In Remembrance Part 1

(WARNING: it's a little graphic)

During my time at NYU I had the privilege of taking care of patient "King" (not the real name). King was a teenager, about to graduate high school who'd been diagnosed a few years earlier with cancer. He bounced in and out of the PICU several times while I was working there and I often was his nurse. I don't think he was excited about me being his nurse, but I had built up a relationship with his mom and really admired this amazing woman so I always enjoyed being his nurse so I could spend time with her. Sometimes we forget that in pediatrics the family are the patients too, and this woman was taking on so much during such a trying time in her life. She was so positive, the kind of positive where I knew she had a hope in something bigger and through our time together we shared our journey of faith and how it gets us through the day to day, good and bad.

In April, King got really sick and was again admitted to the PICU. We all had a bad feeling and could see the slow, steady decline of his weak body. Day after day we transfused platelets and tried to prevent infection. We started TPN and lipids when he could no longer eat or drink. We initiated oxygen support when he struggled to breathe. We debated about putting in a chest tube, (it was quite a heated debate as I felt that it wasn't in the patient's best interest---they wanted to do it at the cramped/dirty bedside instead of the clean OR for this immunocompromised pt, AND this was 3 days after his respiratory distress and we had weaned him from Bipap back to nasal cannula)---thanks, that was my medical rant. We got him better, we celebrated his birthday and even had cake & pizza (which he didn't eat). I tried so hard to be the best nurse I could to him and his mom, at that point in time not knowing I'd be his last nurse to care for him.

I think I was gone for 2 or 3 days and when I came back to work he was dramatically worse. I talked with mom extensively, sharing my opinion of what our options are and talking about what is in his best interest. She was realistic, but still hopeful. My first shift with him was ok, my second was awful. We had a family meeting and in my opinion the medical team painted intubating him as a "rosy picture that would help" while I knew how traumatic it'd be and that it's not what he'd want. King was maxed out on Bipap settings and a Dilauded gtt for comfort. It was heartbreaking. Family came, we were all somber. He'd cheated death before, but would he do it again?

I came in for my 3rd shift, got report, sadly but realistically supported the DNR/DNI plan of care, noted mom sleeping in the corner, went to do my assessment and as I started to tell King that I was his nurse for the day his heart rate dropped from the 80's to the 60's to the 40's and I woke mom up and said these dreaded words, "Mom, I think this is the end".

She immediately was by his side, whispering her love, grasping at his hand. The PICU team arrived and we all watched, waiting, for that last breath and the official calling of King's time of death. I don't know if you've ever experienced this with a loved one, or as a medical professional but it's just odd. To think that one minute you're here, and the next you are gone. My confidence in times like this is that I do believe in an after life, I believe in heaven and hell, and after getting to know King and his mom I believe that I will see him in heaven one day with a healthy body!

Mom alerted the family, the nurses whispered what happened to one another throughout the unit, the room was quiet, peaceful, and then so cold. I sat with mom, we held hands, we cried, and then I prayed with and for her. As I write these memories even now my eyes are flooded with tears, being joyful that his pain is over and sad for the loss of such a great young man. Praying with her was so significant to me at the time because I'd spent over a year living in NY and CA, places were any religion except Christianity is tolerable and having to hold back offering "Can I pray with you?".

After all the family arrived and spent time with King and mom, I escorted them to the elevators, and as the doors closed I was allowed to grieve. He was MY kid. I loved him. I loved his family. I felt his loss too. As I collapsed in the hallway from emotion and heartache a kind nursing assistant got me a chair and cup of water. After composing myself I went back to the room because my job was not yet finished. I was still in charge of taking care of him, his body. Meticulously and carefully I removed tape, dressings, monitoring equipment knowing how fragile his skin was. We bathed him, then wrapped him in a plastic tarp (yes NYU, I'm still mad that you did not have the decency to supply us with adult zip up body bag. I hated every minute of rolling him over and over to tape the too small bag closed.) As if preparing his body for the morgue wasn't traumatizing enough I also had to take his body there myself, pushing him through the hallways, and place him on a giant "cookie sheet" to be picked up. This was just TOO much for me to handle. I'd never had to do that at any other hospital. In my previous experiences there was someone who staffed the morgue who would come pick up your patient and deal with that aspect. After returning to the unit my manager suggested I take a walk to clear my head and get my emotions under control. When I came back we had a small debriefing moment with coffee and stale bagels, they wanted me to stay and pick up another kid but I couldn't. How do you ask someone who'd just had their patient die pretend that nothing happened and be bright eyed and bushy tailed and excited to be someone else's nurse for 4 hours?

On my way out of the hospital I'm face with the question of what to do. I went on a walk. I showered and changed clothes. Am I allowed to lay on my couch and cry? Should I just act like nothing happened and call a friend for dinner? I ended up at Niobe Nails. It was a mindless activity that killed the time and forced me to make the only decision of "what color?" and "10 minute extra massage?". As sweet little Jun rubbed my hands and pulled my fingers, cracking my joints and tsking at my built up cuticle I knew today was for the best. Life goes on. King was happy and healthy in our Father's arms. His mom while heartbroken has the peace from that same Father who is holding him. And I had the privilege to be their nurse, to witness his final breaths, and one day see him again.