Memoirs of an Emergency Nurse (7 page)

T
he most beautiful
child
I have
ever
set eyes on
was a
little
blonde girl
,
aged
three
when I met her
.
S
he had a stunning head of pure
soft
blonde ringlet
s
.
To this day I
can
still remember
all sorts of details about her
.
H
er name
,
her
mother’s
name, how many brothers she had and what her favourite colour was
.
It was pink
.
It suited her
soft snow
-
white
skin tone
.
She seemed just the type to like dressing up like a princess and would look fabulous in dress up clothes
.

I
had taken over the shift from my
colleague
and
I
was in the resuscitation room again. I was given handover just a few meters away from the baby and her mum
.
The little girl was
disconnected
from all the monitors and was laid on the colourful paediatric mattress which measures
children’s
weight by how tall
the
child is laid on the bed.
She was small for her age and as her mum and I helped to dress her
back in her clothes
,
I noticed that her sleeves
were too long.
I
rolled up the cuff so that we could hold her small hands
.
Her m
um was telling me how much she loved having a little girl, she was very feminine and not at all like her brother and his boisterous temperament
.
H
er smile made people laugh.

The pretty girl
had been
born with a congenital heart disease and
,
despite several surgeries and numerous
medications
,
she wasn’t given a hopeful life expectancy
.
Her mother talked fondly of what they had done over the past week and that today they
had been
planning to
visit grandma
.
Her dad had decided to go home and mum was happy to stay at the child’s bed
side while the nurses organised things
.
It was early morning and the sun shone through the windows, lighting and warming the oversized mattress above the girl’s head, setting off her
blonde
soft curly hair
with a
halo of
light
.
Mum kept hold of the little one
’
s hand and smiled at her through tears
.

When
I met this little girl
,
she was
already
dead.

Few people
,
when sitting impatiently in the waiting room,
can appreciate what goes on in emergency
.
Behind closed doors
,
I treated this little girl with dignity and respect, taking time to make her look beautiful again despite
the fact that
her temperature
was
cooling
and
she was
not talking back to me
.
I brushed her hair and wiped the blood from her arm
.
I changed her nappy and ensured she was cuddled in a blanket
.
I counselled
her
mum and gave
her
information about registering
her
death and
making
funeral arrangements
.

I recall the air was crisp that morning
but
the sun
was
warm
.
I
t
was
so peaceful in
the
quiet
resuscitation
room
.
I
comforted
her m
um
,
who was by the
baby’s
side until
grandma
arrived
.
The family stayed with the baby for about two hours and after
grandma
had said her goodbyes, they went into
the
relative’s
room to
comfort
each other while
I
attended to their precious little girl. As
is the
usual process for dead children
,
I
asked
the
family if they would like a lock of hair and footprints for keepsake
.
W
ith delicate care
,
I
snipped a small piece of soft blonde curl
from
the back of her head and placed it into a plastic
ziplock
bag. I also got a
colleague
to help me stand the little girl up and take footprints. We applied
the
invisible ink to each foot and stood
the
girl up
so we could
firmly press her footprint into a folder piece of white card. I wrote her name, her age and
the
day’s
date on th
e
card in my neatest handwriting. The footprints were tiny
and barely filled the A5 card.

The family were
overwhelmed and drained of emotional energy
when
I
gave them the footprints and lock of hair. The doctor and
I
talked them through the next steps of investigative post mortem treatment
, and then
they said their goodbyes for a last time, kissing the little girl on the cheek. They asked me to look after her and
I
said
I
would give her my best care.

The doctor had ordered full body
x-rays
of the girl as part of post mortem investigations,
so I
phoned for a room to be made available and
told
them I
would bring her around.
She was so small that I was able to carry
her instead of taking her on the
trolley, so
I
wrapped
the little girl in a blanket and
held
her in my arms
down the
corridor to
x-ray
. I was met at the door by
a
friendly radiologist who closed the lead doors behind me.
I gently laid her on the bed
. The radiologist commented on what a beautiful girl she was and we both position
ed
her body on
the
x-ray
plates. We had several
x-rays
to take but we didn’t take long. I remember
lifting
the girl back into my arms and her cold face touched against mine as
I
walked her back to the
resuscitation
room.
I then placed her back on the colourful mattress she had been
lying
on
before
.

