© Marcia Hess, BSN, RN, CPN
Children’s Hospital
My colleague was frazzled, her shift report terse. “You’ll need roller skates tonight,” she said, glancing at my assignment sheet. “Bed 1 won’t stop crying since mom left, Bed 2 gets triple antibiotics, and Bed 6 – what a day. Let’s see him first; you’ll be in there all night anyway.” We stopped outside the room as she pushed the door open. “No isolation orders, but I’d wear gloves. He’s got something brewing for sure.”
From the chart I had already read the H&P – a pediatric service patient who had suffered a hypoxic brain injury at birth. Neurologically devastated as a result, this was a child with the developmental level of an infant in the awkward body of a pre-adolescent boy. Recent worsening seizures had led to respiratory distress and feeding intolerance; my tasks this shift would include care of his G-tube (oozing), colostomy bag (leaking), central line (positional) and trach (due to be changed) as well as frequent neuro checks and vitals plus meds almost every hour.
“I’ve changed the whole bed twice today,” Kelly whispered as we entered the room for report and safety checks, “but he’ll probably need another bath tonight. Mom will help –she’s really good with him.”
In a recliner on the far side of the bed a woman in business attire cradled my patient, a frail pre-teen clad only in an adult diaper, multi-colored cords and wires connecting him to clustered machines. “He hates clothes,” Kelly shrugged, “and with the fever we just left everything off…”
She chatted with Mom as I quickly scanned his cardiac monitor, confirmed his IV fluid and feeding rate, noted his emergency equipment. Oxygen, suction, code sheet – check, check, check. When I greeted his mother and bent down to examine the ID band on his bony ankle, I was surprised to see under his name today’s date (different year). Only then did I comprehend what my mind had initially glossed over in favor of a hurried clinical assessment – the colorful balloons by the window, a stack of unopened gifts and the crumbs from a partially-eaten frosted cake littering the bedside table. His mom followed my glance and smiled.
He’s twelve today,” she explained. “Don’t worry – I’ll clean up the mess, but after we almost lost him last week we just had to celebrate. Please, have some cake – there’s plenty.” She bent to kiss his acne-scarred forehead, gently stroked his spastic limbs as she wiped a spot of drool from her cream-colored silk blouse.
“When he was born they said he might only live a few weeks, “she explained, “so every birthday is like another miracle. Isn’t that right, my sweet boy?” As if in response, his lanky arms jerked, unfocused eyes still staring ahead. “You understand Mommy, don’t you, even if you can’t talk back.”
Here is what joins us – what separates us. Tonight we would both be busy; by morning, both exhausted. (I’ve never seen any parent sleep well on those bedside cots.) We were both gentle and efficient caregivers, both striving for the best outcome for this young boy. Yet – on the scribbled paper in my pocket and my electronic “task list,” I anticipated twelve hours of strenuous work. His mother’s eyes projected twelve years of unabashed love.
Peeling off my gloves as Kelly took a phone call, I pulled over a padded green chair. “Happy birthday, Jimmy – thanks so much for sharing your cake with me. I can’t wait to try it! And chocolate is even my favorite!”
Judge’s Comments
This wonderful piece of writing shows, not tells, what makes a nurse a real nurse. It shows the gulf between
the patient and the caregiver, and that some can at least come close to crossing that gulf. Work can be love.
Oh for a taste of that chocolate cake!