Saturday, July 09, 2005

PICU, schmicu

you guys are going to think i'm anal and depressed all the time. this post will be an attempt to redeem myself in the name of all that is sane. i am in the pediatric intensive care unit (picu) now...still doing this externship at the large teaching hospital. needless to say, it is a particularly stressful unit and i'm not good at "leaving it" when i walk out the door. i am super emotionally involved with these children and their parents, and i come home and cannot sleep because i'm so filled with worry. the past few mornings i've left feeling like i just might lose it and hurl before i even get to my car. now, i can handle bodily fluids with the best of them. internal organs, invasive procedures, gastric contents, poop smeared everywhere, wound packings, sutures, staples and drains: i've never thrown up or passed out handling things like that. but let my 3 kilo ex-preemie continually de-sat on me and keep me hovering over her for 2 hours. THAT i cannot handle. my stomach will not handle my patients trying to die on me.

i was caring for the afore-mentioned ex-preemie, who we will call sweet pea for HIPPA purposes, this week. she has a plethora of complex issues, but her main one at this point is respiratory. she was on a ventilator and needed to be transferred to a bigger hospital where she could have a primary pulmonologist. texas children's hospital is where we decided she would go. they agreed to take her. so we prepared her as best we could for her cross-country flight.

after waiting over 24 hrs. for the family's insurance company to finally okay such an astronomical expense, a team put together just for sweet pea flew over in a leer jet to get our baby. when they touched down in georgia, they did not have an isolette for her. an isolette is the small, clear incubator-looking equipment with all the monitors and temperature regulating device. they had brought a stretcher for her. and they argued with us on the phone, saying "she's 4 months old. she doesn't need an isolette." needless to say, this EX-PREEMIE on a VENTILATOR who weighs 3 KILOGRAMS and cannot regulate her own body temperature and is in ICU cannot be thrown on a stretcher. she lives underneath a radiant warmer. this baby has not been out of our sight since the moment she was born. i think we know what she can and cannot handle. when i relayed this to the physician from texas children's, do you know what she said to me? "we'll bundle her." umm NO, mrs. i-just-took-my-boards and apparently know nothing about this child, you will NOT bundle this baby for a 2 hr. plane ride. she will die before you get there. so after coming all the way out from the airport and looking at this baby for 5 minutes, the medical team flew BACK to TEXAS (at a cost of $1 million that texas childrens' will have to eat) to get an isolette.

and that's not even the most infuriating part. sweet pea was stable the first time they got there. for the last 2 hours before they returned, she became very unstable. she kept dropping her o2-sats and wanting to die on us. by the time they returned, her parents and our medical team thought it may very well have been too little, too late.

SO...when things like that are happening at work, and i leave not knowing if my baby made it somewhere or not, then i get my panties in a wad and am not much fun for a few days. BUT, as of this morning, mom called and told me that they made it to texas okay and she was still stable. so for now, that's good news. but she probably won't make it to her 1st birthday anyway. if anybody has a suggestion for a better way to handle this stuff, i'm open to hearing it. i'm getting opposing views from most people. some say "nurses get too hardened over time. they need somebody as emotionally involved as you." then others are saying "you've got to leave that shit at work or you'll end up with stress ulcers and insomnia." but for tonight, i will sleep well knowing that sweet pea is safe, and my other kids are stable. she's only one of 8 stories i could tell you about this week. all in good time...

12 comments:

lightfeather said...

You are truly an angel to these children. An earth angel who will never harden.

Sarah said...

Oh Camilla,
You do some of this earth's most difficult and most important work. Thank the stars your patients have you! They are blessed.

Puffer said...

Great post Camille
your blog is to post everything that is about you
and sometimes when things are not going well it feel so negative, but keep getting all that is worrying you out and you will feel better and your friends are here through thick and thin.
love yah

Anonymous said...

http://christianagha.blogspot.com/

Dixie said...

You have a pure and true heart. Even if it sometimes makes your job harder, it's better than having a heart of stone.

My sister has been a nurse for thirty years and she's always told me that while you get more "used" to the tough stuff, you never get over it fully. Expect to still have patients who tug at your heart but also expect that you'll learn your way of managing it.

Jaded&Opinionated said...

I don't know how you could leave that much emotion at work when you leave... you're literally holding lives in your hands. But, I know there must be some way to balance the two. Does your hospital have a social worker or therapist you could get some advice from? Just some coping strategies to reduce the stress. I don't know if that would be helpful, but it might be worth a shot.

You are truly a strong woman.

pack of 2 said...

maybe you can see a therapist to talk out some of the stress you deal with on a regular basis. I know they also have situational anti-anxiety meds that you only take when needed but not daily.
It is a very hard job & that is why most of us can't do that kind of work. Thank God for people like you who can.
Thanks for doing what you do..I know that those kids are better off because of your compassion.

Jan said...

Camille,
The best way I have found over my 23 years to deal with the stress of sadness, sickness and death, especially of children, babies is to talk about it. To your friends and family....to US.
We are here to listen, to hold you hand and cry with you. To give you a shoulder to cry upon.
It does get easier with time, it did for me anyway.
Also, you can try talking with your hospital chaplain....hopefully yours is as great as ours.....very down to earth, non judgemental guy.

We had one of those days today. 0734am EMS called in 13 month old male cardiac arrest. Thats the only information given.
Body temp 85.7 degrees cold, no signs of life....tears by many in our little ER.
It's always hard on us as nurses, docs, respitory the ones in the room. What I seem to forget is that it's equally hard for our wonderful registration folks...ie. Annie....They have to see the family first, the tears, the questions. Then after doc has talked with them they still deal with family coming in....talking with them and escorting to our family room.
Pediatric sickness, death is hard as hell to deal with. Both on the nursing end and also as deputy coroner. My mind goes in two different directions.

Hang in there Camille....we are here. Reading, listening.
Yell, shout, rant all you want.
Hugs to a nurse friend,
Jan

for_the_lonely said...

I agree with Jan...
I think that as a nurse you are entitled to cry for your patients..for their triumphs and catastrophies. Life is a constant roller coaster, but God gives us nurses, His angels, to make it through the pain. You are one of the most compassionate people that I know, Camille. Thank you for just being you.

Love you,
Sarah

maceydoo said...

Camille,

I have no answers for you and will not pretend too.
You have a very intense job and I don't know if I could do it.
How do you seperate yourself and let go of these little ones when you leave?
I am glad that sweet pea is stable!
Take care,
Lisa

Traci said...

Oh Camille, all I know to say is this: If one of my children were in ICU, I'd want a nurse just like you to be there with them...and me. I've been blessed to know so many wonderful doctors, nurses etc with a heart such as yours. They have made my work life and my after work life a better place. I feel so blessed to know you. Keep writing and talking about it all sweet friend. I will listen. Peace.

Under A Blackened Sky said...

Oh my dear girl, you post something like that and have me soaked in tears myself. Cry if you need to, blog if you need to. It's difficult not to take part of your work home with you, especially when things are so touch and go, so intense. I don't know how you deal with the babies, I just can't do it, it's hard enough to deal with the adults, but you have followed your heart and that is all that you can do. It's the path you have chosen. There is a reason for everything, a lesson in everything be it yours to learn or teach. Dealing with death and dying is a difficult thing to do, no matter how long you've been doing it. What you must know is that when these parents are lost on so many levels, there you are to give them the support they need. Your smile alone probably makes them smile. Take comfort in knowing that these kids do not die unloved, because I know that you love every single one of them. I do not know you well, but I know that you have a very compassionate heart, a heart as big as the sun, and something tells me that it shines just as bright.