Chapter 55

I leave PICU, and report to the pediatric unit.

No offense to my pediatric nurse colleagues, but no PICU nurse enjoys floating to pediatrics. Not because you aren’t incredibly good nurses, you are. It’s because you work way too hard in a way different from PICU nursing.

In the PICU, I’m assigned one or two critically ill patients. I run my butt off evaluating vital signs and pulses up to every fifteen minutes, unless the patient is on the verge of coding and then it’s at least every 5. I titrate powerful drip medications, and monitor serum blood levels drawn from a complex highway of lines criss-crossing a patient’s body as he or she rests in a drug induced coma. It’s intense, challenging work, but I’m able to focus on just one or two very sick patients, developing a dynamic rhythm of patient care.

As a patient improves, they’re allowed to come up from sedation. Keeping a three year-old intubated until an intensivist decides they can protect their airway and orders removal of the breathing tube is hell on earth for a PICU nurse, but once it’s done the patient usually transfers quickly to the general pediatric floor, right about the same time they are no longer willing to stay in their crib.

Of course, caring for children too sick to go home, but too well to stay in their crib is the job of the pediatric nurse. In the PICU, most medications are administered IV, but on the floor it’s often changed to oral. I don’t care how much the pharmaceutical company labels medications as “fruit flavored,” no kid willingly takes medication that comes from pharmacy in a syringe, even if you convince him there’s no needles involved. For infants, you can squirt a few drops of the med at a time into just enough formula to fill a nipple, and they’ll suck it right down especially if you allowed them to get hungry enough. A toddler, however, is on to you right away, and spits out the spoonful of pudding or juice laced with medication. The last alternative no one enjoys is holding the child down on his back, sliding the needless syringe into the side of his mouth, towards the back, which makes him swallow as you squirt it in.

Of course, none of these skills or the extra workload carried by pediatric nurses prevents a patient from suddenly decompensating, and a code being called. All of this, with the family watching from the bedside. It’s not all cute print scrubs and bunny blankets for pediatric nurses. Theirs is a very special brand of vigilance and expertise.

I took report from a day shift nurse I don’t know. She gave me three patients. Two are post-open heart surgery, transferred from PICU, on the mend and getting ready to discharge. The third is a 14 year-old boy who is blind as a result of treatment for childhood Rhabdomyosarcoma. He had a bout with influenza and was admitted for dehydration. He’s going home today too. His parents spent the night at home. In their place, his Seeing Eye dog, Reege, a golden retriever, lies calmly alert on the floor by his bed.

I realize they gave me a pretty simple assignment. In fact, it’s possible all three of my patients will be discharged. I might get to go home early!