The Red Nike Tennis Shoes

Would I be able to care for this teen-ager with traumatic brain injury? My shift in ICU started as usual but the day would be anything but usual as I faced one of my most challenging days. His name was Jason... Nurses Announcements Archive Article

The Red Nike Tennis Shoes

I had been off work a few days, but I'd already heard about Jason. The teenager in our ICU. From the tragic car crash that made news over the weekend.

But hearing and seeing are two different things. Standing at the foot of the bed, the first thing I noticed were the big (size 12?) red and white high-top Nike tennis shoes on his feet.

The shoes were to prevent foot drop, but there is something disturbing about out-of-the-box-brand-new tennis shoes optimistically perched on the feet of a young man who would never walk again.

Turning my gaze away from the spanking white soles which had never touched the ground, I turned looked questioningly at the night nurse. She sighed and began report.

The Accident

The teens had been out driving around on a Saturday night. Driving on a fairly isolated road near the outskirts of town, in the midst of almond orchards.

It was a one-car accident.

Not terribly late- around eleven pm. No one was under the influence. Four kids just being kids. But..not all wearing seat belts.

The driver, a youth leader in a local church, had lost control of his dad's jeep right where the road made a steep turn just past a tunnel underpass. Probably driving a bit too fast. Probably trying to impress the young girl in the passenger seat, who, along with the driver, died instantly and mercifully, when the car slammed headfirst into a telephone pole.

The first people on the scene were Steve, a veteran local police officer, and his partner.

They were the ones who discovered the vehicle and observed a young person dazedly climbing out of the back seat of car.

The two teens in the front were motionless.

The fourth passenger lay thrown from the jeep, half on, half off the road, not moving. There was no sound in the country night except for the chirping of crickets and the car radio that was still playing, some popular hip-hop tune.

Steve scanned the body with his flashlight. He first noticed the feet that were clad only in socks. Both shoes were missing, blown off by the impact. Looking again, something hit him. Shaking, he aimed his flashlight beam at the head.

This couldn't be happening. He dropped to the ground. The body was a boy. His boy. His son, Jason.

The night nurse and I just looked at each other, wordless.

The Patient

She continued giving me report. Jason was severely brain-damaged with a Glasgow Coma Scale of 4. Decerebrate posturing. His skull crushed on one side from hitting a large rock.

There was talk of getting a PEG tube placed soon. She named off all the consultants who would be rounding.

Moving up the from the foot of the bed and past the obtrusive tennis shoes, I leaned in closer to Jason. My hands on the side rails, I studied him.

He already had that smell many neuro patients get. That smell that doesn't wash off. I knew without touching him that his pale skin would be cool and moist. His fists were tightly clenched with rolled washcloths inside.

Decerebrate posturing that would make it hard to work with him and position him. A foley that I knew he would hate if he were conscious of it. Any seventeen-year-old boy would.

The Nurse

My stomach sank as I took it all in. I was used to caring for adults, not teenagers. I was already swallowing and blinking hard not to cry. Steve, his Dad, Jason's Mom, and Ashley, his eleven-year-old sister, would soon be coming in - No - I can't do this.

I might have been able to care for Jason that day, but to have to face the parents? NO They would have seen the grief in my eyes, and worse, the pity. And I couldn't be hopeful for them.

Because I saw his future - first a trach, then a PEG. Then transfer to...a facility inconveniently located somewhere far away where he would "live". Turning and suctioning and infections and pressure ulcers and...

You see, I had a son the same age as Jason. Alive and healthy. Still vulnerable to teenage antics. Still capable of risky behavior.

But for fate, my son could be Jason.

The Change of Assignment

I went to the charge nurse and did something I'd never done. I told her please, I needed a change of assignment, that I would take any patient, anyone at all, just not Jason. She took one look at me and changed the assignment.

I didn't know it at the time, but I was experiencing transference. I was grieving as if it were my loss, experiencing the trauma as a parent.

A natural emotional human reaction or an inappropriate response? An emotional empath or a Mom? I felt guilty for abandoning Jason, and emotionally jangled inside.

I probably could have pulled it together that day if there had been no choice. It would have taken tremendous effort and energy but I wouldn't have fallen apart. Fortunately, there was a choice.

What I learned that day. My limitations. That having a patient who reminded me of a loved one could trigger intense feelings. The need to draw on my coworkers for help. The relief of having a wise charge nurse.

A friend of mine who is a Pediatric Program Coordinator told me it's hard to recruit new nurses to Peds because of transference. They are afraid of the intense feelings they might have seeing an abused child, a burn victim, a little one with cancer.

Years later, glimpsing red and white Nike tennis shoes still makes me feel sad and think of Jason.

Have you ever had an experience like mine? Do you think I did the right thing?

Please share, I'd love to hear your story.

