Christmas Miracles in the Emergency Room!

spotangel, DNP, RN, NP

Everyone watches the schedule like a hawk to see who gets the holiday off especially Christmas! We had to work every alternate year. Sometimes some interactions made us pause and reminded us of the true meaning of Christmas once we stripped away the hype and jazz.

December 24, 2004- O' Holy Night!

The moaning was quiet but intense. I stopped in my tracks my ears perking up. Was it from room 12 that I was covering for RN Ruth's lunch hour? I went into the two-bedded room. An elderly lady was on the first stretcher.

"Thank God! Nurse! Can you help that child! She has been screaming for the longest and no one's come in to check her!"

"Thank you ma'am!", I acknowledged as I hurried past her to the next stretcher behind the curtain.

A young woman was writhing in pain, her legs thrashing around, sweat beading her forehead. She was wearing jeans and an oversized sweater.

" Hi, I am Annie, a Registered Nurse. What is your name miss?"

"Samantha White. call me Sam!"

"When is your birthday Sam?"

"April 10, 1987", she gasped out.

17 years old, I calculated. This was the abdominal pain x 2 days that Ruth had told me about. She had not been evaluated yet.

"What's going on? I can see you are in pain"

"I have pain. It's getting worse. I feel constipated but nothing is coming out."

"What kind of pain is it?"

"It comes and goes. I am passing gas but cannot poop!"

The pain looked out of proportion to what she was telling me.

I helped her change into a gown. Her abdomen looked big.

I took her vitals and threw in a line in her, collected labs and started a saline drip. I had to stop in between as she was in pain.

A growing suspicion in my head, I casually made conversation as I hooked her up to the saline. Her mom was in Florida, her brother was at work. No one else at home. She had irregular periods and was occasionally sexually active. There was a pediatric resuscitation room next door with a single stretcher and I moved her over. I had done a quick abdominal exam and was pretty sure I knew what was going on. I excused myself and went to my buddy Dr. Richard Nordin.

"Rich, come with me! You are going to love this!"

As we walked to the room, I discussed my findings and what I thought was going on.

"You probably right Annie", he said walking into the room with me. I introduced him and he did a quick abdominal examination nodding at me.

I set her up for a pelvic exam and assisted him. We then pulled chairs and sat near her. Sam was holding my hand tightly. Rich gently broke the news to her.

"Sam we know why you are in so much pain!"

"Why?" Sam gasped as another pain hit her.

"Sam! You are pregnant. Nurse Annie felt the baby when she checked your abdomen. I confirmed it when I checked you lady partslly."

Sam started shaking, crying uncontrollably clutching my hands.

"Sam you are having labor pains. It comes and goes and it's going to come more frequently. You may have your baby today!", I gently told her.

"Don't eat or drink anything from now. You have IV fluids going and that will hydrate you."

"Annie, I will call OB-Gyn and NICU to come to the ER. Can you set up?", Rich asked me as he walked out.

I got the L&D pack and baby resuscitation pack ready, checked suction, and turned on the baby warmer. I stayed with her, reassuring her and timing her contractions. This was her first baby and she was progressing real fast. I thanked God for my experience delivering babies in the back of ambulances and in tents in Saudi Arabia as a Public Health Nurse.I was ready and able if this baby decided to show its head now!

"Sam who can I call to come to the hospital?" After all, she was a minor and it would be good to have family there.

She gave me her brother Alex's number. Alex was 24 years old and working. As I called his number from the wall phone in the room, the OB team and the NICU team arrived and took over. Sam's contractions were five minutes apart and she was screaming with pain and fear.

"Hi, Alex! This is Nurse Annie from Providence Hospital Emergency Room. Sam is here and we are taking care of her."

"Is that my sister screaming in the background? What are you guys doing to her?"

"We are not hurting her Alex. We are helping her. She is in a lot of pain. Can you come?"

"I am on my way!"

I gave him the hospital address and asked him to ask for me when he came to the ER. He must have gone through every light and was there in 15 minutes. I escorted him to our family room and Rich met us there. We told him what was happening and he was in shock.

As we walked him to the resuscitation room we heard a wail of a crying baby from the room.

"Congrats! Looks like you have become an uncle! ", I softly told him as tears sprang in both our eyes.

