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
