Non-accidental trauma

In the last few weeks, we’ve had some non-accidental traumas (that is an injury purposefully inflicted on a child – also known as child abuse). One kid was declared brain dead and the team decided to wait 72 hours before ending life support. In these 72 hours, the child is brain dead, but we are keeping them alive with a ventilator, medications, and other support systems. The ventilator pushes air in and out of their body, acting as their lungs, to keep the rest of their organs perfusing. One of the nurses, gave this kid a bath on their shift. It surprised me, that this nurse made the time to treat this kid with the same compassionate care as if they were alive.

Working in the ICU, we experience a lot of death, but the more difficult deaths are the ones that are non-accidental.

One of the ways I was taught to cultivate moral resilience, and combat moral distress is to acknowledge the grief > engage in activities that give you meaning > Eat, exercise, sleep > Find and express gratitude >

Listen to something nice – i.e. the wind blowing

Feel something nice – i.e. a soft fleecy blanket, pet a dog

Smell something nice – i.e. coffee, a fresh flower

Look at something nice – i.e. the multitude of green colors in the foresty trees, the mountain views of the Olympic Cascades, the ocean water

Touch something nice – i.e. the softness of lip balm on your lips

36 hours

Since February, my life has turned into a series of 36 hours, like the “36 hours” column from the New York Times. “How to experience as much as possible in a limited time” is the tag line of my life. I work hard for 36 hours, 12+ hour shifts, usually 3x in a row, then on my off days, I try to use the set block of time, getting the most out of a single place over short stay. This is not a true vacation, but my regular days off work any given week.

I drove to Portland, OR for an overnight for an author lecture. It was my favorite book of 2023. While the author is on tour with a stop in Seattle, the book was selected as the library book of the year in Portland so I thought the engagement and audience might be more interesting. I stayed in an Airbnb, I selected it due to the retired service dog, a golden retriever that lives there. I saw friends for coffee, dinner, and breakfast.  

A friend visited me for a weekend and we geocached “Trolls”, driving north, east, and west and one ferry ride to find the four outdoor wooden troll sculptures around Seattle. We hiked a few parks and saw waterfalls too. I have one more troll to find, but it would have been another ferry ride. We weren’t able to do it in one day, while also making it to the Symphony in the evening.

I went to Mexico City, Mexico for a few days to visit a friend, seeing the Pyramids, the Anthropological Museum, and taking in the city while eating vegan tacos.

Next weekend, I’m going to San Francisco to meet my friend for her theater performance, who is flying in from Texas. While there, I was luckily enough to set up a “fly around”, shadowing a life flight RN for a 12-hour shift. I am hopeful, we’ll get called out to fly so I can see what it’s like, if flight nursing is something I’d like to do. I will also see my other friend’s theater performance, eat at my favorite dim sum spot, and stop by to see a special exhibit at MoMa.

In May, I am going to LA for a few days to see my friend graduate from her phD program. While I’m there, I’ll see what’s on exhibit at the Getty Museum, hike up to the Griffith Observatory, and see SoCal friends.

Memorial Day weekend, to Cabo, Mexico for 36 hours to see sunshine and sand. My friend is staying longer to scuba dive. I’m just visiting on my days off.  

In June, maybe meet up with a friend in Budapest for a few days and will try to make it home to NYC to visit family.

People often ask how I have time or money to go places. I’d rather see something for a short time, and experience something than never experience it at all. If we wait until we have time, you might never have time. If work has taught me anything, tomorrow is not promised, live fully now. Don’t wait until retirement.

living life

Not an overstatement, my every day at work, is the worst day of someone’s life. Just when I think what I saw was possibly the worst thing I have ever seen, the next shift surpasses that experience. Recently, I worked with a family that had a terrible car accident, one parent died and several children died in the car at the scene. The children that survived were brought to us, critically injured and very broken. The opposing driver was driving at a very high speed, also brought to us but a different unit for critical care. The family grieved and cried in my arms. The family that stayed at bedside, I tucked them in with a pillow and a blanket and told them to sleep, that their children were safe here. We would care for them while they slept.

