Saturday, March 12, 2011

Hand molds

I didn't know if I even wanted to write this post. I still don't know if I want to write this post. But what I do know is that I'm getting teary eyed at things that would never make me cry. Feeling like I'm going to cry when a certain song comes on the radio. Or becomming more sensitive to things that would never bother me before.

Those of you that know me, know I'm not a cry-er. And you know that I generally have pretty thick skin. I think most PICU nurses do. So what brought about this change this week??

My patient at work has made a huge impact on me. On my view on life, and clearly, on my emotions. This, in combination with being consistenly tired, and stressed, and a bit overworked/overschooled, is the reason for this change.

div>My patient was a beautiful, healthy 3 year old little girl who had been vomiting a few times over the past week. But, after she threw up, she looked fine and went back to playing, like so many toddlers do.

But on Thursday morning, her mom went in to check on her and she was unresponsive. After calling 911, she was rushed to the nearest hospital. They put in a breathing tube, and rushed her to get a head CT.

The resuls were bad. Really bad. Like ginormous tumor in both ventricles of her brain, causing her brain to go through the hole in your skull (foramen magnum) bad.

So what does this hospital do?? They tell the parents that there's a little water on the brain and that they would be sending her to our PICU for further care (WHAT?? A little water on the brain!?!?). It was so downplayed that the father even told our transport team as they were getting into the helicopter that he was going home to take a shower, and grab some things for the night.

Um, no sir, you must come to the hospital NOW!! Follow this helicopter!!

So the patient rolled into the PICU room, and no sooner than I could even get her on my monitors, the neurosurgeon did a super quick exam and said "She's brain dead, there's nothing more we can do."

Just like that! There's nothing more we can do. We can keep the breathing tube in place until her parents get there to keep her alive. But there's nothing more we can do.

What do you even do with this information?? Myself, the nurse helping me, the nurse charting, and 2 PICU docs all just stared at her in disbelief. Here was this beautiful little girl who had a raging tumor in her brain that nobody knew about until it was too late.

Until there was nothing that we could do.

I must say, listening to the doctor give the family this information when they walked in (after telling them, "We need you to sit down. We have some very bad news") was probably one of the hardest conversations I have ever been a part of.

I have been in countless meetings where we've delivered this same information. But never in such an unexpected, quick, life changing way. We told the family about the tumor, about her brain herniating, and about her brain death. We then told them that when the brain is dead, the body is as well.

This is a concept that is so difficult for families to handle. They see that the heart may still be beating on its own. But when the brain is dead, the body follows shortly. When the brain is dead, what is keeping the rest of the body alive is machines. We then told them we would have to do 2 brain death tests 12 hours apart (state regulations) and would have a family care conference the next day to discuss the results, and talk about options.

This family went from having family dinner and movie night the night before, to trying to decide if they want a Catholic or Lutheran memorial service. If they want their little angel to be an organ donor. If they wanted her cremated or burried.

And I was left to create her hand molds. These are one of the momentos that we can give families as a reminder of their little loved ones. A heart shaped plaster of the precious little hands that once held her dolly, once played with play-dough, once brushed her cute, curly hair. Now just a small imprint of what once was.

In a way, making these hand molds is very therapeutic for me. A way to help bring closure, whether I was the patient's nurse for one day or one year. A way to provide a "task" when the patient is at end of life. PICU nurses are not great when there are not "things to do." It's the quiet moments that are hard. The hospice moments that become very difficult.

In a way, these moments become difficult, because it's almost like admitting we didn't do our job right. And while this is definitely not the case in many, if not all patients, it still can feel like we failed.

So the hand molds are our way of showing that we still can do "something." We can still be providers, nurturers, protectors. Because that's what we are as PICU nurses.

And when the hand molds are completed, the family will have a momento of their loved one. Only this week, I am realizing more and more, that what's a hand mold to the family, when they really want the full-of-life hand to hold?? And the "therapeutic" effects that normally take hold of us PICU nurses, help us cope with the situation, did not fully "therapize" me.

Instead, I am left becoming tearful at things that usually do not make me so. I become apprehensive when I think about having my own children. Who's to say that the same thing would happen to my beautiful little princess?

But I guess that's what life is all about. That's what PICU is all about. Our greatest successes feel so great, because we have experienced life's biggest downfalls. The greatest miracle in the PICU is even more miraculous, because of the one's that we've lost.

So while I was left to mold this little girls hands, she has helped to mold my heart. She has made me so very sad for her family. But she has also made me so very grateful for my own. She has taught me that one day, when I do have kids, not to take a moment for granted, for I do not know if it may be their last.

And finally, she has taught me that sometimes it's ok to not have something "to do." That just, "being" is ok. It's ok for myself as a PICU nurse, myself as a wife, a friend, a daughter, and it's ok for the families that I care for. In fact, it's in these quiet moments, where we just try to "be," and not "do," that our characters, our souls, can truly be molded into what they were created to be. If only we allow these moments in. And while that may mean a few more tears than normal, or a few angry screams, that is the molding taking its shape.