Tammy: A Ray of Sunlight

Jessiedog, RN

That was as far as the frailty went, though! Alicia had a temper like a tiger and was as feisty as they come. Being hospitalized for most of her life, us nurses at the kids' ward where her extended family. We knew her parents well, and her little brother was happy following us around as we treated other kids; we were his big playmates. Tamara's familiarity with the ward had its drawbacks, too. She was very comfortable in telling us what she would and wouldn't do. Most of the time, trying to treat Tamara was a cross between being stern with her and then leaving the room before you could burst out laughing.

She was the first child we ever nursed who had a port-a-cath (which shows you how long ago it was) and trying to access that port, so we could start her antibiotic therapy, was always interesting. It took at least three of us to hold her still enough so that the pediatrician could get the Huber needle in! We'd do all the preparation, talk to her and explain what was going to happen, and Tamara would nod and laugh and understand. After all, she came in for 'tune-ups' every 6 weeks or so.

Everything would go fine until we walked her into the treatment room and the Emla cream came off. She just hated to be held, and she would scream at the top of her voice, kick us and even spit when she could get back at us no other way! We'd grit our teeth, hold on, and get the procedure done as quickly as we could. We'd walk her back to her room, give her hugs & kisses, set up the video machine and give her a treat or a toy, and she would be all smiles again; the cute little 'butter wouldn't melt' child.

Chest physio was another regular part of Tamara's day and had its own set of challenges. Whenever the physiotherapist came, Tamara would be all smiles and co-operation. She'd breathe in and out, and cough on command. These coughs often turned into nasty bouts lasting several minutes, and the little thing would gag and vomit with the severity. She had a cute habit of calling the sputum she produced a 'frog' ('Cos it was green, I suppose.) She'd pick up the bowl and scrutinize the 'frog' she'd just deposited before declaring whether it was a 'boy' or a 'girl'. I could never see the difference; they all looked the same to me, and all made their way down the pan hopper. But it helped her to cope with her illness, so we encouraged her in it, often prompting her to determine the sex of the green gunk, and cheering her when she did.

Anyway, when it came to the nurses doing chest physio, it was a whole different ball-game. As far as Tamara was concerned, nurses were fair game, and the better she knew you, the more she played up. I recall one session, she was about 6 years old, when I retreated, exhausted, and still no physio had been achieved. I'd set up the bed, placed the pillows, and got Tamara's co-operation. She draped herself upside down over the pillows and had her bowl ready. I was in 'play' mode, laughing and joking, telling stories and tickling her as I tried to make the experience as much fun as possible. All was well until I prepared to start the first lot of percussion. With a wicked sideways glance at me, Tamara was up, off the pillows, and presenting me with her derriere for physio. I laughed, joked, and said: "Okay, you want to lie that way, that's fine." Moving the pillows, I got her ready with her head facing the foot of the bed. I moved into position again and Tamara grinned, and squirmed like lightning, representing her rear end.

Getting the message that she wanted to mess around a little before her session, I got into the mood, laughing "Hey, where's Tamara? I can only find a bum. Where'd she go?" Tamara giggled, looked wickedly at me over her shoulder, and wiggled her bony little bum. We played this several times before I got a little more serious, saying. "Okay, we've had fun, now we really do need to do your physio." That was like a red rag to a bull! She wriggled, squirmed and 'charmed' her way out of laying down for me. I'd cajole, laugh and explain, all to no avail. The session ended half an hour later, with Tamara crouched under the bed, laughing and grinning at me as she dared me to come and get her. I declined the invitation and retired, beaten.

New nurses were a great opportunity for Tamara to try out her act on an unsuspecting newbie. I remember shepherding a student nurse around for a couple of weeks, and I remember her first experience with our never-to-be-forgotten Tammy. There had been some minor fracas, which escalated into a major tantrum. I entered the room to find the student nurse on her hands and knees, retrieving soft toys that had been hurled around the room. I forget what had started it, but Tamara was bombarding the student with every toy she could reach, cursing and shrieking with the full capacity of her diseased lungs. The poor student was in shock, not knowing what to do. She was faithfully picking up the toys, trying to calm Tamara, and replacing them on her bed. This, of course, just gave Tammy more ammunition. I, the 'big mean nurse' came in to find Tamara in full flight. Knowing the futility of trying to talk her down, I encouraged the student to leave immediately, with the toys strewn around the room. "If she put them there, they can stay there!" I declared firmly. Student nurse heaved a sigh of relief and left to try and recover her aplomb in the formula room.

