Monday, March 24, 2014

because sometimes trauma is funny

It's been a big month for traumas. Dog bites. ATV crashes. Motor vehicle collisions, which we used to call motor vehicle accidents, until someone somewhere deduced that if we refer to them as collisions, it will somehow make mankind in general be more cautious while driving and our numbers will go down.

One of our trauma nurse practitioners told me yesterday that we have the third busiest pediatric trauma center in the country. I believe it. When our trauma patients are brought to the ER, they're assigned a name like Bob Trauma. We've had so many Bob and Julie and Ted Traumas hanging out that the cafeteria workers thought they were all sibling or cousins.

I was helping another nurse clean a cervical collar on a four-year-old the other day. A cervical collar is that thing you see on someone's neck when they've had an injury. When you're hospitalized, one nurse has to clean your neck and check for skin breakdown every 12 hours while another nurse holds your neck completely still in c-spine to prevent further injury. Doing all of this on a four-year-old who has just had a big, scary accident takes some finesse.

If you've never been surrounded by pediatric nurses, you should know that they never stop talking. Ever. We narrate all of our actions so that the tiny people we're taking care of don't get scared. Sometimes it works. Most times, it doesn't.

So I'm standing over a four-year-old, trying to pull a brace off of his sore neck without scaring or hurting him. And I am grilling him like an FBI agent.

"What's your name? How old are you? How long was your hair before they buzzed it all off? Are you doing okay?"

He's four. He doesn't go to preschool. He likes that he gets to stay home with his mom. His birthday is in June.

"So are you going to have a birthday party?"
"Are you going to go anywhere with your mom?"
"Well, are you at least going to eat some birthday cake?"
"I can't have birthday cake! I got hit by a car!"

Monday, March 17, 2014

When I was in nursing school, one of our instructors told us that most nurses get divorced. She said that this was because we like to fix everything. We love lost causes. We fight until the end. And that's true. Every part of what she said was absolutely true.

We lost a patient yesterday. She wasn't just any patient. She was a baby. And worse, a baby that, as a team, we had taken care of for the past five months. She was a very sick little girl. We watched her more closely than the rest of our patients because we knew how quickly her health could deteriorate. She coded at change of shift. And we couldn't bring her back.

We are experts at fighting off death. For us, it is literally a science. Actually, it's an algorithm. We follow the steps. We start compressions, we give breaths, we give meds. We are experts at fighting off death, but sometimes we lose.

We work with very sick children and many times, they will not live to the age of eighteen. We have the hard conversations about time and quality of life. We prepare our patients' families for the inevitable. But as nurses, we believe that if we watch closely enough, we can keep these kids safe.

We are the gatekeepers. We are the guardian angels. We are the ones who call the doctors at three in the morning to tell them that a kid "just doesn't look right" and that they need to be transferred.

We forget that our patients decide when to keep fighting and when they've had enough.

When that sweet baby girl went to be with Jesus, the residents took it the hardest. They are young in their careers. They are arrogant, as they should be. The foundation of their practice is the belief that they know everything and that they make the correct decisions to keep people alive and well. They are wholly unaccustomed to failure. They sat in the team room and cried for most of the day.

We gave our condolences to the family. Her mother said that every day that she spent with her daughter was a blessing.

The nurses cried. In our field, it is acceptable to shed a few tears with the family. But after that, you have to hold them back. You are allowed to cry in a closed room, where your grief cannot affect the rest of your work. You are required to fight back tears until the end of your shift and then cry on your drive home. You find ways to cope. Have a drink. Take a bath. Eat all the carbs you want. Take a sleeping pill. Call in sick for a day or two.

We give ourselves some time to grieve, although it's never long enough. And then we open the door and we get back to work, because the rest of our patients still need us.