When they opened the door, I got a glimpse of a beautiful child wrapped up in hospital blankets. The NICU team whisked her upstairs and the OB Team took Sam to L&D with a shellshocked Uncle Alex following. I heard that Sam had a girl child.

I clocked out at 11.30 pm and left after high-fiving Rich! As I drove home on the empty highway on that peaceful night, I thought of another birth 2000 years ago in a stable, of a young girl much like Sam who didn't have an extended family to support her during her delivery! I am sure she would have loved to have a nurse with her for support and guidance!

As I drove home, I hummed along with my favorite radio station. As I pulled into my driveway Mariah Carey was singing "Oh! Holy night! the stars are brightly shining! It is the night of our dear savior's birth!"

I felt happy that I assisted in Sam's Christmas Miracle. I checked in on mother and baby the next day (yup, I worked Christmas day too) during my break time. Got her a huge pink giraffe balloon and some onesies from the gift shop. Her mom was flying in from Florida that evening, she told me. She had named her beautiful girl Christina meaning follower of Christ! Assisting Sam in her time of need and seeing beautiful Christina: that was my Christmas Gift that year from my savior Jesus Christ!

December 24, 2006- To Receive

The ER was dead and we were bored. There were 17 of us and 3 patients! Each ER bay was stocked, dinner trays were served and we were itching to do something. Christmas Carols were playing on the secretary's computer and we were chatting with each other about the ethnic dishes we had made for our staff Christmas dinner celebration. We laughed and shook our heads over some of our coworkers who always managed to get Christmas off somehow! We were stuck here but it was a good team and we were going to make the best of it!

The call came in from triage. A mom with three children under the age of 10 had arrived. The little one John was three, had fever, was screaming, and might have an ear infection as per triage. They came into the ER, the three-year-old's frightened screams preceding them. As charge nurse, I put them in the pediatric resuscitation room with its wallpapers lined with Winnie the POOH, Eeyore, and piglet! The ceiling had Disney characters stuck on them! I figured it would ease the anxiety somewhat!

Seemed like a straightforward case of ear infection. I assigned Dr. Taylor and RN Ruth to the case. They saw the patient. Both ears were red and irritated and he was to get Ceftriaxone IM. That was a battle in itself leaving two nurses exhausted as the little tyke John was very strong! His cries were sharp and pierced right through your eardrums! Thankfully between the crying, Motrin, and the ceftriaxone, he fell asleep and we had a bit of heavenly peace!

When Ruth went to discharge the child, the mother told her that she had no place to go. They lived in a shelter that closed at 9 pm. Since it was Christmas Eve, we would have to wait till Christmas day for the ER social worker to come in and make arrangements with the shelter to take them back. Since they would stay the night in the ER, we wanted to make it special for them.

We quickly huddled and came up with a plan. We were like busy elves. At almost 11 o'clock, I went to their room and knocked. Hiding a Christmassy bell behind my back, I shook it and opened the door. The older two kids, Bert and Jina who were 9 and 7, were still up reading books we had given them.

"Excuse me did you hear bells? Someone told me that Santa was in town and has come visiting our hospital!"

Staying outside the room, I rang the bell again (courtesy of one of the nurses who wore it around her neck and let me borrow it!).

"I heard it!" they both jumped up.

"Can you help me find Santa? May I?", I asked Helen (mom).

She smiled in agreement, her eyes lighting up in spite of her tired smile.

My friend Ruth, rang a bell hidden behind a curtain as I walked them two rooms down as the rest of the ER staff pretended to be busy.

I paused by the door and whispered, "Be real quiet now. Don't spook Santa!"

The kids nodded, their eyes wide.

I slowly opened the door and they gasped.

The light was off but the room was lit up with Christmas lights (security found some in their back office), Balloons (blue and yellow gloves), a small Christmas tree that we had in the ED, and presents that we got from the 24-hour supermarket (Barbie dolls, cars, water pistols, bubble blowers, lots of junk food (chocolates, candy), puzzle books, storybooks all wrapped up neatly with bows and name stickers(from our label maker). We also had some stuff for Helen. On one side of the room, we had decorated the stretcher and put out a spread for them Burger king meals with the crowns and plates of ethnic food we had prepared and brought from home to share. Everyone had pitched in to contribute.

