Inspiring stories

Pediatric Critical Care Columnist · Feb 3, 2007

Oh my gosh... there are so many, where do I start?

There's the 12 year old girl who came to us with a C5-C6 spinal cord transection who subsequently stroked... who now boots around the rehab facility in her electric wheelchair, cheeky as ever and almost ready to go home again. She has spunk and determination to spare and is a living miracle, given that she nearly died every shift for the first two weeks we had her in the unit.

There's the 15 year old who came in with flu symptoms and ended up needed a ventricular assist device, who was successfully weaned from it and will be going home soon with a nearly healthy heart.

How about the 14 year old who suffered 3rd degree burns over 70 % of her body, including her face and neck, who seriously tried to die for weeks, and was very depressed and suicidal. She's now at home, with only slight scarring to her face and looking forward to a long, busy, worthwhile life.

And how could I forget the one that I live with? My son spent many weeks in PICU as a little guy; he had a liver transplant in January 1989 followed by multiple stokes in March which led to multi-organ dysfunction syndrome and a decision to withdraw active treatment should his renal failure worsen. He went to the brink, then turned around and hasn't looked back. He's soon to be 24 years old and is the happiest, most grounded person I've ever met.

Of course there are the ones we cannot save, and they stay with you for a long time. But when a child you've seen in extremis comes back to the unit to visit, looking like a million bucks and laughing at you, it makes the heart a little lighter. I hope you go into your career in PICU with a healthy respect for the resiliency of children and the power of love and hope to make miracles happen.

googabin02 · Feb 3, 2007

Wow-how amazing...I am really looking forward to it!! I have so much love for kids and I am amazed by how courageous and tough they are!! Keep the stories coming!!:roll

AliRae · Feb 4, 2007

There's the 8 year old near drowning. Came in and we thought his spirit had already flown. Chest tubes, pressors, the whole nine. I was a tech at the time and was washing him up when he woke up. Later that week I took him out into the hall for his first walk, and he walked out of our unit to go home. No rehab, nothing.

There's the son of one of our own nurses. Was in a bad snowboarding accident, head injury and ended up trached following injury from a traumatic intubation. He used to come back to visit us and joke around with us about how funny his "trach voice" was. He just had reconstructive surgery and is doing just fine.

There's the little 9 year old paraplegic who reminded me that, despite our scars, we're still beautiful.

There's inspiration in death, too, sometimes. The mother of 6 kids who decided, after a 13 month struggle, to let her youngest go back to Jesus. He was a former 24-week preemie, and had every problem you could think of. When they found a huge cyst growing in his brain, she and her husband had the strength to take him off the vent and let his disease process take over. He died quietly, tucked into bed with his mom.

There's the ones who are so cheerful and so grateful, despite the fact that it takes us over a week to find the right diagnosis. We have one who's been back to visit 3 times since we discharged her, just to let us know that she's fine and back in school and thankful for all we've done.

And I'm inspired by the people I work with, too. We just had a couple really rough days at my work. It seemed like everyone was sick, and we were all pulled in 100 different directions. I didn't hear a single complaint, as everyone calmly went about doing what needed to be done. I love the teamwork in the PICU!

Welcome to the family, googabin! =)

googabin02 · Feb 4, 2007

Thank You! I have been finding myself getting really really nervous to start. I mean don't get me wrong, I CAN'T WAIT!!! I am so excited and I always think I can't wait to be a great PICU nurse who isn't a new graduate and can think on my feet and know what is going on and someday be able to share the knowledge with another new graduate. I hope the day comes! I'm so excited to start but just really nervous that I'm not going to know enough...:smilecoffeecup:

Pediatric Critical Care Columnist · Feb 4, 2007

I'm so excited to start but just really nervous that I'm not going to know enough...:smilecoffeecup:

How much is "enough"? After nearly 10 years in PICU, I still don't know "enough" about a lot of things, but every day I learn something new and add it to the pile. When you finish your orientation you will know "enough" to care for a stable patient with a single system problem. When you've become comfortable with routine nursing care in PICU, they'll give you more challenging patients and let your knowledge and experience build. Then one day you'll find yourself caring for the sickest patient in the unit and you'll wonder how that happened! You don't have to know everything to give good care. Nobody will ever know everything there is to know, but we all should know "enough" to know when we don't know and are in over our heads... then ask for help. Don't worry so much! Be excited! Learn and grow! Hold on to your enthusiasm! Be happy.

