Holding it all in

Last week I found myself forwarding my mail to the local trauma center PICU. I had arrived early that morning to a busy unit, nurses running everywhere, kids crashing... A kid being put on on oscillator, your general business. Somehow, a little boy who had yet to see his second birthday, had ended up there too just like me. I walk into his room, no one is there and I look down at this kid mentally throwing up the daily wall. Hey little guy, its you an dme for the next 24 hours... what do you say? Ok, first things first... Apnea exam... This gets done with lightening speed as all things do in the picu. I meet with the childs mother who stares at me with tears in her eyes and asks what he can donate. I explain in a shaky voice, even though I have done this a thousand times that he is so young that he could give other children the gift of life through his heart, lungs, liver, intestine, and kidneys. She starts crying, the childs father is to her left with his arms around her attempting to be supportive. I wonder if I ever would have the strength to make this decision about my own children. I notice that her hair is unwashed, her clothes are wrinkled, she has dark circles under her eyes and I wonder again how long she has been by his bedside hoping for a miracle. The consent process seems to take forever, the room is dark, my gaze drifts out the window to the city, and I remember looking west while mom thinks over her decision. Slowly she initials the blanks next to what she will give. I dont know if my hand would work if I were in her spot. No matter how many times I have done this, it NEVER gets easier.

A few hours later, mom decides she would like to see her son after surgery... My reaction? oh no, not again. I have done the dressing of the dead child after surgery before... very low on my most fun list. I try to talk her out of it. Do you know what he will look like? The color, the lifelessness, the lack of warmth... I explain all these things. She seems to think about it, nodding like she understands what I am saying and that it is logical as she is laying next to her son in bed. I walk out wondering if I would want to see my child afterwards. A nurse is standing outside the room with a couple others, they have heard the conversation inside. She says "No one could stop me from seeing my child if it were me"... weird. I would never want to, but then again how do I know, my kids are home, alive and healthy. So I really dont know how I would feel unless it happened.

Much later we prepare for the OR. Mom is still laying in bed and she has decided to see him later after we are done. My stomach twists at the thought. I can do this, I say to myself... and luckily the childs nurse is coming to OR with me, she would like to see the process, but we have bonded and we can do this together we agree. Every now and then I meet some very cool nurses, she was definately a keeper. The process of leaving the room is how you would expect and more. I try to hold back the tears, but they come anyways as I tie up loose cords and unplug the bed. By the time we roll out of the room, I am already mentally exhasted but know I have a few more hours to hold it together until I can sit in my dark car and have a good cry on my way home.

After the usual shenanigans in the OR by a transplant center of another state, its finally done. Or nurses are cleaning up the room and the childs nurse and I give him a warm bath, whiping off all the old blood and trying to cover up any sutures and incisions. I place a cap made of cast stocking net on his head and smaller sections over the IVs on his arms. He is an MEs case so it all has to stay in. I even put one over his ETT tube trying to cover that also. We wrap him in warm blankets as his temp is quickly dropping, dress him in a gown and I place him back on the bed he came in. We wheel him back into the PICU... utter silence as we come in the doors. I feel like the grim wreaper walking down the hall. We turn into the room and mom is waiting. She crawls into bed and holds her little boy in her arms. I think it might have been completion she needed, something to show her he was truely gone, to see with her own eyes he is gone. I finally left the room and leaned against the wall in the hallway wishing I was in my car so I could let it go. Its getting really hard to hold it in.

I gather up my stuff, its been a long shift. Its 6am, an hour left to go in my 24 hours of call. I just want to go home and hug my children, feel their warmth and life. I thank the staff and trudge to my car and call my husband to talk me home because I am afraid I will fall asleep and run my car into a tree.

At home, its still early. My kids are still asleep... I creep into their rooms just to look at them, assure myself they are there and to watch them breath. They are so warm under the blankets, their nostrils flare with proof of life, there is no wires, no tubes, no incisions. I take a deep breath, kiss them good morning and head to the shower to let it wash away some memories. I know there is so much good that came out of this, and I try to focus on that as I drift asleep.