I could NEVER do PICU!!

by NotReady4PrimeTime, RN Senior Moderator | 7,296 Views | 20 Comments

This blog post serves as an explanation of why my career as a PICU nurse isn't something to simply survive, but an opportunity to serve the needs of a very special population of patients with love and humour.

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    I've lost count of the times I've heard that exclamation from another nurse. I've also forgotten how many times I've heard, "I just don't know how you do it," not only from other nurses but from friends, casual acquaintances and family. But I don't know how I could do anything else.

    My first exposure to the nursing specialty that has become my passion began with the PICU admission of my youngest child following a liver transplant. I'd kicked the idea of going to nursing school around in my head every so often over the years and always let the notion go... until I spent seven weeks at my son's bedside in PICU. Even when it seemed our world was collapsing and that life would never be the same, a part of me was watching, listening and absorbing the work the nurses around me were doing. When my son recovered and left the PICU for the last time, I knew this time I would not be letting the notion go again.

    It took me five years from that time to get my ducks in a row. The day I graduated though I despaired of even finding work since it was right in the middle of the nursing lay-offs of the mid 90's and no one was hiring anyone. Not being one to wait for doors to open for me, I kicked a few down and by the fall of 1997 I was starting orientation in a small general PICU. My last day of orientation I seriously questioned if I had made a mistake when I accidentally decannulated a trached baby - who then had a bradycardic arrest... (thank God and Dr H. that she survived unscathed) then took the lessons learned and moved on. These days I work in a quaternary care PICU where we provide extracorporeal life support, highly complex cardiovascular surgery, pediatric ventricular assist device implantation and care, trauma care, solid organ transplants and every other sort of pediatric critical care available.

    I have seen incredible miracles in PICU. One of my patients was the youngest child in the world to receive a heart transplant. Identified in utero with a fatal heart defect he was listed for transplant the same day. When a heart became available he was delivered by caesarean section and whisked to a second OR where his transplant took place at the tender age of four hours. His capped a very busy year for us which saw our hospital perform seventeen successful pediatric heart transplants and the implantation of our first two Berlin Heart VADs. All but one of those children are alive and well.

    Another miracle was the little boy who, following a Stage 3 Norwood procedure for hypoplastic left heart syndrome, suffered a prolonged cardiac arrest leading to emergent initiation of extracorporeal life support. He was not expected to recover even with ECLS, and then he appeared to suffer a cerebral bleed we all felt would severely limit his recovery in any event. His family was bereft, but kept putting one foot in front of the other and praying for a miracle. Their prayers were answered with a heart transplant (ironically on the anniversary of my son's liver transplant 19 years before) and slow but steady improvement. He went home two months later and is back to his previous level of function.

    Then there was the young lady whose neck was broken in a rollover at highway speed when her aunt tried to swat a bee that was flying around her head. This girl had limited movement below her clavicles and while she was in spinal shock she also suffered a left hemisphere bleed. Amazingly, she recovered her cognitive functions completely and after two years of rehabilitation is back home with her mom and her sisters. I saw her one day when I took my son to an appointment at the rehabilitation center. She was laughing gleefully, whizzing around in a motorized wheelchair while her mother tried valiantly to catch up with her.

    I've also seen my share of tragedy. A beautiful little girl came in with respiratory failure brought on by juvenile myelomonocytic leukemia, a disease with a dismal prognosis to start with. We gave her every possible treatment and for a while it looked like we might actually get her well enough for a bone marrow transplant which might save her life. Another nurse and I had a lovely experience giving her a tub bath one night, something that almost never happens in PICU. But this little girl looked so happy sitting in the little tub balanced so precariously on her bed that I took some pictures of her to share with her mom. Weeks later, she developed an overwhelming sepsis and died the day before her fifth birthday. My photos were made a part of the slideshow at her memorial service.

    Around the same time, we had a toddler who came to us from a remote community in the far north. She had adenovirus pneumonia and respiratory failure. She went on ECLS in an effort to keep her alive while her lungs recovered. They didn't. After eight weeks on ECLS, she had life-sustaining therapy withdrawn and she died in her parents' arms. They had suffered another horrible loss just days before this baby girl became ill; their older daughter had been abducted, sexually assaulted and murdered. We were all willing to take whatever steps necessary to keep this girl alive for her parents, but in the end nothing we could do would have saved her.

    The trauma victims we get are always emotionally difficult to care for. Their injuries are always preventable and the waste of potential is overwhelmingly sad. The parent of one such patient has made it her life's work to push for legislation requiring a driver's license to operate all-terrain vehicles. Her daughter had grown up around ATVs and was taught safe practices from early childhood. She had a helmet, elbow and knee pads and a leather jacket to wear when she rode; she was also not to ride unless supervised. She and a friend had been riding double on one, something her daughter had been prohibited from doing, on a rural back road, unbeknownst to anyone. They came around a curve and collided head-on with a pickup. The other girl, who wasn't wearing a helmet, died on impact. My patient's helmet was cracked in half; she suffered a serious head injury and a more minor spinal cord injury. She has recovered for the most part but still has some cognitive impairments.

    The experience that has had the biggest influence on me however is one that makes most people question my choice of career even more strongly. Several years ago I assisted with an admission of a very sick neonate from the OR following cardiac surgery. I was also there the next day when he arrested and was emergently cannulated for ECLS. I offered to be a primary nurse for him when he came off ECLS and spent many days and nights with him. I was amazed at his stamina, and also deeply saddened by how we continued to treat him long past the point of any positive outcome. The day he perforated his bowel I came on for a night shift to learn that they had just extubated him, but he was still breathing. His parents, who had never bonded with him and were unable to remain with him at that time had already left the unit. I spent the next forty minutes rocking this beautiful little man, singing off-key and holding him close. I think I held on to him at least ten minutes after he had gone with the angels, but this was the first time anyone had ever held him and I didn't want to put him down. Later I carried him, in his yellow sleeper, green sweater and booties and wrapped in a white blanket, to the morgue. If I had ever had any doubt that I was doing what God had made me to do they evaporated that night.

