What Is The Shift You Will Never Forget?

Ruby Vee, BSN · May 10, 2013

I was a brand new dialysis nurse, but had worked in our ICU for years before changing jobs. The ICU was short and needed someone who "knew VADs and drips" to float up to take care of a new patient they'd had to accept even though they were down a few nurses and full. The nursing supervisors had worked it out that the dialysis unit would float me up there because I had so much ICU experience, and "by the way, the patient is on dialysis." It was my old unit, and I've been a cardiac nurse forever.

When I got upstairs to the ICU and was given my assignment, I realized that the patient was about 12. I had never done peds before, and that fact threw me completely for a loop. "It's OK," I was assured. "He's a big kid -- med doses are are adult sized." The kid had collapsed playing soccer or football or whatever kids play at that age, and went into full cardiac arrest. His heart was floppy, oversized and nonfunctional. His only hope was a transplant, and the VADs were to keep him alive long enough to find one. I went in and did my assessment of patient and technology, and everything seemed to be going smoothly. The dialysis tech dropped off the machine, and I checked the bath and my settings and got the kid on dialysis without incident. Did I mention that it was my first solo run as a dialysis nurse?

The kid was about 12 hours post arrest, and all narcotics were off as we waited for him to wake up. The docs had told his parents that it would help him to hear their voices as he was waking up, and so the father was sitting by the bedside reading to his son -- some book about snakes which I understand was a favorite. During a particularly creepy portion of the book, the kids blood pressure suddenly spiked and the father leapt to his feet in joy. "They told me he would do that just before he woke up," he said. "He's waking up! My boy is coming back to me." I know nothing about neuro -- and have many stories about floating to neuro units that did not end well. But this father was so positively joyful that it was infectious. As the blood pressure trended back down to normal, I checked the kid's pupils, sure that I was going to see something positive happening. Instead, they were so dilated I couldn't see any iris at all. And they weren't reacting . . . .

My charge nurse told me later that I did all the right things, called all the right people, did everything I could. But that kid, whom so many people loved and whose father was standing with unconcealed hope in his face waiting for the doctors to come and tell him GOOD news, had herniated. First one pupil blown and then, while the neuro resident was still running up the stairs to the ICU, the other. And I still had ten more hours in my shift in which hope turned to abject grief in each family member as they one by one and two by two filtered into the room to visit "their boy" and talk to the doctors themselves. Of all of them, the father was the worst. Calm, dignified and unfailing polite and grateful for the nurses and doctors who had tried to save his son, he was a constant presence at the bedside. The child's mother and her boyfriend visited and hurled blame and insults at Dad, and he remained calm and dignified. "This is my only son," he told me during a break in the visits as we waited for his son's grandmother to come and see him one last time "before we let him go to Jesus." "My daughter drowned a few years ago, and her mother blames herself. That's why she's so bitter."

I cannot imagine the pain that man must have been enduring, and yet he stayed at the bedside, holding his son's hand and alternating reading to him with telling him stories about "the time you and your Grampy caught all those fish" and "the time your mother took you to the boyscout camp because I was working and couldn't." Good stories about good times and funny stories about misunderstandings and good intentions gone wrong. That kid was loved and treasured. And had no hope of recovery. After the grandparents had all visited, we began to withdraw care. There was a lot of weeping and wailing, but Dad was an island of calm and strength. He held his son's hand until he drew his last breath, and then asked for time alone to tell his son the things he should have told him more often. I was near enough to hear his anguished outpouring of love and grief.

It's been over twenty years now, and sometimes I still dream about that shift and that father. In every one of my dreams, the blood pressure spikes heralds the boy's return to consciousness, a joyful occaision. And then I wake up and the grief is brand new again. When I leave this world, it would be a priveledge to have a man with that much love to share and that much strength to bear the load at my side. I know my husband is a man who would be the calm and the strength at my side if I were the one dying. So when I wake up from that dream, I hug him fiercely and tell him that he has to outlive me so he can be at my side when I die. He always promises he will. But I know we cannot see into the future.

By chance, I ran into the Dad again at a high school sports event. He was cheering for his child's team from the sidelines and was accompanied by a plain-looking woman who was transformed into beauty when she turned her lovely smile on me as he introduced us. "I thank you, Ruby, she said."

"I had not met my Charles yet, but you were the one who gave him the strength to hold together for his family when Charles Junior died. I thank you for what you did for him." They had two children on the playing field and one at the concession stand, and it was obvious to anyone with eyes that they were very happy together and considered themselves blessed. I met my own dear husband not long afterward.

**canoehead, BSN, RN** · May 10, 2013

Ruby, that was an amazing story. Thank you.

MomRN0913 · May 10, 2013

Wow ruby, what an amazing story from start to finish. Definitely brought tears to my eyes.