During my years of working in the large urban teaching hospital’s Cardiothoracic ICU, I had been called to the Emergency Department to help on only a few occasions. This was one of those occasions. I chose Gail, a dear friend, and great critical care nurse colleague, to accompany me on this call for help.
It was the Fourth of July. We were told a severely injured male was in route from a fireworks explosion. Of course we immediately thought “some kids playing with fireworks.” Just prior to his arrival we were told the male was only 14 years old. Before the days of regional trauma programs, cases like this were treated in an Operating Room within an Emergency Department (ED), that is if the ED was lucky enough to have one. The young patient arrived by stretcher and was treated in our ED/OR accompanied by a group of the hospital’s best staff.
On first impression, he looked tan. Then we realized his skin was burned, mostly off. All of his hair, brows, lashes were gone. He had that unique odor that only burn victims radiate. That odor every ED nurse can recognize. The clothes, which remained were almost melted to his skin. Aside from the burns, the most obvious injury was a severely compound fracture of his right femur. The emotional defenses we all possess as nurses immediately came into play as we approached the individual body part and specific task we were assigned. These defenses allow us to operate during the moment on specific tasks at hand. They allow for nurse and patient survival, in the moment. IV lines were started. Blood was sent. Portable X-rays taken. Fluids were poured into every possible IV line. I went to work at his head.
I asked one of the people “What’s his name?” To my surprise, I received the answer from our patient. He responded in a whispery, raspy voice – “Joey.” I leaned down close to Joey’s ear and told him “We’re doing everything for you.” He attempted a grin. The grin was quickly followed by a grimace as a colleague of mine punctured his skin to start another IV. I asked “Are you having much pain?” He bravely replied, “Some.” My friend Gail and I had an instant, between hasty activities, to knowingly lock eyes. I yelled that we needed some morphine. A physician replied that we had to wait to check him neurologically. I said “ Then now is the time to do it, he is awake and in pain.” I listened to Joey’s lungs. The coarse sound indicated that he was burned internally as well. He coughed. Arterial Blood Gases were back. The Oxygen mask would not be enough to keep his body oxygenated with the extent of his lung damage. His respirations became labored. An anesthesiologist arrived, while I remained at the head.
Joey opened his eyes and looked at me. I leaned closer and gently touched his face with my hand. In his hoarse voice he asked, “Will I be okay?” Gail glanced my way again. What to say? I hesitated for what seemed an eternity, then looked down at Joey and replied “We’ll do everything we can to make sure you are okay, Joey.” Despite the excruciating pain, his gaze caught mine and he attempted another grin. A tear formed in the corner of his eye and fell down the side of his face. He rasped, “Thanks.” Seconds later he was medicated to ease his pain. The anesthesiologist skillfully passed the tube through his vocal cords in order to ventilate his damaged lungs and oxygenate his body. Immediately he was whisked to the OR.
I learned that Joey died some time later. One never knows when the connection we make with someone will be his or her last.
N.B. Later, we learned that Joey had volunteered to help at a fair with the fireworks display. A Roman candle misfired and landed in the truck where Joey was unloading the other fireworks. Joey’s family had been watching the display from their porch across a field and saw the truck explode.
Jim Kane, RN
In my career as a critical care nurse I identified a mentor Pat Reddish. Pat had a powerful and direct impact on my career. She was our Psychiatric Consultation Liaison Nurse in our large medical center where I worked in the Cardiothoracic ICU. Her compassion, wisdom and unique role inspired me. I later left critical care and pursued my Masters in Nursing specializing in Psychiatric Consultation Liaison Nursing, to a large extent due to the influence of Pat.
When compiling stories for this book, I naturally sought my nursing mentors. Pat was one of these people. She had moved several times, changed jobs and we had not spoken or had contact in over ten years. One of her prior secretaries helped me to find her. In our seeking contributors we sent sample vignettes, “Joey” was a sample. I never knew, despite our working at the same facility at the time, that Pat had even known about Joey until I received her contribution to this book, some fifteen years after the incident.
Among other things, these stories illustrate the unity of nursing as a healing force and perhaps help to find meaning in tragedy.
In the early hours of the Fourth of July weekend I received a phone call from a nurse in the Burn Center. A teenage boy had been severely injured in a fireworks explosion. His parents and grandparents were in the waiting room. At that time they had no idea how devastating his injuries were. I was the Psychiatric Clinical Nurse Specialist for the critical care areas of a tertiary care hospital. My role was to provide crisis intervention for the patients and families. With only a psychiatric nursing background I was truly a beginner. This was my first encounter with a major crisis. The intensity of the next eight hours and the relationship that I developed with Joey’s family would become the foundation of my learning about trauma, grief and healing. More importantly it taught me the meaning of being a nurse.
Joey died the next morning. I had asked his parents if they wanted to go see him. They refused. They did not want to see the damaged body of their child. I was unsure so I did not force the issue.
Over the course of the next few months and years I maintained my relationship with the family. I referred them to self-help groups that dealt with the loss of a child. I helped them find a family therapist to assist the family in their grief. Joey’s cousin Eddie had also been injured in the explosion. I referred Eddie to a child psychiatrist to help him cope with his own trauma and survivor’s guilt. As time progressed they also shared happy events and milestones. I was invited to Eddy’s homecoming after successful completion of Army basic training. I attended Grandpa’s 80th birthday.
Our contacts became less over the course of the next few years. Joey’s parents became very active in the self-help group for parents who have lost children. I now referred families to them. They were always available to share their knowledge, sorrow and hope with these families.
One afternoon in August 1986, Joey’s parents called me and asked me if they could see me within the next half-hour. They were at the county courthouse. Joey’s lawsuit had just been resolved. When they arrived we reviewed both the sadness and happiness experienced over the past six years. They were relieved and felt a sense of closure now that the legal proceedings were over. They wanted to return, for the last time, to the place where their child had died. My office was in the Burn Center. I had forgotten that his parents had never been in the unit. As they were leaving his mother said, “Joey was in room 15 wasn’t he?” I was surprised and asked her how she knew. She said, “I was too afraid to see him but I was with him. I hope you’ve always made a mother be with her child before he dies no matter what.”
This final visit was a powerful reminder of how we as nurses are permitted entry into those most intimate moments of people’s lives. Joey’s family permitted me to share their lives. They taught me about the intensity and endurance of grief. They also taught me that healing and hope endures. They helped me to develop objectivity, empathy and skills to help other families facing these devastating moments. They showed me that a nurse could heal wounds that can’t be seen.
Patricia Reddish, RN