    So my response to people when they tell me they could never do PICU is that we're all meant for something, and PICU is it for me. I was attracted by the technical stuff and the pace, but I stay for the opportunity to give families and sick children that which was so generously given to us years ago. If I can give even one mother a decent night's sleep for once in a long ordeal, or help one dad to look past the gadgetry and see his baby, or find a way to let one sibling spend some quality time with a dearly-loved brother or sister who will surely die, I'll never be able to walk away.
    Last edit by NotReady4PrimeTime on May 11, '14 : Reason: typos
  2. About NotReady4PrimeTime, RN

    janfrn has 19 years of pediatric nursing experience, with 17 of those years in critical care.

    NotReady4PrimeTime has 'more than a few' year(s) of experience and specializes in 'NICU, PICU and peds oncology'. From 'waiting on the wonderful'; Joined Jun '01; Posts: 9,182; Likes: 6,880.

    Read more articles from NotReady4PrimeTime

    20 Comments so far...

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    What beautiful writing! Yes, you do belong in the PICU. I had also worked in the PICU and loved each and every moment and each little one. I always called my patients my "little angels". I miss working so closely with them and their parents, but at the same time I love working in the cath lab.
    Thank you for expressing so eloquently what I felt while working in PICU.
    NotReady4PrimeTime likes this.
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    When people say they could never do PICU, what they actually mean is that it takes a very special person to do PICU. It just so happens that you are a very special person.
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    Jan, that was beautiful.

    I can't imagine dealing with that sort of heartbreak every day. You truly are a special nurse, and a special person, to be able to do this work. God bless you!
    NotReady4PrimeTime likes this.
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    There are so many more things I wish I would have added, but it would have been so long no one would want to read it! For example, I never for a moment feared walking into the unit and seeing someone I knew there... until it happened. Two days after Christmas 2001 I went to work to find a little boy named Brian who rode the short bus with my son. This little boy had a profound birth injury and was a non-verbal spastic quad. But he recognized my voice every single day and smiled hugely at me as he drooled all over my hand when I chucked him under the chin. He was always immaculately cared for and so happy. On that December 26th he had a sudden cardiac arrest (we later found was from aspiration) at home; his foster parents, who loved him as their own, did not know CPR so he was in asystole for at least 6 minutes before EMS arrived. They achieved ROSC but his brain was so much more damaged that he was unresponsive. After several days, both his families decided on withdrawal and they all came to his bedside. We extubated and he breathed. The family had been expecting the TV version of WLST and when the monitor didn't immedicately flatline they were bewildered. I had the unfortunate task of explaning to them that he could continue to breathe for hours, days or even months. He did; he finally passed away in late October. Since then I've cared for the child of one of my daughter's friends and the grandson of an old friend of mine who I'd lost contact with. It hurts to be in that spot, but it's worth it.
    DeLanaHarvickWannabe likes this.
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    What a beautiful article! Very well written, and totally took me to PICU with you!! Yes, I had tears in my eyes. WELL DONE, and thank you for sharing your story!
    NotReady4PrimeTime likes this.
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    I Can't Imagine Myself Not Doing Picu!!!
    THANK YOU SO MUCH, YOU MADE ME CRY!- I WILL NEVER FORGET THE MIRRICLES DURING MY PICU / NICU work!
    NotReady4PrimeTime likes this.
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    I know just how you feel. I get the same comments as a NICU nurse. I just can't imagine doing anything else. What a wonderful write-up. Must go wipe tears....:angel2:
    NotReady4PrimeTime likes this.
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    jan,

    I am a former PICU nurse who heard this question over and over again. I can all too well understand you and your motivations. Unfortunately, my old joints won't let me continue on. Please know that for everyone out there who questions your choice, there are those who know why you do it and love you for it.
    NotReady4PrimeTime likes this.
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    Dear Fellow Traveller in the PICU world:

    Having always known I would do nothing beside pediatric nursing since I graduated in 1994, I can attest to your passion and your experiences. I also endured that time when nursing jobs were hard to come by. Who would have believed it?!

    I take such comfort in knowing there are others like us in the PICU world who are having the same miracles and the same heartaches every single day. Knowing we are not alone makes the grief more tolerable and the victories sweeter because there are people who really understand. I have been married to the same wonderful man for 13 years and while he emphathizes with me when I have a "bad day", he knows he doesn't really understand. When I tell him I haven't urinated for 14 hours or eaten since 0530 (and it is 2100 when I drag through the door), he will shake his head and say, "How can you not pee for 14 hours? I mean, how long does it take?" But he will have my side of the bed turned down with a Diet Coke awaiting me and our children all scrubbed and fed and tucked in tight, ready for Mom to kiss goodnight. So what he lacks in understanding, he makes up for in pure sweetness.

    However, it is my fellow soldiers in the war to save the lives of kids (and sometimes the sweet surrender to that enemy death) who feel my pain and smile at the hilarity of life as a PICU nurse.

    Great article!
    Press on dear friends....

    PS- Say a prayer for me- I start working at a new hospital in 4 weeks. Tremendous opportunity and I am excited, but a little nervous. Even old farts like me still get butterflies in a new job.


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