My best and most memorable moment involved our DON (Director Of Nursing, or Matron). The children's ward flanked the front doors of the hospital but was one floor up. In the days before air-conditioning, all of the windows were able to be opened. One day they were open wide inviting in a bright Spring morning. Tammy was having one of her episodes and thoroughly enjoying yelling at the top of her voice. Our DON, coming in for the day, heard the racket, and stormed up the stairs, appalled at the carryings-on. She stalked into the ward demanding "What are you doing to that poor child?" We backed off, waiting to see what would happen. DON walked into Tamara's room, and cooed "Honey, are you alright? What's happening?"

Tammy stopped mid-flight and eyeballed DON. She paused, took a deep breath, and shouted: "Shut up you fat cow!" DON gasped; stunned, as fragile-looking Tamara renewed her tantrum, picking up where she'd left off. Needless to say, our DON retreated quickly, in reverse, deciding that the pediatric nurses were, perhaps, better qualified to deal with our little spitfire.

As her illness progressed, Tamara, never on the large side, began to lose weight drastically. Her digestive problems coupled with the huge amount of calories she burned in her severe, almost constant, coughing attacks wore her little frame down to almost nothing. In an effort to provide extra nutrition to a little girl who had no appetite, we resorted to gastrostomy feeding overnight. We'd mix up the feed, and wait until little Tammy was sound asleep, then sneak in and connect her up. When the feed was completed several hours later, we'd take down the feed, flush her tube and make as nothing had happened.

One night we had an ant invasion. This wasn't uncommon, and we'd usually kill them off and clean the place up. There must have been a small spill of Tamara's feed, though, because there were thousands of ants all over her bedside table. They'd crawled up the IV pole we'd hung the feed on, were covering the outside of the tubing and feed bottle, and one or two had somehow made it inside the sealed bottle and were floating on top! We hastily took down the contaminated feed and managed to avoid feeding her black ants in addition to her Pediasure.

We were very quiet during the proceedings, not wanting to wake Tamara and cause panic and she slumbered peacefully on, unaware of the near disaster. The next morning she woke bright and happy, ready to play and have a good argument with whoever walked in her doorway first. When her mum came in Tamara hugged her hard and sat up proudly. She looked her mum in the eye and stated happily "Mum, I got ants in my tummy!" Who knew? The little blighter must have been faking sleep, watching with glee as we dealt with the ants. There was a little explaining to do over that one, but mum was a great, loving, down-to-earth person, and was not unduly shocked once we reassured her that no ants actually made it down the tube into her child's gastrointestinal tract.

This little girl was only one of the thousands that I have nursed, and one of many terminally ill children that have passed away while under my care. I don't think you ever get used to that. But I will always remember this ray of sunlight, who impacted me to such a degree. She showed unrelenting courage, and her attitude 'never let the buggers get you down' was such an inspiration. Her desire, even during the final stages of her illness, was to enjoy life as much as she could. Her courage, her naughtiness, her feistiness, and her unexpected kindness will never leave me.

Tamara is one of the reasons that I stayed nursing children despite the heartache and difficulties. I came to see that it is every child's right to laugh and smile each day. I understood that painful and uncomfortable treatments can be made a little less threatening if you play and allow your little patient to have some control, some say in what happens to them. I saw that children want to enjoy life, no matter if they have years, or only weeks ahead of them. I learned that nursing can make you laugh and cry at the same time. I experienced many, many many emotions, good and painful, joy and grief, as I became a part of this little girl's life, and even a part of her family.

When asked "How do you cope with nursing children" I can state: "Because I know I am making their life better." Even if helping them involves multiple injections, restraining them for lumbar punctures and blood tests, and strapping down their arms so they can't remove their I.V.'s. All these awful and painful experiences are sometimes a necessary part of treatment, and without them, the child's condition would not improve.

These are the difficult parts of nursing children, but Tamara showed me that a little kindness, a hug, a reassuring touch, and playing a game can make these intrusions almost bearable. All of these painful and frightening treatments do help in the end, and if I can be with a child during the rough times, hold them and reassure them until they are well enough to go back home, then I know that what I do is worth the struggle.

Tamara has been gone nearly 15 years now, and I miss her even now. I can see her mischievous smiling face as she bounces on her bed, and skates up and down the lino hallways while standing on her I.V. pole. I can see her as she plays hide-and-seek in the ward, and the delight on her face when she catches me with a loud "Gotcha!" as I round a corner unawares. Yes, I helped her live a few years longer than she may otherwise have had, but she taught me so much in return.

Thank you, Tamara. You are a part of me, and always will be.

Tammy: A Ray of Sunlight

About Jessiedog, RN

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