This is why I do this job

I was finishing my shift in the Pediatric ICU. We had a call out, and I volunteered to stay an extra 4 hours past my scheduled time, even though I was to return the next morning. One of my patients was a young girl with a degenerative neuromuscular disease. We'll call her Anna. Anna had been in our PICU for several weeks, admitted after an ENT surgery and had been unable to maintain oxygenation without constant Bi-PAP since. Anna, despite her condition, was a very joyful child, and though she couldn't speak, would offer huge, beautiful smiles when you spoke to her. After much discussion, Anna's mother (Rachel- pseudonym) had signed consent for a tracheostomy which was scheduled for the next morning.

It was a quiet night, and Anna was sleeping, but her mother wasn't. She alternated between wringing her hands in the back of the room and quietly pacing at Anna's bedside. She looked unsettled and worried. I had the time, so I went in and asked if she wanted to talk. She was grateful. We sat on the pull-out couch and she showed me photos of Anna and her brother. Anna's brother (David) had the same neuromuscular disease- he, too, had gotten a tracheostomy and been on a ventilator. He had passed away in our PICU a year earlier. Rachel began telling me about how David's life had changed after his tracheostomy. He had lots of secretions and needed frequent suctioning. He couldn't get in the pool, which he had loved to do. He didn't smile anymore. He lost his joy. Rachel talked about her fears that the same thing would happen to Anna, her worries that she wouldn't be able to properly manage her medical needs with a trach/vent while also caring for her other children. She expressed that she felt pressured to consent for the procedure because she had been told that Anna couldn't go home with a BiPAP machine without significant out of pocket expense and the trach was the only way to get her out of the hospital. She talked about how, more than anything, she feared that she was doing the wrong thing her her child. She talked, and I listened. That's all. I listened.

After our discussion it was clear to me that Rachel wasn't comfortable with Anna having the surgery. I contacted our intensivist, so came in and continued the discussion with Rachel. Eventually, she withdrew her consent for the tracheostomy. I called the director of our pediatric palliative care program and we set up a family meeting for the next day. Rachel thanked me and hugged me before I left that night.

I was able to attend the family meeting. The palliative care program director sat down with us and told Anna's mother: If you want to take Anna home on BiPAP, we will make that happen. We will pay for everything.” Rachel burst into tears. Her relief and happiness were palpable. A few days later, after all the resources were set up, Anna went home with BiPAP and hospice nursing care. She lived for another two years, at home with her family, continuing to smile.

Every time I think about Anna and Rachel, I wonder what would have happened if I didn't stay that extra time at work. If I didn't recognize Rachel's distress, and didn't take the time to listen to her concerns. I wonder what would have changed for her and Anna had the tracheostomy surgery been done as scheduled. Maybe nothing. Maybe everything. This is one of my stories. One of the moments that keeps me coming back to work. It doesn't involve expert nursing skills, or world-renowned care. It involves being perceptive and compassionate. It's an opportunity that I had to make a difference as a nurse that no physician, anesthesiologist, or surgeon ever could have. And it's why I'm in this profession.

As a relatively new grad, probably 1-2 years off orientation, I walked into a night shift and got told I was in charge. I told them I had no training and literally no idea what charge even does. I got told to suck it up, buttercup.

It was me and 2 nurses who had about 6 months of experience, and 3 completely fresh new grads (literally less than a month off orientation). So total of 6 nurses for 36 patients, myself included. Not so bad, I mean, not great, but we'd all seen worse.

2am, patient codes, it's open heart surgery so we code these people for absurd lengths of time, so anyway, I basically run this code for 10 minutes until anyone else bothers to show up, then we code the patient for another 30-40 minutes, she lives, I transport her to CCU, and then I'm in the elevator coming back up to my floor, I'd washed my hands but still had blood splashed up to my shoulders from post open heart CPR (messy). I cried in an elevator because I had been so afraid that if I had made even one error in those first 10 minutes, there was no backup to catch it. The weight of the responsibility was crippling for that 15 second elevator ride. And then I got my **** together, wiped my tears by the time the double doors opened, and went right back out there and helped my nurses write their code notes, catch up on patient care and charting, and try to provide emotional support to the nurse who had been caring for the patient who coded and tell her she did nothing wrong and didn't miss anything.

At the time, I was scared out of my gourd, but I just ran on autopilot and did what needed to be done. I was so glad she was asystolic and it was an easy algorithm (kind of a crummy thing to be glad for, but what can you do?)