Until next time friend,

Nurse Beth

Beth Hawkes

2 Votes
Nurse Beth

About Nurse Beth, MSN

Career Columnist / Author

I'm a Clinical Nurse Educator and a professional writer. I blog about nursing at http://nursecode.com

145 Articles   3,509 Posts

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Sometimes you just can't. Don't feel bad. Don't beat yourself up. We all have days like that.

1 Votes
Specializes in Tele, ICU, Staff Development.

Thank you, that is kind... we just have to do the best we can as we can, right?

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I could hardly read your story and am still crying. Way too close for me. My kids still grieve the loss of their friends from a similar accident. My son saying good bye to his brain dead friend in ICU. My daughter still remembering the anniversary of his sister's death every year. The fund raiser to help the parents pay for the funeral expenses of THREE of their children.

I've had to tell myself many times, you're a pro and you will handle this. But nope, I don't think I could have done it either. Sometimes we just can't.

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Specializes in Infusion Nursing, Home Health Infusion.

You did what was best for you and the patient and family and that is a wise nurse. It was a decision actually based on knowledge of yourself and your strengths and limitations. My dad's best friend lost his son when their car made a 180 and hit a brick road sign surrounding a sidewalk. He was killed instantly when his spinal cord separated from the base of his scull.. There were 4 teenagers just days from starting their senior year in a private Catholic prep school. Two died instantly....one that was not seat belted flew from the back seat through the windshield to the hood of the car. The driver lived for a few days but never again woke.Later it was discovered the driver had used an inhaler, some duster.

Our friend not wanting to profit from his son's death took every penny from the insurance he received and set up several scholarship plans for high school students wanting a Catholic education and funded them in honor of his son that never made past sixteen. None of the other teenagers had taken anything illegal or had been drinking. It was only the driver who stopped at Walgreens to get some candy and some duster. The crash site is just two blocks from my house and it took them at least a year to rebuild that large brick road sign...every week when I drive by I think of those three lost lives and remember that one bad decision can cost you your life. Teenagers and others please do not get in the car with anyone who is under the influence or who insists on speeding...it could cost you your life.

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This is why I can never work Peds. I'm so sorry, and thanks for writing this. I gave it to my 17 year old son to read.

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Some of my best nursing lessons have come from the assignments I was most afraid to take. You are obviously a caring and compassionate person, a necessary trait for an ICU nurse, and you are right, you could have done this if you had to because you are a professional and put patients needs before your own. But know that realizing your limitations as a human being and being able to pass on an assignment to another skilled professional, is equally important. We evolve and change in our profession based on our experiences, you may not have been able to do this assignment on that given day, but at some point you will, and at some point you will step in to help another professional. You did what you felt was best for the patient, family and yourself at that given moment on that given day, not something you should ever feel guilty about.

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Specializes in Tele, ICU, Staff Development.

Libby- now you have me in tears! thinking about your son and daughter's loss - you know how we always want to protect our kids from pain. Thanks, appreciate your supportive insight.

0 Votes
Specializes in Tele, ICU, Staff Development.

I've read your post three times now. I have no words. It's too tragic and similar to my experience.

Your dad's friend is a hero in my book. Peer pressure and teen-age immortality kills.

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We all have our breaking points, a true professional can usually get through the worst of it, but sometimes you can't. I have been s police officer for ten years now and have seen hell on several occasions. It never affected me quite like the other night. I broke down into tears as we arrested a male party for oui-drugs b/c he had taken pain pills for his back, never intending to drive; until he found out his 1 month old daughter had been rushed to the ED and was looking at admission to the NICU. It hit too close to home as my daughter (first child) had just been discharged from the NICU.

0 Votes
Specializes in Infusion Nursing, Home Health Infusion.

Hawkesbe, I hope that my sharing has helped you a bit. I support what you did and would have gladly changed your assignment too. I think in healthcare is is sometimes forgotten (not always) that we are human beings too, just doing our best to take care of other human beings during difficult, all the way to tragic times in their lives.

I will never forget that tragic loss of young life. My dad's friend also did a local commercial telling his story and urging other young people to think before using any drugs, alcohol or inhalants and then getting behind the wheel of car. I still struggle with the memory when I drive by that wall and I remember his young friends weeping at the grave site as they gently placed their roses on his casket. I remember thinking at the time....this was probably their first experience with death. I can only imagine how difficult it was to see the teenager whose grim future you envisioned. You see the red shoes and I see the wall every time I go to Target, Nordsrtom Rack or Trader Joes and more! I NEVER pass it without thinking about the loss and I use the story to teach my teenager!

0 Votes
Specializes in Tele, ICU, Staff Development.

Thanks- I hope your son and his friends make good choices.

I could never work Peds, either.

At one job I had when I was a float LVN going to school for my RN, I was floated to Peds a few times. Giving meds was pretty terrifying (dosing error fear) and seeing a repeat ten yr old cystic fibrosis pt was heartbreaking.

And then, sure enough, 3 days after my float, I would always get an URI. Darling little germ manufacturers. :)

0 Votes