CHLA 2015 Nurses’ Week Essay: Nursing at CHLA – How We Go Above and Beyond

I incorporated part of a blog post from last year as part of my tribute to all the nurses I know for National Nurses’ Week 2015. Our work is not well-understood, and as a result, neither are we, as the ones who not only do but *experience* the work for all its beauty and ugliness, joys and pains. But nurses are some of the most amazing people I know, and I am both proud and humbled to be a part of this profession.


“How is work?” It’s an entirely ordinary question, a part of entirely ordinary conversation, which is why it can be so hard for nurses to answer. Most of the time, I give the simple answer, for my ease and perhaps more so for the ease of my listener. “Work is busy. It gets a little crazy sometimes. Hard? Yes, sometimes it can be hard. But it’s rewarding.” It’s a palatable, expected response from a nurse. The person inquiring about my work is usually satisfied, and the ordinary conversation moves on. But as a nurse, I am left uncomfortably unsatisfied, as that simple question has triggered a quiet but loaded myriad of thoughts, memories and emotions regarding my patients, their families, their stories, their implications, and my role, all so profound and complex and significant. What we see, what we hear, what we do every day we come to work at CHLA, it is extraordinary. The real response to that ordinary question would only just begin to tell the listener how nurses at CHLA go above and beyond, every single day.

“How is work?” I spent a day caring for a child severely abused by adults who were given a chance to honor his innocence, and blew it with their own anger, their own immaturity, their own unresolved pain. He wanted milk and then he didn’t. He wanted to walk and then he didn’t. He himself didn’t know what he needed, and all I wanted was to quiet his confused heart and reassure him that his wishes would never be disrespected again. I wanted to fix it all. Fix his life, fix the system, fix this awful complicated situation, fix it all. On any given day, a CHLA nurse might tell you how he or she went above and beyond by encountering head-on the reality of what most people cannot fathom, and quite truthfully, often try to ignore, with regards to the cruelty that can exist in this world towards innocent children. We hold children who may have never been lovingly held until now, here, in our care. With our hands, we gently tend to wounds inflicted by other human hands. With our hearts, we perpetually carry an inexplicable, unpredictable sorrow because we have made ourselves vulnerable and open to extraordinary suffering, with extraordinary compassion that says to a child, Here, let me take some of your pain. In return, I will give you everything I can that is good. Balm for your wounds. Advocacy for your powerlessness. Tenderness and opportunity to enjoy simple but necessary play, for all that you have been deprived of in life. I will be hungry today so you can be fed. I will be weary so you can rest. I am your nurse today and I will go above and beyond for you, sweet child. So that you will know you are worth it. Please know, you are worth it.

“How is work?” I spent a day with a child who was not well. He got really sick, and then he got a little better, and then he got a lot worse. The doctors and I looked at the monitor, and they told me I should probably go get more help, in that calm, sober voice that PICU doctors use when they recognize what is starting to happen. I went to get the crash cart and I had to pass by the parents. I could feel their searching eyes on me. I could not look at them. I always thought that would be my strength, reaching out and bravely giving the parents the respect of eye contact, acknowledging their fear, giving them some kind of expression that would tell them, as your child’s nurse, I’m going to help, I hope I can help. I could not look at them because I was afraid my eyes would tell them I’m sorry for your loss, before it was time to say I’m sorry. The numbers on the monitor were not good. It was my first time doing compressions. It was just like all those CPR classes, but it wasn’t, really. It mattered now. The two longest minutes of compressions finally were up and we looked for the rhythm. It wasn’t good. Two more minutes. No. Two more. No. Two more. No. Two more. No. Two more. No. Two more. No. Two more. No. Two more. No. No. No more. I turned off the pain medicine, the heart medicines. The parents had been at the doorway the entire time. The nurses and doctors quietly stepped away from the bedside to let the family come say good-bye. “No me dejes!!! Tu eres mi bebe!! No me dejes, mi amor…!!” There is no sound that exists in the world like that of a mother’s cry for her baby to please, don’t leave me! I barely kept my composure long enough to take off my mask, gown and gloves before leaving the room. A coworker found me and I rested in her arms for a long while. We carried each other’s heaviness. On any given day, a CHLA nurse might tell you how he or she went above and beyond by summoning the courage to come to work, fully aware it might be the most dreaded day of tragedy for a family walking on tenuous ground, and it might be that nurse’s job that day to go above and beyond in order to try and prevent such tragedy. Today, I came to work burdened with my own life’s worries. I often feel I don’t know enough. I always wonder how I can do my job better. But today, again, I resolve to go above and beyond. To be alert. To be quick. To be smart. To be brave. To be strong. To be tender. To be everything, sometimes literally everything, my patient and family needs to hold onto life as they know it, in those extraordinarily crucial moments. And even when that is not enough to save a patient’s life, I need to have the courage and grace, above and beyond, to be kind to myself, and come back to work for the next day’s challenges.

“How is work?” I spent a day with a once vibrant teenager who suffered a severe spinal cord injury from a random diving accident. I watched his stoic eyes take in the MRI images as the neurosurgeon quietly, clearly explained why he would likely never walk again. I watched his stalwart father crumple his face into a pillow, shoulders heaving with muffled sobs, half-hidden by the curtain in the room. The surgeon quietly left the room and I stood there as their nurse, carrying the weight of their world on my heart, searching, praying for the right words to carry us through the next ten hours together. On any given day, a CHLA nurse might tell you how we go above and beyond in those shifts when we meet a family for the first time, just as the entire trajectory for their future has been tragically sidetracked. We have to gauge the most personal and sensitive emotions in a family we have only just met. We have to find words for a situation in which it feels no appropriate words exist. We have to begin to lead them down an unfathomable road. In light of all of this, I go above and beyond simply by being present as your nurse today. I will be here, with you and for you. It may break my heart and challenge me to rethink so much of what I know about life and goodness and hope, but that is where you have found yourself as well, so I will go on that journey with you. I will go above and beyond and I will not leave your side, because this is my work, and this is my heart. I am your nurse.