My Story, My Journey, My Reflection
By Olly Jennings
I’m stood at the foot of the child’s bed, as two parents say what they believe to be goodbye to their three week old child.
I'm a first year student at this point, working in intensive care. I have been independently working with this child all day, some seven hours come this point, as well as shifts over the last three days. I’ve gotten to know the little girl well, I’ve shared laughs and jokes with the parents, and I’ve gotten to know them reasonably well. I have never seen anything like this before.
The little girl has a life-threatening cardiac condition with Wolff-Parkinson White syndrome (a form of cardiac arrhythmia) and we have just spent a long period of time giving life support (PLS) to her whilst we try and keep her alive until the surgeons can take her. I was the one who raised the alarm, the first one to respond to her, the first person to react in PLS. I was quickly relieved, instead given the job of runner (the one who goes to collect equipment during the life support) and then of timer (shouting out the times to give adrenaline, and informing the scribe when drugs are given). I am myself running on adrenaline; I am acting out of body, with the confidence of one who is not a terrified first year on their first hospital placement.
We have been going now for a long time, with very little response. The team are trying as hard as they can, but it feels like paddling upstream… she is tiny, and her heart is already damaged. After what seems an eternity, we get an output, the tiny line on the screen dancing, slow, small but something. It’s hope. The surgeons phone, and tell us they are happy to take her. As we have an output, the team say they want to get the parents in now, so they can see her whilst there’s something.
"I have to leave the bedspace because I am going to fall apart. No amount of training or discussion can prepare you for this"
I can picture them walking into the crowded bedspace. I can picture mum’s face, tears pouring and visible pain on her face. I can see dad, standing tall, clearly trying to hold it together, his arm round mum. They approach the bedspace, cutting through the doctors and nurses like a knife through butter, the same knife that I now feel in my heart. I have a lump in my throat and I feel my eyes become wet. I have to leave the bedspace because I am going to fall apart. No amount of training or discussion can prepare you for this. This is real.
The parents say their goodbyes, and I sit in the room next door crying. I feel responsible. I feel scared. I feel hurt. An experienced sister on the ward is able to talk me through this, to begin to put pressure on the knife in my heart, stop the bleeding. I pull myself together, my eyes red and swollen. Put a face mask on, that’ll hide it. We take her round and I say my own goodbye, silently.
Fast forward to now; I am at the end of second year. I have three more clinical placements under my belt and with every placement I feel more confident, but I still carry her with me. She passed away in the end, her heart just too fragile, the trauma too much for her tiny body. I still get down, and sometimes when I’m on my placements out of nowhere I will just feel down about it. It’s something in my practice that part of my mind clings onto, something that I knew I would have to experience at some point in my career, just maybe not a year into it.
Tonight on my current placement I run down to resus call from ED for assistance on a paediatric attendance (there are no paeds specialist nurses on so the ward provides help), lingering memories of this present themselves. The little girl is coming in tachycardic, inconsolable, pyrexial and hypotensive. She too is only a few days old. The parallels are uncanny, but I can’t afford to be distracted. We gown up (it’s currently the height of the COVID 19 pandemic, so it’s hot on the agenda). I take my place as an observer, I’m here to gain learning experience of ED operating procedure and team dynamics, but I secretly (and silently) really want to be a part of this.
She comes in, a hive of activity around her tiny frame as we get fluid boluses in, Antibiotics and the like. At this point it becomes clear respiratory support is needed so they administer highflow, the medic holds the mask to her face and holds her airway in the correct maintenance position but he has things he needs to do. I step forward and offer my assistance.
Now I’m involved I feel like I’m more focused.
My job is to keep her airway open and to assist with obs during the resus every 10 minutes. We perform an ECG which confirms she’s in Supraventricular Tachycardia (SVT) and we suspect she has been for some time. The given treatment for SVT in children is administration of Amiodarone which suspends and helps invert cardiac waveforms in ventricular disorders. After several incremental dose increases eventually she responds, so we now keep administering it at regular intervals. The effect is short lasting in her before returning to SVT. PICU and the local patient transport team are on the phone for consultation and the plan is to transport her to the same PICU which I worked on.
To treat her tachycardia we also give iced water to the face. This is something which I had never witnessed before, and it seems strange holding a glove full of cold water and ice chips to a child’s face but the effects are amazing, she rapidly comes out of tachycardia and sustains for two minutes. PICU are coming in the next six hours to retrieve her.
After four more long, exhausting and hot hours, I am relieved to go on my break. As I remove my PPE after leaving the bedspace the person relieving me says she didn’t recognise me with all the equipment on and she hadn’t realised I was a student, she had thought I was a member of ED staff. I take the compliment and I feel like I am a different person.
I hear from the nurse an hour later that she had been transported to the PICU but it was touch and go for her whether or not she’d make it. However this time I feel differently, this time I feel like I was able to contribute, I feel like I had done my best and this had helped stabilise her, despite the outcome.
"You may be reading this and wondering why I am writing it all down, but there’s several parts of these experiences which I feel have been important to me and hopefully these will provide comfort to others in similar scenarios"
Firstly,
loss is huge. It may sound obvious but nobody wants to talk about it and I feel like we should. Losing a patient is a tragic, and sometimes life changing experience. In the work we do we cannot help but get close to children, families and carers, it’s the nature of the work. Feeling grief and loss is to be expected, and it’s okay to feel this grief. It’s a sign you care.
Secondly,
there is help out there. On the PICU I worked on they had a clinical psychologist who sat down and gave me the time and freedom to talk about the experiences in my own time and way. It was amazing. I had dark days, standing outside the ward in tears before a shift, scared to go through the doors, but processing these feelings, and realising that it was normal to experience them and how to tackle them practically was an opportunity which I was so happy to have. I attended the debriefs on her case, which also really helped. This is something I would encourage anyone who’s been in similar position to go to as all members of the team can discuss the case and it’s an open forum to discuss how we feel as professionals. Many university support teams will also have help they can offer, I know my tutor heard this story a few times. The help is there, and if you are struggling, don’t suffer in silence.
Thirdly,
it’s the team ethos and mentality which will pull you through. A good team can really help you on dark days. I still talk to some of the lovely staff on PICU and the team on the ward I’m on are the most lovely and friendly bunch. On those days we have to pull together and get each other through. As student nurses we are uniquely placed, we have our colleagues student nurses and staff on the ward.
Finally,
REFLECT! It’s something that seems so easy and at times like it’s not worth the time, but by reflecting and learning we can deal with the rubbish that arises and really challenge our own viewpoint. Through writing and talking through these experiences, I have dealt with some of my concerns and misconceptions of guilt. I would say that I have learned so much about myself from these experiences and taking the time to go through with a fine toothed comb can really benefit you clinically and personally.
I’ll leave you with a happy ending to all this as well. It was my birthday a few weeks ago, and on my night shift that night I saw the name of the girl with the SVT on the handover sheet. I felt so happy. I asked to take her as my patient and when I walked into the room mum recognised me and said thank you. The best present I could ever ask for. As the night progressed on, I had a lovely cuddle with the little girl and when I picked her up I could feel the wounds of my previous trauma slowly but surely healing. Yes I might still feel grief and loss of my other experience, but with time I’ll grow and feel more able to take it in my stride.
Please don’t suffer in silence