This was my first chance to assess his physical condition. I knew his trust in me was only a temporary truce while he remained fascinated with the bubbles.
Tommy’s bright red cheeks were smudged with dirt and stained from tears. I realized this redness on his cheeks was the shape and size of a hand—angry welts slowly rising in the form of fingers. His left eye, almost swollen shut, was discolored red and purple. The other eye, big and brown, lined with long, dark lashes, was still intent on the bubbles. There was a freshly scabbed cut below his cracked and edematous lower lip. A crusted, linear abrasion encircled his neck. As Tommy reached to catch a bubble before it hit the floor, I noticed a small circular blister on the palm of his right hand, evidence of a burn likely made from a cigarette.
I sat silently with Tommy and the bubbles, trying not to show the emotions I felt for what he must have suffered and the anger I had for the man who had done this to him. The rest of the assessment would have to be done when his clothes were removed for a bath and Tommy was not ready for that.
Shyly, in a voice barely above a whisper, he asked to blow the bubbles. Soon the room was filled with them floating in the air and Tommy laughing at the simple joy of this game, everything and everyone else temporarily forgotten.
The police officer came and knelt on one knee by Tommy and told him he had to leave. He pinned a toy badge to Tommy’s shirt and said Tommy was an honorary sergeant because he was such a brave man today. I watched Tommy stiffen and grow silent once again. His eyes glistened with tears as the police officer shook his hand.
Tommy threw his arms tightly around the officer’s neck, the bubbles forgotten. He said, “Tell Daddy I love him.”
Rebecca Skowronski
THE FAMILY CIRCUS
By Bill Keane
“She’s listening to PJ’s heartbeep.”
Reprinted with permission from Bil Keane.
Taking Care of Joey
The tones of human voices are mightier than strings or brass to move the soul.
Friedrich Klopstoch
At 3:00 P.M., the young nurse looked up from her charting at the nurse’s station to see the emergency room orderly wheel her admission into room 107. She had hoped to finish her charting and dictate report before he arrived. And she still needed a final set of vitals on her post-op tonsillectomy. And the ice packs needed to be replaced on the knee in 104. It’s a good thing she’d set the room up earlier. She was ready for the admission—bed linens turned down, water pitcher filled, pediatric nightgown on the bed.
The nurse scribbled her signature on her unfinished charting and hustled to 107 to greet her patient. The ER phone report said six-year-old Joey had been removed from a violent home situation that afternoon and was being admitted for evaluation of injuries resulting from physical abuse. She was relieved to see the little boy walk from the wheelchair to the edge of the bed. That was a good sign—his injuries didn’t seem severe.
The nurse bent to Joey’s eye level and smiled. “Welcome to pediatrics, Joey. We’re going to take really good care of you here.” The small boy forced an uncertain smile.
“I have a few things I have to finish up real quick, then I’ll be back to get you all settled in.” Joey sat stiffly on the edge of the mattress, his hands folded in his lap. The young nurse reassured him with another smile. “It won’t be long.” With that she rushed out of the room, and so did the orderly—but not before handing her two pages of orders from Joey’s doctor. X ray STAT . . . lab work STAT.
At the nurse’s station, she dialed X ray with one hand while filling out pharmacy requisitions with the other. The charge nurse walked in. “Did you see your admission is here in 107?”
The young nurse took a deep breath. “Yes, I saw him. But until I get the X rays ordered, the drugs from pharmacy and the supplies from central service, I can’t take care of him, can I?” She smiled weakly. “And I still have post-op vitals due in 110 and an end-of-shift report to dictate.”
The charge nurse said, “I’ll check the post-op vitals. You can give oral report later. Right now, prioritize and just do what’s most important first.”
The young nurse held the phone receiver to her ear with her shoulder and dialed the lab, while stamping central service requisitions. That’s when her colleague handed her the other phone. “It’s admissions. They say there’s a discrepancy about the age of your new patient in 107. The social service form says he’s six and the police report says he’s five.”
The nurse groaned. “I’ll ask Joey when I admit him.”
“They say they can’t complete the admission, which means they can’t fill the doctor’s orders, until they know.”
The young nurse heaved a sigh and pushed the intercom button.
“Joey?”
He didn’t answer.
“Joey?”
Silence.
“Joey, I know you’re in there.” With false patience the nurse said sternly, “Joey, answer me.”
She could barely hear the small, quivering voice. “What do you want, Wall?”
With a lump in her throat, the nurse put down the phone, put down the forms, put down her stethoscope and went to 107 to do what was most important. To take care of Joey.
Donna Strickland
As told to LeAnn Thieman
Pennies from Heaven
Only the person who has faith in himself is able to be faithful to others.
Erich Fromm
Arriving early at the hospital one morning, I stopped by the cafeteria for some juice and a danish. The total came to $1.96. I got four pennies in change. Four pennies to rattle unsettlingly in my scrub pants pocket.
After finishing breakfast, I proceeded to the newborn intensive care unit. In the course of the next shift I would have four different infants entrusted to my nursing care, four precious pennies from heaven dropped into my pocket.
