We take any number of off-service patients. While we are a respiratory and infectious disease ward, we were known to be able to make a bed for anyone. Today is bipap, tomorrow is suicide protocol for a soldier from the local base. We could do it all. Sometimes, though, you wish it was just a little old lady with hankies up her sleeves.
She arrived shortly after supper. She had the look of any new mother; tired but proud of her new son. Her bedside table held her favorite dog-eared books, including What to Expect When You're Expecting. Next to it, though, was a Holy Bible and pamphlets from our Palliative Care Team and local funeral parlors. The admission was brief. Postpartum would be supplying us a float nurse, as many of us were unaccustomed to postpartum patients. The nursery would be bringing the baby shortly, along with his own nurse.
Mom identified herself as a Type-A lady. She had preferred to be in charge of everything. Until she received her diagnosis, at 32 weeks, that she had a large, aggressive breast tumour, she had been in charge of it all. She picked all the nursery furniture, purchased the new family-friendly car, and even put her tiny cottage up for sale so she could move her family to a new home closer to the park. Her husband was not only expected but encouraged to take a backseat in all things baby. Mom had it covered.
Now, Dad was receiving a crash course in baby. Mom had waited until she had been given the report from the MRI that confirmed end-stage breast cancer with metastases to the lungs. bones and brain to give up. When Mom opted for a morphine PCA with a generous lock-out program, she chose to check out in a haze of narcotics. While Mom dozed in and out of consciousness, under the watchful eye of our nurses, Dad watched the in-house parenting class DVDs in our breakroom. He practiced holding and changing the baby with a borrowed teaching doll from the prenatal program. Dad was a mess. He cried some, smoked some, and contemplated his future.
Our ward was great with all kinds of disasters. Patients from the federal prison who stabbed nurses with their own pens. Alcoholic patients who, despite massive doses of Librium, were able to fracture skulls and noses with their fists. Lousy managers who slept in their office while nurses sank in the mire of an understaffed ward. But this was different. We needed help.
By day three, the baby had gone home with Dad. Mom wanted nothing to do with her baby, as she was never going to be able to raise him. No amount of emotional support from our social worker and palliative counselors would convince her to bond now while she could. Her husband was denied access as well, as Mom decided that he should stay with his son at home. (And it was a very nice home, situated next to the park, across from the large grassy playground of the elementary school, as pictures showed on her bedside table). The postpartum nurse returned to her ward, and the patient was signed off to us. No visitors came. The telephone never rang. The Mom layed in bed, pressing her PCA button like she was playing Jeopardy. By now, the books were gone from her bedside table- tossed in the garbage. The photos were turned over, except for the photo of the house.
We wanted to be able to do something. Make her better so she could go home and start her new life as Super Mom, where she could grow organic vegetables for her baby as she had planned? That would have been wonderful. So many of our patients had been admitted at death's door but were returned home with a new, albeit short lease on life. We wanted that more than anything. Sadly, this 25-year-old new mother, with the shiny photos and the beautiful new baby that she had never held, was not that patient.
Night shift started at 1900, as it always did. My partner and I arrived in The Pit as we called our observation unit to discover that Mom was our only patient. The other 3 had been moved to ward beds to allow for what was going to be a very memorable shift. At 1915, after report, a basinette arrived. A case of ready-to-serve formula accompanied it, along with tiny diapers and other baby items. Mom had agreed to have one night with her little family. Her high-flow oxygen kept her in the observation room for the night, with all the appropriate monitors, balances and checks. The two of us looked at each other. What was this? We had become resigned to a grieving mother, an absent father, and a feeling of misery in the room. We were not prepared for what happened that night.
Football runs deep. Mom was a diehard fan of her home team, while dad was a local hometown boy. Tonight, though, everyone was on the same team. Baby arrived with Dad shortly after 1930. Full uniform of team jammies, little matching helmet and booties. Dad had on his own jersey. Both had the family's name on the back, to show family solidarity. Mom, who had not done more than play Jeopardy with her PCA and doze for most of our shifts with her, broke out in the biggest smile of all. Bigger than even the one in the fairy tale wedding photos we had seen when she first arrived. To top it off, Mom was given her own jersey, family name on the back. It was a very comfy, cozy jammy dress for Mom. I was about to help her put it on and feed the IV tubing through the sleeves. My partner asked her if she wanted to use her button as I would need to undo the PCA tubing briefly to prevent dislodging the saline lock. Mom surprised everyone, even herself. She smiled, said no. Just take it off not to hook it back up again for a while. Mom wanted to make some memories with her family, and wanted to be clear.
We helped Mom into her team jersey, helped her pull her hair back out of her face. Dad looked hesitant. He had made this evening happen, and didn't want to jinx anything by pushing Mom too much. He held his infant son up to his wife to show her how beautiful he was. How much better he looked than the grainy ultrasound. He pointed out all the things that baby shared with Mom. Her chin, her forehead, her kissy lips. Then he sat down, in a nursing chair from the maternity, placing baby on the nursing pillow on his lap. It was the one Mom had picked out of a baby magazine. To match the rest of the nursery. Mom teared up. She called us over.
That night, Mom held her baby for the very first time. We padded the siderails of her bed with blankets. We wrapped her saline lock to avoid any accidental scratching she was afraid of. We prepared the bottle just as she directed, even though it wasn't breast milk and wasn't what she would have fed the baby had she really been in charge. Then Dad placed the baby on her lap, on the pillow. Mom and Dad spent the next 3 hours with their little family, with their little boy. Baby cluster fed on and off. Dad showed his wife how to burp their son, showed her how he helped with the tummy gas. It was a magical end. By 2300, Dad and son had returned home.
Mom's high-flow oxygen had stopped being enough, and she was now on bipap. Our magical moment was over and we were right back into respiratory nurse mode, with RTs and pre-code teams on the way. We directed traffic, started lines, gave meds. We moved furniture, took report and admitted 3 more patients. Business as usual.
By next shift, Mom was gone. She had made it clear that she was to be a DNR. She passed away that morning in a private room. Her husband and son were not at the hospital, as she wanted. They were at the park, watching children play. Mom wanted to be in charge of that, too.
We sent a photo to Dad from the previous shift, circumventing the computer rule. We uploaded a photo we took of his little family with the wound care digital camera. His one and only family photo for his little football fan.
Being a nurse is hard. We can't always find the moral of the story, or the benefit of every situation, but we try.