of them so he wouldn’t have needed two people there to feed him.

            The nurse visited me in Jackson’s room later saying that the Doctor had ordered the oxygen to begin being weaned. So she reached for his 30% humidified oxygen… And took it off. She placed him on room air. Room air! After being on 30% oxygen… She left the room and I just stayed by his bedside. I swear, I never took my eyes off his O2 saturation monitor (shows the level of oxygen in his blood). It went from 98-99 down to 95.. Down to 90. I went and told my nurse. She said she wasn’t concerned. It kept dropping. I kept reporting. She could tell I was anxious but did not seem concerned. I couldn’t stand it! 87…86..85. 84. That’s it—if she doesn’t turn it back on, I am going to! Forget clinical grades!

I was past frustrated. Past mad. I was furious. I was so mad I literally could not force the words out to my nurse. I walked up to her. Told her the monitor was reading 84. And stared at her. No words. No compassion. Just pent up hell-fire.

            Finally, she stopped slouching, stopped sulking, stopped pretending to continually chart on Aaron’s status, and followed me into the room. “Well gosh, that’s the most relaxed I’ve ever seen him…” Did she really just say that?! Did she REALLY?? Relaxed… He had stopped his movements. His face was pale. And his eyes, which were once so dilated they were more black than blue, were now so constricted they were nearly all blue. “No, he’s not relaxed. He’s suffocating.”  These were the signs and symptoms of hypoxia. Mary just looked at me and said real slow, “Kati, if he were a normal baby, I would be worried”.

           “If he were a normal baby”…

Normal.

           She finally hooked him back up to oxygen. His eyes dilated. His cheeks returned to their normal color. He still didn’t move. I held his hand and refused to make eye contact with my nurse. She just left. His movements finally began again. Eventually my anger for the nurse was controlled enough where I could start praying again. Jackson probably didn’t know it, but I was praying for forgiveness for being so utterly disgusted with my nurse. To be transparent with you all, I am still shaking with anger.

I need to pray more.

            Once I was assured that Jackson was stable and that my nurse was nowhere near his O2, I went and gathered all the supplies I could find. I made a sign to hang above his bed.

“Hello friends, my name is Jackson.
                I am two years old.
                You can tell when I am upset because my cheeks turn pink.
                I always calm down again when people hold my hand and stroke my cheek.
                I especially like being sung to.
                Thank you for visiting me  =)
                Please come again soon,
                                Jackson”

                I needed people to stop seeing him as “the regular” that’s back again. But as a little boy. So that they could visit him. Love on him. Pray for him. The other nurses reported that they disliked visiting him because he smelled bad. I will say this, it is absolutely 100% their fault that he smells bad. With just a few short hours he was clean, he smelled nice, his skin was softer, and he was calm.

I do not tell this story to bash my nurse, she was smart and gave impeccable care to Aaron. I am saying she showed a bias in patient care based on how physically cute the children were.

What I am asking you, is that you respond to this pain. To Jackson. And pray. And never allow yourself to be biased against someone based on looks, smell, or socioeconomic status.