Upon entering, I surveyed the large, open unit. Against the far wall halfway down the left aisle, two nurses stood. One of them talked softly and patted the other on the arm in a consoling ritual. I looked down upon the warming bed beside them. On it lay a tiny, sickly, ghastly gray-colored infant hooked to a high-frequency ventilator. One thing surprised me. She kicked like there was no tomorrow.
My eyes moved up to the monitor screen overhead. Heart rate normal. Blood pressure borderline, but I had seen worse. Then I saw the oxygen saturation reading. It read 30 percent. Normal is above 90 percent. I stared at the tracing several seconds, wondering if it was a mistake or an artifact. It held steady at 30 percent.
Thirty usually means you are dead, not kicking.
I walked over to the bedside. Dehlia, the consoling one, turned and said, “You want to sign up for this baby? You’ll be taking her to the morgue.”
I nodded. “You know me. I’ll take my patients wherever they need to go.”
Pam, the baby’s nurse through the night, eyed me sharply. Although my shift had not yet begun, she started to give me report.
Baby Camille was a twenty-five-week-gestation infant, a transport from an outlying hospital. She was delivered by emergency cesarean section the previous night after her mother became seriously ill with an infection. An ambulance team had brought Camille immediately to our unit. Throughout the night our doctors and nurses had tried everything for Camille, but her lungs were simply too immature to function. Now, we were just waiting to see if the father could come to see her before we removed her from the ventilator and allowed her to die. The father had remained at the other hospital with his critically ill wife.
I looked down at Camille again. Still gray, still kicking. I glanced back up at the monitor. The oxygen saturation now read 28 percent.
The attending neonatologist came over, just off the phone. “That’s it,” he told us. “The dad’s on the way, but he doesn’t want us to wait. Take her off the vent and stop the IVs.” I reached up to turn off the monitor as well.
Dehlia asked if I wanted to hold Camille as she died. It was just after 7:00 A.
M., and the baby was now my responsibility. I deferred to Pam, who readily agreed. We brought over a rocking chair and bundled Camille in her arms.
Off the ventilator, Camille died quickly. Pam said she wanted to stay until the father came. She and another nurse took the now-still body, wrapped in a pink blanket and wearing a knitted cap, to the bereavement room to bathe and dress her.
Upon his arrival, the father was taken back to the bereavement room, where he held his daughter while Pam and the doctor talked with him. As Pam finally prepared to go home, I went in to introduce myself. I asked the father what I could do to help. He said he just wanted time to be with his firstborn child. I left him, showing him where I would be and promising to check back soon. I knew he felt guilty, having stayed with his wife while having to let his infant daughter be taken away alone. What a choice.
Returning to the unit, I found I had been assigned a second baby. This one was a large, full-term infant of a diabetic mother, on our unit for observation. Another nurse offered to cover for me until my tasks with Camille were done, but I declined. After the wrenching start to my day, I felt good holding the fat, warmly wrapped, squirming boy in my arms while he took his bottle.
I thought of Camille’s father, holding his small, wrapped, unmoving daughter only a room away.
After laying my big baby boy back down to sleep, I returned to the bereavement room. I sat, and we talked together, father to father. I told him my first vision of his daughter. “She looked awful,” I said, “but she was kicking. She fought to the end.”
“That’s how she was after the delivery,” he told me with a sad, proud smile. “She was always kicking.”
He called his family. He asked me to take one picture while he held her. Then we took Camille back into the unit where, behind the screens placed around her bed, he said his last good-byes. We walked to the elevator. “Thank Pam for me,” the father wiped away a tear as we shook hands. “I know everyone did their best, but some things are not meant to be.”
Back on the unit, the charge nurse informed me that my other baby would soon transfer back to the regular nursery to be with his mother. After that, I would be taking over the assignment of another nurse who had to leave.
Having a free half-hour, I decided to take a quick break outside to clear my head. A cool drizzle fell as I walked along a small street beside the hospital. By a wooded area, I stood and looked into the trees, absently fingering the four pennies.
Minutes later I returned, ready for my two new babies. One was a little girl, a growing preemie doing well and starting on feedings. The other, inevitably, was a tiny twenty-five-week-gestation infant hooked to a high-frequency ventilator. “He’s very unstable and sensitive to stimulation,” his nurse looked at me seriously. “His saturation dropped down briefly to the thirties the last time we turned him. Try not to touch him, or he absolutely dies.” Then, knowing what I had already been through that day, she caught what she had said. “Oh, I’m sorry. I didn’t mean it that way.”
“Don’t worry, I understand,” I grinned and sat back. “I can take my patients wherever they need to go.”
The day progressed. My growing preemie little girl took her feedings well, a big step for her. My twenty-five-week boy stabilized on the ventilator. He even tolerated being turned. I was busy enough not to think of Camille.
The shift ended. I walked out the doors to leave. The drizzle had stopped, and the evening breeze at sunset felt light and cool. Before going to my car, a strong urge overcame me. I walked back down the side street. Sad thoughts of Camille returned. Stopping at the woods, I took the pennies from my pocket and looked them over.
