Back at work, the photo shoot is quickly forgotten in the revolving chaos of pediatric intensive care nursing. Despite the cute styles and print fabrics of the scrubs we wore on the set, tonight I’m wearing plain green scrubs pilfered from the OR. You have to know someone with the keypad code to the dressing room to get them. Everyone in PICU wears OR scrubs, even the doctors. I suppose this confuses patients, who can’t identify the different roles of the myriad of staff entering their rooms. Despite Registered Nurse stamped in large letters on my name badge, I’m often asked by parents, “Are you the doctor?”
What makes a nurse look like a nurse?
Tonight I walk into a change of shift admission. In pediatrics this sometimes happens because everyone agrees that a child shouldn’t die in the ER if there’s time to transfer them first. Tonight, this is the case.
My patient is a two year-old near drowning. Near drowning is sort of like saying a patient has an infection. It describes a broad range of outcomes from “The kid swallowed a bunch of water, and we suspect aspiration pneumonia,” to “He’s brain-dead, and the parents requested organ donation. We’re waiting for the team to arrive.”
The parents of my patient have requested organ donation services.
Gerald sets the child up on the ventilator, Kris transfers the monitor leads, and Dr. Polk assesses the child, while Corey gives report.
“He was with a babysitter, while his mother went to work. The baby sitter is a close friend, like a grandmother. The two year-old had a cold, and he can’t be sick at daycare. The babysitter says she was only on the phone for a few minutes while the child watched TV. When she turned around, he was gone. After searching for him inside and out for about fifteen minutes, she called the police and the child’s mother. Waiting for them to arrive, she knocked on the doors of her neighbors, asking if they’d seen him. It did not occur to her to look under the heavy cover of her hot tub. She knew the cover was too heavy for a toddler to lift. It was the first place the policemen looked when they arrived. Somehow, the boy lifted the cover, and fell into the hot tub. His face had wedged below the water. CPR was started, and a heartbeat recovered. He was intubated at the scene, and arrived at code speed by ambulance to our ER.”
In my mind, I visualized the rest of the story:
In the ER, his heart stopped several more times. The doctors and nurses performed heroics, while a social worker wrapped her arms around the child’s sobbing mother, “Please don’t die, please don’t die.”
They stabilized his vital signs long enough to transfer him to PICU, where our nurses will guide his parents through the remainder of their child’s journey on Earth.
After report, I prepared myself to spend the next twelve hours in a room of suffering in close proximity to a shattered family. You only have one opportunity to get it right. You cannot take away their pain, but you owe it to them to not add to it. Any anxiety I have about the child’s care will be shared privately with my colleagues, not spoken out loud in front of the parents.
In nursing school, our instructors taught us to not show emotion in front of the family, no matter how heart wrenching the story. They told us that our job is to deliver care, and offer support. While I agree that families should never be put in the position of supporting a distraught nurse, in my experience, showing some emotion, even tears, is interpreted by the family as an acknowledgment of their loss. Nurses are the embodiment of humanity in what is dubbed the “technological fortress” of a hospital. The ordeals patients suffer matter to their nurses. We are nurses, because life and death matter to us. We serve by way of our skills.
That is what nurses look like.
I’m glad I wore plain green scrubs tonight. Tonight the PICU is not the place for cheerful prints.