You had two simple requests of me, a drink of water, and to go home. I had started out my shift on high note, caring for my two favorite cardiac patients, working with some of my favorite co-workers. It was going to be a good night, I told myself. Then you came.
The charge nurse had approached me a few hours into the shift. "I'm switching your assignment" she said, "there's a really sick one down in ER, probably septic." I was disappointed to pass along my dear patients to someone who didn't know them like I did. I was nervous about taking a very critical septic patient. After all, while not quite a new grad, I had only been on my own just less than a year. I had doubts in my ability to care for you, to give you all you needed from me. I had barely handed off my patients when you came.
You were so pale I was taken aback when the ER nurses wheeled you into the room. I had never seen lips with no color, like yours. You were so small, so frail looking. We put you in that great big bed. I went through the motions of attaching to you to all of the things that scared you in this unfamiliar environment, obtaining a set of vitals, assuring you it would be okay. If I was scared when I first saw you, your vital signs only caused me more worry. My mind raced...how much dopamine is this kid on...is that really his pressure? I could barely feel your pulses! The physicians faces mirrored my own. Then your parents came.
The physicians spoke with your family, "it would be best to intubate, place central access lines, your boy is very, very sick, and we don't yet know why." I watched your great big Daddy collapse into tears, holding your Mommy to support her as much as himself. Your Mommy and Daddy came to you in the great big bed, wiped your tears, and told you you were going to get medicine to help you go to sleep. That it would be okay. That they loved you so much, you, their brave, strong boy. I provided all the emotional support I could to your parents, directed them to the waiting room, promised to come get them as soon as I could. Then your parents left.
The intubation went well, central venous and arterial access was obtained in lightning speed. How impressed we were with this new attending physician! Fluids running, epinephrine drip started, "maybe back down a little on the dopamine soon, we'll see" says the attending. Your color looked a little better, blood pressure was up, your pulses somewhat better to palpate, my anxiety lessened some. The attending left. Your parents came back.
I explained to your Mommy and Daddy how we gave you very strong medicine before we placed the breathing tube, how you were still under the effects of these drugs. I explained briefly all of the machines, what each one monitored. Most importantly, I encouraged them to touch you, speak to you, reassure you, and not to be afraid to come close. Yes, I told them, you are still very, very sick, but for the time being you were stable. Mommy held your hand, Daddy stroked those beautiful blond curls and told you it was okay, that you would be fine. I thought you would be, too, given time and antibiotics. Then the resident physician left.
It happened in a flash, your blood pressure dropped to 60/30. For just a split second, I thought to myself, oh, Dad must have knocked the artline transducer off of the bed. Yes, he did, I found, but as I replaced it with one hand I attempted to check your pulses with the other. None. No peripheral, no femoral, pressures now 50s/30s, monitor showing sinus rhythm in the 150s. Oh my God, it's PEA. I called the code, your parents were ushered to the side. I have never given so many doses of resuscitation meds in any code since. Every freeable staff member was at your side, doing compressions, bagging, relieving each other as we tried and tried to bring you back. But you were gone.
You broke the hearts of dozens of PICU nurses, respiratory therapists and physicians the night you died. We didn't even get to know you. You broke the hearts of all who loved and cherished you, for they knew you well. It was so hard to console your parents and family with tears running down our cheeks. I helped your Mommy and Daddy bathe you one last time, and put on your favorite PJs. They held you for an eternity before they finally let you go. I know I went through all of the required motions after Mommy and Daddy left, but now that part seems so blurry. You spent less than two hours with me, but you will never, ever, leave my heart.