The notes
had
already
been
finalised by
the
doctor and blood had already been taken by
the
night shift during
resuscitation
.
I
had no other investigations to undertake
so
I
finalised my notes and called for
the
porters to bring a
Moses
basket for
the
girl to rest in
.
I placed two arm bands on her
with her name and date of birth written on, one I placed on her right arm and the other I placed on her opposite leg
.
T
hey
were red, as near to pink as I could get
.
I wrapped her
cold body in a sheet
,
ensuring that her face was the last to be covered
,
and
then
taped
it
in place. The porters didn’t take long to bring the Moses basket and in it
,
there was
a brightly coloured knitted blanket which I wrapped the little girl in. The staff member who had helped me take the girl
’
s footprints had
picked
a few flowers from the nearby garden and taped them tog
ether
to form a small bouquet. I placed this on the little girl’s chest and handed her over with her documents to the porter to take to the mortuary. He said it is so sad when a little one dies
and
he would treat her with care
,
as if she was his own
.

I came onto my shift at
7am
and couldn’t find the night staff
in the main department area
, so I had a leisurely stroll round the department and found them all in the resuscitation
.
A
female had been brought in with a very fast pulse
-
160bpm (tachycardia)
.
O
n
awaking at
6am
,
she had
the
feeling her heart
was
leaping out of her chest
.
She
and her husband came to emergency as soon as they could
and
.
s
he’d
only just arrived when I
entered
the room
.
She
had
a
good skin colour, was breathing normally and didn’t look in pain or distressed
.
             

The night staff took a tracing of her heart
,
measured her blood pressure and connected her to a continual pulse ox
i
meter
.
I introduced myself to the patient and took over from the night staff
.
I attached her to more monitors so that a continual tracing of her heart rhythm show
ed
on the defibrillator monitor
.
The patient herself had said that she had an episode of tachycardia previously and the doctors had to give her several drugs to slow her heart down
.

The patient was worried about
whether
she’d done the right thing or not by coming into hospital
.
She
rationalised that by
saying that if she’d
call
ed
the GP
,
he would have only said to come into emergency
and thus would have
delay
ed her
arrival
.
I agreed with her that she had done the right thing getting here straight away and informed her that if she ever got chest pains
or the same symptoms
and she
c
ould
n’t
get here quickly, to call an ambulance as they can give essential drugs on th
e way
.
The poor lady
was
feeling her heart beating out of her chest and yet she was
wondering
if she’d done the right thing by bothering us
.

The doctor had referred her to the medic
al team
and the protocol
was
to discuss
things
with the medical senior house officer prior to starting any infusions
.
The patient was young and was more likely to be stable so she could afford to wait to get a cardiologist review.
T
en minutes later
,
the medical
registrar
arrived in the emergency department
.
He
had had no sleep and was on auto drive
.
The
emergency
doctor gave hand over
to
the
cardiologist
and he
took over her care
.
He looked at
the
monitors and spoke with the patient before making the decision to commence an infusion of Amiodarone to try and encourage her heart into normal sinus rhythm
.
The patient was quite relaxed and calm even though her heart was still racing at a hundred and sixty beats per
minute
.
Her
husband stayed by her side throughout and was a great comfort to her
.

As I started the infusion
,
I continued to monitor her observations and look out for any reactions
.
The
doctor had clearly explained what the drug should do and if
there were
any side effects to tell the nurse and we w
ould
stop it
.
The drug continued without
any
problem and the patient
’
s pulse began to drop slowly
.
The patient continued to feel better and had less of a pounding chest feeling. There was no need for her to stay in emergency with the infusion running so I called for a medical bed and transferred her without delay. B
y the time we had transferred her into
the
coronary care unit
,
her pulse was a hundred and twenty
;
still crazily high but lower than before.