I Could NEVER Do PICU!

NotReady4PrimeTime, RN

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 ever finding work since it was right in the middle of the nursing lay-offs of the mid-'90s 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 cesarean 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 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 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.

I Could NEVER Do PICU!

About NotReady4PrimeTime, RN

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