Life lessons from the PICU

Only four hours into my shift, and already I was tired.  I only had three patients - one had been discharged by a thoughtful co-worker, one was sleeping soundly, and the third...well, this is his story.

The nurse giving me report started with "I'm so glad you're here!"  The first hour went well enough.  He was settled peacefully in the big ICU bed, mama at his side.  I introduced myself, and we peeled open one swollen eye long enough for Rudy* to see his new "auntie" and give me a high five.  With both eyes swollen shut there's little for a preschooler to do for entertainment, so I set up my Ipod and speakers with some wild African music, turned down the midazolam drip a bit, and we settled in for the evening.

For about 20 minutes.  Then the crying started, and the kicking, and the flailing.  Sometimes it was tea he wanted and sometimes bread, and sometimes to get out of bed, and sometimes because he didn't like the diaper, and sometimes just pure temper.  But mostly he just wanted to see.  Hands reached up again and again to pull open an eye just a crack, trying to claw through gauze mittens at steristrips and the row of sutures that marched from under the bandages down his forehead and nose. The next several hours Gina* (Rudy's patient mama) and I walked the fine line of discipline and rewards and strategic ignoring of outbursts when possible, with one eye on the IV lines and surgical site to make sure everything stayed intact.  The delicate balance of trying to decrease his sedatives while keeping him safe, because while I don't mind so much getting hit in the eye with a gauze-covered armboard, too much screaming isn't exactly ideal only two days after major craniofacial surgery.  

Over dinner I prayed for strength instead of just for the food, while the other ICU nurse watched Rudy and a still-ventilated baby just back from extensive surgery, and then it was my turn with baby girl and the ventilator, with one eye still on Rudy.  Gina and I discussed the fears and challenges of young children in hospitals, loving discipline, and the importance of choices.  It's a scary thing to have every choice taken away from you, to wake up and not be able to see, to have surgery after surgery almost every year of your life, especially when you can't understand why, and tomorrow seems like a million miles away.  Granted, it wasn't always much of a choice we could offer (oral versus rectal Tylenol, for example) but hey, we did what we could.  And he dropped into a peaceful sleep long enough for Mama to head back to her bed and get some much-needed rest.

I sat down to catch up on charting, and heard a sleepily murmured Auntie from the bundle of sheets, as a bandaged head popped up and Rudy stood up on the bed in only his diaper.  Auntie, I need a hug.   I pulled over a chair, untangled the IV lines, and settled him on my lap for a good half-hour of cuddling.  I lifted one of his eyelids so he could wave at "Auntie Lindsey" and give her a high-five, and we whispered so we wouldn't wake up the now-extubated baby.

The next day, apart from a few cranky moments, Rudy was an angel.  One eye had opened on its own, just a crack, and he turned his head to peer at me with a half-smile on his crooked little lip.  We set up the music again, and as I suctioned nasal trumpets (here it's known as hoovering) and re-wrapped mittens and re-started IV's for baby Shara*, Gina laughingly commented "yesterday you were busy with Rudy, but now Shara is keeping you busy!"

Yesterday I stopped by the ICU, and found all the beds empty!  Shara is sleeping comfortably next to the nurses's station in D ward; helmet of perpetually damp bandages now almost gone, and swollen eyelids looking more like prunes than balloons blown up to the limit.  And Rudy waved at me from his bed across the ward, gave me a high-five as I hugged his mama, and he proudly showed me how far he could open his eyes on his own.  When the nurses took the patients up to deck 7 he came too, and as the djembe players and dancers went wild, we danced too - first with Rudy in my arms, then as he got tired, tied securely to my back in Gina's lappa.

And as we danced I marveled at how far he's come in just a few short days - from fighting, terrified and blind, to dancing wrapped securely in my arms, knowing he is loved.

Why am I so surprised...how often have I done the same?

*As with many of my blog posts, names have been changed for privacy.