My Pediatric Nurse Experience In the PICU
During my last semester of nursing school, I did my preceptorship in a pediatric ICU in a trauma hospital. We took a huge variety of patients from all over the state as well as neighboring states. There were patients waiting for liver transplants, some on oscillators (for complete respiratory failure), and even some on extracorporeal membrane oxygenation (ECMO).
Nurses in this unit could choose to specialize in different patient diagnoses including neuro/trauma, metabolic (liver transplants, severe metabolic disorders), respiratory (patients on ventilator or oscillator), and cardiac (congenital heart defect babies). Once nurses had certified in all areas, they could specialize in ECMO. The nurse that I was precepting under had specialized in pediatric neuro/trauma which made for very interesting...and sad patients.
One of the patients that was particularly fascinating and horribly sad was a young boy who had been in an accident. This accident was so traumatic that it caused him to be brain dead. He was a good candidate for organ donation and the family decided to pursue this option. I was able to go to the OR with the donation team to watch the organ harvest.
Just prior to the start of this surgery, I had the opportunity to go to the neighboring OR suite and see the soon-to-be recipient of one of the organs. It was a sweet little girl who was literally bright yellow due to her liver failure. The family was so happy (and I'm sure conflicted because of the circumstance) at the opportunity for their daughter to receive a new liver. It was so surreal and strange to see such extremes in emotion all surrounding the same situation: anguish over the loss of a son and happiness at the opportunity for a healthy life for a little girl.
I was in the OR as they removed the organs of the little boy for donation. He was on the ventilator as the surgery was taking place. From a medical perspective, it was quite interesting to watch as they removed organs and prepared them for transplant. The human body is quite amazing. I hadn't watching any major surgeries up until this point. Looking at the inside of the body makes me feel a sense of sacredness for how perfectly it functions.
After the organ harvest was complete, the anesthesiologist simply turned off the ventilator. The young boy stopped breathing and his heart stopped beating. He was already considered dead because of the declaration of brain death, but in that moment it felt much more real. In all of nursing school, I had never felt such conflicting emotions about a single patient. How sad for this poor family, but happy for another?
I have also seen both sides of the donation process while working in the adult ICU. We care for kidney donation patients post-op, and we also care for brain dead organ donor patients. While in nursing school, I did not participate very much (due to my lack of knowledge..and no RN license) in the care of the donor patient. I think not participating in the medical care opened my eyes to feel more emotionally involved in the sadness of the story.
It sounds a little bit odd, but I'm glad that nursing isn't just a job to me. It seems like every few months there is a patient that tugs on my heart strings for one reason or another. Maybe they remind me of a grandparent or they remind me of what I envision my husband and I to be like when we are older. Maybe it's the audacity of pure, bad luck that breaks my heart.
Critical care donor patients are very medically unstable. It honestly leaves you little time to think about the grim nature of the situation. You are more focused on the vital signs, labs, cardiac rhythm, etc., and trying to keep their organs functioning properly. This is another element of nursing that I love...I am constantly learning and challenging myself to care for my patients the best that I can. There is always a new diagnosis, lab value, or pathophysiology to understand more fully. My understanding of the body directly correlates with my ability to properly care for my patients.
There are nights that are incredibly challenging, but I love being a nurse because it is constantly stretching me. I am challenged each shift whether it is by supporting a grieving wife or by increasing a hypotensive patient's blood pressure.
Each patient that I care for helps me to become a stronger woman and nurse.