Four babies. My four pennies from heaven. I tossed the pennies into the woods, as though sowing seeds. If three of them should sprout and grow, I should consider that a very productive day.
Raymond Bingham
Take a Number Please
It’s easy finding reasons why other folks should be patient.
George Eliot
Nurses and orderlies rushed about the maternity ward helping mothers deliver their babies, then more arrived like an endless tide. There was more work than the staff could handle, so they floated some of us in from the recovery room.
We assisted in admitting the patients and doing the preliminary work, as well as looking after the expectant fathers. One young man was not only nervous, since this was their first child, but quite impatient. He repeatedly asked how much longer it would take. His constant pacing was making the young momma-to-be nervous. Finally we were able to convince him to go to the waiting room and get something to drink and relax, because it would be a while before she was ready to deliver.
After a while I went to the waiting room to give the expectant father an update on his wife’s condition. As I talked with him, another nurse came into the room and announced to the husband of her patient that his wife was about to deliver.
The young man with whom I was talking walked over to the nurse and said, “Excuse me. I don’t mean to be rude and I have tried to be patient, but I was here way before he was.”
Naomi Follis
“McGuire! Party of two!”
Reprinted by permission of Benita Epstein.
Reasonable Resignation
Do your best every day, and your life will gradually expand into satisfying fullness.
Alexander Graham Bell
When I was the nursing administrator in a community hospital, I had made it my custom to follow an adult or a child partly or entirely through hospitalization. Usually, I chose someone because his or her condition was unusual, a nurse asked me to, or because the person presented a problem in interpersonal relations. Mary met all the criteria. She was a loud-voiced, henna-rinsed, aggressive woman gushing profanity. Soon after her first admission to the hospital, I heard about her and the staff’s despair in trying to care for her.
The first time I visited Mary, I had to remain on the threshold because the moment she saw my unfamiliar face, she called out, “I don’t want any visitors!” When I asked if she needed anything, I received a sharp “No!” I could advance into her territorial limits only as far as she permitted. It took a week of daily rounds to be allowed at her bedside.
Mary had a blood dyscrasia, which meant an undetermined and fragile future. Denying she was sick at all, Mary angrily insisted she would go back home and be normal again. Mary’s husband and daughter lovingly and anxiously visited her and suffered her emotional outbursts.
Gradually, Mary began to talk with me. About two weeks after we became acquainted, she invited me to sit by her bed. As we discussed her background, she recounted her career as a writer, and I saw her come alive and appear almost well. An experience she shared one day became the turning point in our relationship. During World War II, Mary had visited a Japanese internment camp in this country. She was to write a story for her big New York City newspaper about the conditions there. At the camp, she found herself outside one of the internees’ cabins. She stopped to watch an old gentleman patiently tilling the soil of a small garden plot where flowers bloomed brightly and vegetables grew. She noticed the peaceful, thoughtful and calm expression on his timeworn face.
Mary interviewed the man and learned he had been a successful businessman before the war. She felt compelled to ask how he could maintain such composure in light of the circumstances. Quietly, he responded, “I am not in control of the situation, but I can make the most of my life by providing both beauty and work for myself. I accept life with reasonable resignation.”
Mary recalled that story pensively. Until that moment, she said, she had forgotten all about that part of her experience. Why did she remember it now? She stopped talking for a few minutes then asked if she could rest.
Mary went home twice during the next two months. Each time she returned, I visited her daily. It was easy to see her behavior changing. Now loud profanity subsided; she talked about her writing. Whenever depression weighed heavily upon her, she discussed “reasonable resignat
ion,” and her indomitable spirit rebounded.
During her fourth admission, the once-aggressive, blustery, brave redhead was clearly losing strength. Now gentler and calmer, she took the lead in our daily conversations, which included people, God and death.
It became my habit to say good-bye each Friday until my return on Mondays. If I was leaving town for any long meeting, I let Mary know. When I went to a four-day seminar, I told Mary a week in advance. The day before I left, I dropped by to see her. I knocked, then stood on the threshold as two nurses cared for her, their faces etched with sorrow. Mary saw me. “I don’t need you anymore.”
I could only manage to say, “I’ll see you again,” and quietly shut the door.
The seminar was held in an idyllic setting in central California and my room was on a cliff overlooking the Pacific Ocean. After it had rained all night, the sudden stillness of the storm’s ebbing woke me Monday at 4:30 A.M. I felt compelled to go outside on the balcony. Just as I reached the porch railing, the clouds parted and the moonlight burst through. I felt a tremendous sense of release. It was all so breathtaking that, for the first time in my life, I cried for joy.
When I returned on Wednesday morning, I found, as I had surely known in my heart, that Mary had died early Monday morning. She left behind not only a saddened family, but also a hospital staff crushed by her death— crushed because, on the one hand, they were distressed at their early misunderstandings and, on the other hand, overwhelmed by Mary’s courageous reasonable resignation.
Chicken Soup for the Nurse's Soul Page 19