In a different car accident, a couple was traveling back from their honeymoon, recently married with new wedding bands on, were hit by a semi-truck. One partner was severely injured. The other partner sat at their bedside and I wondered about their vows to death do us part.  

Another patient was shot by their partner in the head and then that partner committed suicide, in an attempted murder-suicide. My patient is not yet dead but I would say also not quite alive. I was taking care of this patient when all their family visited. It was heart breaking to hear them say they loved them and wished for them to come back to them. Tears in their eyes, they asked me if their loved one would get better and I don’t yet have the words to tell them no. I can tell them factually what I see in front of me is not a good prognosis and the things I am working on to sustain life.

Each shift at work is very busy, there are no slow days. There are no easy patients. My life outside of work is equally busy. I have always been like this, since time immemorial, but now it seems to be a little bit extra. I feel like I don’t have enough time. I want to experience all that life has to offer in the time that we are here.

brain death

My job often is to keep people alive, but sometimes I tend to the dying. Deaths are sudden, unexpected, and sometimes prolonged. They impact everyone involved, the living and the dying. I’ve had some life experiences now, caring for people through the dying process and it is never easy. I think, with all things, practice is what helps the most, preparing your mind, builds awareness around practicalities.

I worked with my first brain death patient. They died from a head injury that led to brain death. Brain death is the legal definition of death. It is the complete and irreversible stopping of all brain functions. Brain death is permanent and cannot be reversed. There is no recovery. It was the first time, I had seen fixed pupils, no reaction to light, movement, or pain.

The patient’s family wanted to believe they were still alive and could not accept death. They still had a beating heart because the ventilator was working for them. However, the brain is no longer sending signals to tell the body to breathe. Without the ventilator, the body cannot breathe and the heart will soon stop.

What I’ve learned is to care for our patients without judgment, you must know how they lived. Respect their needs, their story, consider the choices they made in life. Only then can you help guide them to understanding the truth.

keep kids alive.

In the Pediatric Intensive Care Unit, exceptional attention to detail and precision is a necessity. My patient was doing ok until they weren’t. We were talking about Paw Patrol then they were decompensating, and turning blue. In less than 30 seconds I had to recognize the problem and intervene.

I started oxygen and called for additional help. Other nurses arrived and started more interventions. I stepped aside to call the resident to come to bedside, then the respiratory therapist. The patient continued to deteriorate rapidly, turning into a life-threatening event, I then called a Pediatric Code Blue which is paged throughout the hospital for the Anesthesia team and the Code Team to come.

Anesthesia comes with emergent medicines and devices to intubate immediately to create an airway when the patient is no longer able to breath on their own. The code team comes with the MICU Attending (that’s the most senior cardiac doctor) to assist. Then like 20 other people show up, all consulting teams – social work, spiritual care, Pediatrics doctors, Burns doctors, our fellow ICU nurses on the unit to support with chest compressions or get other medication, they support in whatever way is needed.  

This all began with an alarm beeping. It is my responsibility to notice and recognize the slightest changes in the patient’s conditions, then take action to adapt to the evolving situation very quickly. I started the chain of safety mechanisms. Kids are young and vulnerable, often unable to express themselves with under developed language abilities or they have complex medical conditions and unable to communicate.

I didn’t know, one of the required skill sets to work here would be emotional strength and stability, to balance empathy and compassion for the most vulnerable patients with the ability to handle rapidly deteriorating conditions, suffering, and the possibility of death while working with high-tech medical equipment.

The PICU in a trauma center is an intense place to work, even for an experienced registered nurse. Every day is hard, every day is a learning experience. I am challenged every day.

I am told this is what it may be like during May-September, in what is called Trauma Season. Trauma season is when kids are off from school, and there is not only one life threatening event that rolls in through the door, but multiple life threatening events occurring on the unit at the same time. This brings new meaning to summer.