We brought Helen over with the sleeping tyke John. Her eyes filled up with tears as the staff quietly wished her Merry Christmas as no one wanted John to wake up and pierce the walls with his screams! We took pictures and the kids had a blast! While they were there, we got sleeper lounge chairs, pillows, and warm blankets ready in the resuscitation room for them to go back to sleep. I left as my shift got over and said goodbye to mom. She was very appreciative. I went home with a good feeling knowing that it was always better to give than to receive! It was a Christmas we never forgot as we worked as a team and shared whatever we had to brighten up a family's Christmas! There was room in this inn that we called Providence Hospital ER that Christmas Eve for Helen and her family!

December 24, 2008-To Give!

She knew she was going to die. She had walked into the ER with her son with weakness and fatigue. She was septic and her pulse was very high and her blood pressure was dropping. I was her nurse and her eyes clung to mine with questions. When her son went to grab a cup of coffee, she asked me about her chances to survive. I gently told her the normal course of overwhelming sepsis and what our measures would be including intubation and CPR if she crashed. She wanted to discuss this with her son present. I got Richard the attending doc and together we discussed it with her and her son James. She stated that if at any point we felt that she may not survive to switch her active code status to a DNR.

I took James aside and talked to him. I asked him if he had any other family. He said he was the sole caretaker of this 87-year-old mother. His dad had died many years ago. He had a sister, who he had not talked to or seen for 20 years. She lived in the same city but they had a fight and stopped talking. I told him gently that it would be a good idea to call her as his mom was very sick. It would only be a matter of time before her systems collapsed due to the overwhelming infection in her blood. He was bewildered and said, "But she walked in! She can't be that sick". I told him that UTI and sepsis signs in the elderly were very subtle and that she might take a rapid turn for the worse very suddenly. I encouraged him to call his sister Ella.

"After all, wouldn't you want to know if your mom was very sick and you were not with her?" I asked. He readily agreed to that and dialed her number (I got it from the patient) as I held my breath. They talked and Ella asked to speak to me. She told me that she was an RN and so I was able to give her an update on her mom's clinical status. She had just picked up her husband from another hospital after discharge and promised to be there in half an hour. "Try and keep her alive for me, Annie" she begged. I stayed by Mary's bedside but she was rapidly going downhill. I looked at her and marveled at how her dying was bringing her two children together one last time. I now had her on multi drips. She crashed. We intubated her.

Five minutes later her daughter rushed through the ED doors. I took her and her brother to our tiny family room where they talked for the first time in 20 years and hugged each other. Tears and laughter rang as they reconnected. Later Ella came to me and told me that her sick husband was sitting in the car and she had to take him home. She gave me her number and left. James came to me and told me that he could not watch his mother die. By now she was made a DNR after they talked to the doctor. He gave me his number and left.

Another nurse relieved me for a break but I stayed at the nurse's station drinking my coffee and writing my notes playing catch up. A few minutes later I heard a voice in my ear, "It is time". Probably my guardian angel Providence, I thought to myself. I quietly got up and went to her cubicle. I sat down near her and held her hand. I spoke to her softly, "Mary, you did it. You got them back together one last time. Now it is up to them. Go in peace." As I recited the Lord's Prayer, she flatlined and was gone peacefully. I sat at the nurse's station and made the calls to her children.

Mary had gone leaving her final gift behind; the gift of peace to her two children. I walked out of the ER at 12 midnight on Christmas day marveling at a mother's final act of love where she used her death to bring her children together. Merry Christmas and God bless us all!

How privileged we are to be part of our patients' lives in times of birth, pain, celebrations, and death! I love being a nurse and hope to give that spark to others. We are in a position to make a difference but we need to make sure that we take care of ourselves and coworkers and strengthen each other in time of need. This will fill our cups and we will be able to provide the care others need especially in these trying times.

So this Christmas season look around and fill the cup of a coworker with laughter, love, acceptance, and care in your own unique way! Isn't that what Christmas is really about? A loving God who walked amongst us and experienced pain and sorrow, healed, filled us with joy, and finally died for us!

Greater love has no one than this: to lay down one's life for one's friends. - John 15:13

Resources

Reproductive Health: Teen Pregnancy

BUILDING A MOVEMENT TO END HOMELESSNESS

End of Life

What Is Self-Care and Why Is It So Important for Your Health?