When I think back, though...I proved myself on so many levels that night. I could handle a code, I could handle being in charge with no support, I could handle teaching and mentoring my staff, and nobody died. Those new grads remember that night and respect me for it to this day. The specifics of that night have honestly faded into the background for me, but the part where I could definitively say that I'm the reason that patient lived...that hasn't faded.

That moment when you get someone back from a code.

That moment when you surprise even yourself with your leadership, knowledge, and skill.

That moment when you turn off the waterworks because your 15 seconds of feelings time are over and you've got to put on your brave face and help your peers.

THAT is why I'm in this profession.

(Yes, I realize this sounds really cocky. Just run with it. Sometimes nurses have to be confident.)

This isn't a glamorous story, but: 18 yr old girl, injured in a freak accident at her own graduation party. She'd arrived on my unit shortly before I came on. She was very fortunate -- she was blinded in one eye (optic nerve severed), but escaped what could have been a severe brain injury. She was naturally very scared, however. That a.m. towards the end of my shift, as I was showing her dad how to get to the caf, he said "She said she's really glad you were her nurse."

When a TBI patient comes to visit us and say "thank you for saving my life" -- when s/he had been minimally responsive when she'd transferred to an LTACH months before.

19 or 20 yr old young lady, deliberately run over by her boyfriend. Mom was devastated -- told me she knew she would get a phone call from a hospital someday. She wasn't one of those family members who interrogate staff, but was terrified. That first day, she was acting....regressive? "Mommy's here sweet baby girl," etc., would barely let go of her daughter's hand. On day 3, I had finally earned enough trust that Mom finally was able to go home and shower and sleep! That was very gratifying for me!

My big worthy-of-TV moment: A woman a life-threatening condition, in the SICU after a caesarean birth. She was still intubated, VSS, but didn't look good from the get-go. A few hours later her HR started to slowly climb, BP started to slowly fall. My spidey sense told me it wasn't a simple need for fluid or blood products, and I told the resident I really feel uneasy about this one, and had she considered putting in a central line? She agreed... good thing, because about when she was finished was when the pt really started to decline. Within minutes, she coded, and began to require several pressors. She ended up getting an IABP at the bedside to buy some time to get to the OR (as her planned procedure was now emergent). I was still pushing epi and bicarb while rolling her into the OR! (Remember the Christopher Walken "more cowbell" SNL sketch? A picture of it popped into my head from all the "more epi," "more bicarb" from the code team leader. ) She came back on ECMO, and CRRT, with 2:1 nursing plus a perfusionist. And her baby has a mama. :)

But most of the time, it's a simple "thank you" from someone on the worst day of their life. Those "thank yous" make it all worthwhile!

It's gonna sound bizarre, but when other nurses (who don't know I'm nurses) thank me for being patient/understanding when I'm a patient. Also what the PP said, the small thank you's from patients or family members.

I would say the night I was called into work to be 1:1 with a new resident who kept trying to roll his w/c out the door. I came in and one of the sons were there. I asked him to tell me about his father, the work he did, hobbies, children,grandchildren just in case I would need to talk with him about anything to help him settle in. Son also told me they didn't realize that Dad was so bad as Mom kept the severity of his condition hidden. I also told him that in my experience it usually takes about 2 weeks to feel comfortable in a facility and will do better once that happens. He was also impressed that I would come in on a day off to sit with his father. Every time I saw the son after that night, he would tell people that I was an angel who helped them all that night. Not only could I be of help with the resident, but also the family.

I still remember a patient from one of my clinicals (LPN) on a med-surg floor. I was assigned a stable patient post-colectomy who needed frequent wound care. She was fairly young, and in a lot of abdominal pain. It was personally affecting, because my mother has Crohn's (previous dx UC) and had been through multiple (partial then full colectomy with ileostomy, J-pouch with stoma reversal) surgeries when I was a child. The primary nurse was very busy and couldn't bring a PRN, and my instructor was somewhere busy with other students, so I ran to grab warm blankets for her to hold to her abdomen (flashbacks to those days playing by the couch, my mom curled up with a heating pad to ease the pain). I felt awful that I couldn't do more for her in that moment. But - it helped. Afterwards, she thanked me and said, "You're going to be a great nurse." The feeling of problem solving something I didn't have full control over and seeing the emotional relief of someone who's suffering has been noticed and at least somewhat relieved, that reaffirmed my choice to pursue a nursing career.