AliRae · Feb 4, 2007

Then one day you'll find yourself caring for the sickest patient in the unit and you'll wonder how that happened!

I remember that day! I was cracking up the whole time thinking "What on earth?!" But the HN had asked me in the morning if I felt comfortable with the assignment, and pointed out that the 2 nurses on either side of me were my 2 former preceptors. I think her words were "I think today's the perfect day for you to jump in the deep end." And she was right!

Take it from a former new grad (who's about to get replaced by a new new one!) ... you'll have a ton to learn, and it'll be scary at times. But if you love PICU, you'll do just fine. I always remember what a friend of mine said when I was complaining about the Everest-scale learning curve ... "Relax. It's just Kilimanjaro."

googabin02 · Feb 4, 2007

Ha! Thank you all for your encouragement....I'm so excited to start and I really can't wait to start learning. I just hope I don't get anxiety and what not!! :roll

Pediatric Critical Care Columnist · Feb 4, 2007

A little anxiety is GOOD! It keeps you sharp. When you let down your guard and relax, thinking that everything's just rosy, that's the day that your patient will decide to do something funky and you'll be in the soup. I say "never turn your back on a PICU patient"! You can put the anxiety to good use by letting it keep you focused on your patients and their needs.

googabin02 · Feb 4, 2007

Thank you. Your positive thoughts really help me. Is there anything that you would really try to review before starting work? I have a 20 week orientation so it should be helpful. I know I have to get my PALS certification but I'm not sure if there is anything else? :clown:

Pediatric Critical Care Columnist · Feb 5, 2007

Wow! 20 weeks' orientation will be great! In our unit a new grad gets 16 weeks, and we're a quaternary care facility. You'll learn so much and have so many opportunities.

Virtually all PICU patients will have respiratory issues, so try to develop your skill at respiratory assessment. No big rush, since you'll be able to hone that once you actually get into the PICU. Take advantage of the RRTs' skill and knowledge; you'll be working with them closely.

Drug calculations are another huge thing for PICU nurses. You aren't expected to know standard dosages off by heart, just how to look them up, and you really must make it a practice to do that for all meds ordered for your kiddies if it isn't a unit policy. Remember that meds are always prescribed based on the patient's weight; you can do some practice calculations to help get used to it. Ancef 30 mg per kg per dose on a 17.7 kg patient for example. If you reconstitute the 1 gm vial with 10 mL of sterile water, the concentration will be 95 mg / mL. How much med do you draw up?

Review your shock states. It's not as important to know exactly what kind of shock you patient is experiencing as it is to recognize that they're heading that way. Treatment is slightly different for each one, but all involve fluid boluses and pressors. Understanding how each of the usual ones work will help you to understand why the one that's chosen was chosen.

If your unit sees a lot of cardiovascular patients, bone up on normal circulation and electrical conduction so you'll have an easier time recognizing the abnormal. Read a little bit about congenital heart defects, but don't get too caught up in them because they really are had to really "get" until you start caring for kids with them.

Review normal neuro exams for different ages. Some facilities don't have a separate Glasgow scale for infants, but they really should.

Those are the biggies. You'll learn what you need to know from your preceptors to provide safe care, and the stuff you learn will be building blocks for all the things you'll learn as you go. And remember why you're doing this... to help sick kids and their families!

nursprl · Feb 5, 2007

How about an 11 year old girl who was on vacation and ended up with a severe head injury after falling off a cliff. She ended up in the PICU for 6-8 weeks, intubated, ICP monitoring, craniotomy for severe head swelling, and neurological storming. We didn't think she would be back to normal; would have major deficits. We sent her home to NY for rehab and one year later, on her anniversary, her mom calls us up in our PICU to tell us how she was doing. Mom said she walks with a slight limp and a slur in her speech. This girl came onto the phone (we had speakerphone on), said hello to all of the nurses, and played her violin as if she was never in an accident. Listening to her play her violin 1 year after her accident brought tears to all the nurses eyes. :scrying: I should mentioned she is a classically trained violinist before her accident and second chair in one of the orchestras in NY.

How's that for an inspiring story!