Refreshing Integration

Fall is upon us, bringing a multitude of coughs, sneezes, and gastrointestinal disturbances. Needless to say, the volume and acuity of our ER patients has changed yet again, creating a gridlock of unhappy patients and family members. Just a few weeks ago, we were holding over thirty patients for admission. My hopes of maintaining a positive demeanor at work has been challenged more than I had anticipated. Winter is supposed to be our busiest time. How am I going to ‘cruise' through this season knowing that the worst still lies ahead?

The past few weeks, I have been working primarily in the Pediatric Emergency Room. To be honest, this is where my heart can be found. Though I love all aspects of emergency care, from triage to trauma, there is something in Pedi Nursing that beckons me. Some people balk at the perceived threat of parents' watchful eyes. Others fear the smallness of the patient's every body part. I thrive on it, knowing that, more often than not, I will actually be able to see the fruits of my labors. Children are notorious for rebounding from illnesses quickly; it is instant gratification at its best.

There are times, however, when answers cannot be found. Working with a new graduate one night, I found myself faced with a challenge I had previously chosen to run away from. It was a busy night-one filled with IV starts, fluid boluses and albuterol updrafts. Babies were crying and parents were angry from waiting. In the ER, it can be so easy to forget how to care. The nurse, Jess, I was precepting helped me to remember the pledge I had made to myself merely weeks before with one simple question, "What is ‘ALTE'?"

"Oh, that," I said casually, waving off the diagnosis. "It just means that the baby had a witnessed episode of MAYBE not breathing. It stands for Apparent Life Threatening Event."  I ran off to check on other tasks that needed to be done, leaving her to ponder what may or may not have happened at the family's home. But, her question stuck with me and rang through my head numerous times, before I finally took a moment to really explain it to her. It was then that I realized I had forgotten to address the needs of the parents, who were too scared to ask for help. I made a mental note to check on them soon.

Moments later, I walked into the room to complete the admission paperwork. Dad was holding the sleeping baby; mom was pacing. At that moment, the baby decided to demonstrate what had brought him to the ER in the first place.

Dad yelled, "He's doing it again!" Baby did not startle.

I looked down and saw a pale, limp baby. Instinct took over and I sternally rubbed the baby as I instructed Dad to lay him on the bed. Slowly he began to respond and opened his eyes. After what felt like an eternity, he cried.

"How are we ever going to let him sleep again?" Dad turned to me for the answer.

In the past, I would have deferred that question to the doctor. But, alas, I remembered the bottle of refreshment that I had stored during my last vacation. I uncorked it, took a chance and sat down next to the parents. "Honestly, I don't know," I sighed. "What I do know is that we are trying to find a cause. Right now, we are trying to rule out infection. Beyond that, we just have to go step-by-step and see if we find anything wrong."

Both parents' eyes opened wide in shock. "If you find anything wrong? What if you don't, then what?" The terror was plastered to their faces, breaking my heart more each second.

I droned on about tests and apnea monitors, knowing I was only trying to fill the space with some answer that may not exist. Until, finally, I relented, "As much as we try, we don't always have definite answers. It may be 2007, but there is still a lot about the human body that we do not understand."

Dad then asked the ultimate question: "Is this what causes SIDS?"

"We don't know," I said cautiously, knowing that his sanity hangs precariously in the balance. "That is why you are here. We are going to do everything we can to make sure your baby is ok and stays that way."

A visiting family member looked at me and quietly said, "Well, at least you are honest."

It was then I truly felt the power of nursing. I began to wonder how many of our patients exhibit anger and frustration merely because they feel we are not being honest with them. It was very hard to give that part of me away, but the gratitude in their eyes, as they were escorted to the children's unit, was far more rewarding than the ease of shrugging them off. The crew on my cruise ship was right; one person satisfied can make every sacrifice worth it.

The more I think about it, the more I realize how frequently I see infants admitted with the diagnosis of ALTE. It has led me to learn as much as I can about this problem as well as SIDS. I found a few web sites that were useful to me and wanted to share them:  Apparent Life Threatening Event is explained here: read and explanation of apparent life threatening event and more on SIDS.

I want desperately to be able to save the world; maybe that is why I went into nursing in the first place. But I think I have found what can keep me here: the patients and their families. Taking vacations and learning to relax will probably help me as well. I also think the secret lies in remembering that we are all human and small offerings can go a long way.