The Language of Kindness: A Nurse's Story

by Christie Watson

When I started nursing, I imagined nothing more upsetting than caring for sick babies. But I look after a child who, for no apparent reason, has cardiomyopathy—an enlarged heart. A teenager. I watch her face, the tiny prongs of oxygen in her nose. She looks at the X-ray the doctor holds up, showing the size of her heart taking up too much space. She will not live. “I have too much heart?” she asks.

There is a tiny duct that is helping to keep the baby alive, their fetal underwater circulation. Usually this closes a few days after birth, but Baby Murphy’s duct needs to stay open. Oxygen can speed up the closure of this hole. If these babies cry, they let in too much oxygen.

Siobhan is fearless; touches his head feather-soft, smiles a wide smile. “My brother looks like a robot,” she says, looking at all the machinery and equipment. And Robert Murphy gets his name.

It is a multitude of experiences that make an expert nurse, but the ability to think deeply about them, and to search for meaning, is what a good nurse is often born with.

Wong’s Nursing Care of Infants and Children,

The Color Dictionary of Childhood Dermatology

I need this

Suffering, and even the sensation of pain, can be reduced by kindness. She found that giving a patient a window to look out of, or a bunch of flowers, will significantly affect their experience of illness.

At the time I am learning to nurse children, my mum is becoming a therapeutic social worker.

Rohan may have more chances of survival by living in a bubble, with extremely limited exposure to people. But at what cost? Later, though, I hear that Rohan’s bone-marrow transplant was successful and he made it home. I like to think of him in the park, on a bike, with the sun and wind on his face.

One who works in an office complains all the time about her difficult day. Another complains that his baby’s crying is worrying him so much, there might be something wrong. “Really sick babies don’t cry,” I say. I have decreasing sympathy for normal problems. Friends I grew up with ask about nursing. “It’s hard to explain,” I tell them. “You are changing,” they tell me.

Exactly

I can’t imagine what it must be like for him, for his mum, to be constantly reminded of the difference. He gives me a big smile, and his face is beautiful at once.

She tells me that the Glasgow Coma Scale is important, but there are other neurological signs and symptoms that the chart does not recognize, although her nurses must: a child who hiccups regularly, has a change of tone, becomes stiff or floppy, has a tense or bulging fontanelle, vomits, shows sun-setting eyes or has a parent or caregiver who reports a change. “Always trust the mother,”

A ventricular peritoneal shunt is one of the treatments for hydrocephalus,

Doug?

It doesn’t take long until I hardly recognize myself. It is impossible to describe exactly what I learn, though I know it lies somewhere between science and art. It is all about the smallest details, and understanding how they make the biggest difference.

neurofibromatosis

If the oxygen is set too low, or too high, the baby can develop retinopathy of prematurity, among other complications, and blindness can occur. If the baby’s oxygen saturation levels swing (these babies get nicknamed “swingers’), other complications can happen and can lead to multiple devastating injuries. If the suction is not available and the baby’s tube gets blocked, the baby can suffocate to death; or if the bag valve mask is not available, the baby becomes hypoxic and can end up brain-damaged, or with intestinal ischemia, or bradycardic (low heart rate); if the wrong-size mask is fitted onto the bag and pressed on the baby’s face, slightly too large, it can hit the vagal nerve and cause life-threatening bradycardia.

percuss his chest to check it is resonant (normal), hyper-resonant or dull (indicating a serious problem).

Babies keep their blood pressure at normal levels, for example, until they are about to have a cardiac arrest, whereas 80 percent of adults show clinical signs of deterioration for twenty-four hours before arresting.

A baby in serious respiratory failure will grunt, blowing out air in such a way that they are forcing their own alveolar in the lungs open in the same way as a mechanical ventilator, making their own PEEP (positive end expiratory pressure),

As we become physically stronger, life makes us more emotionally fragile.

Caffeine is a central respiratory stimulant and is widely used for small babies who suffer from apnea (periods of prolonged breath-holding).

Nothing better than a cuddle.”

Childbirth is like a soul splitting in two: that’s why it hurts so much. In not holding him, Joy is still missing a half of herself. He is not real, not whole, until she holds him. And nor is she.

She is unable to stand still,

Withdrawals or cocaine?

mess of sores on her arms

Heroin abscesses?

Her own eyes have yellow edges.

Yikes

spina bifida, a serious type of the condition that caused a myelomeningocele, whereby her spine and its protective layer have pushed outside her body.

It tells stories, if you listen hard enough, of the wrong kidney being removed,

Dumb

A heart cell beats in a Petri dish. A single cell. And another person’s heart cell in a Petri dish beats in a different time. Yet if the two touch, they beat in unison.

There are people, too, who donate a kidney while they are alive, well and simply want to save another life. A level of kindness that I can’t imagine.

There is a danger of forgetting what nursing is, what it means: the importance of providing care.

Kindness, empathy, compassion and providing dignity. This is what makes a good nurse.

But having spent most of my time as a children’s nurse, I’ve never got used to the violence with which adults vomit and shit and bleed.

Exactly

had a bowling-ball-size growth filled with hair and teeth and bones, removed with an ovary,

Are you referring to your child?

Spinal-cord patients like Tommy are at risk of autonomic dysreflexia, which is an abnormal physiological response to damaged spinal nerves, resulting in severe hypertension. It can be caused by something as straightforward as constipation or a kink in a urinary catheter, and so good nursing care is essential.

The most helpful task of all is to build a trusting and therapeutic relationship with Tommy and listen to him. Really listen.

It’s a terrible thing to happen. I can’t even imagine how you must feel. And I’ll do anything I can to make it even a fraction better. Take each hour with you. Each second.” I stroke his hair as I speak. “I am with you.

Right here, all through the night.” It is not enough, but it’s all I have.

We read Harry Potter and, as the story develops, his eyes close a little: he escapes a fraction.

Tommy’s mum also suffers with depression, his dad tells me. “We’ve been in a bad place. But maybe something like this puts everything into perspective. This kind of thing brings people closer. You don’t realize how lucky you are until something like this happens.” I try to let my head agree with him but it knows better.

This is ignorant and horrible. Whbat a POS husband and human being.

Her room smells of nail-varnish remover.

DKA breath more acetone than fruit?

If the acid level is too great, we produce hydrogen ions to neutralize it,

OPPOSITE OF CORRECT

giving fluid and insulin and bicarbonate, before we realized that this aggressive treatment was making children’s brains swell, hastening—if not causing—coma and death. DKA is now treated softly, slowly.

Sepsis is now understood to be the leading cause of maternal death in the UK.

I position her leg in front of me—it is cold and pale, like a twig from a dying tree—and screw an intraosseous needle into her bone, confirming placement with the sudden crunch.

Lactate is the level of acid in a person’s blood and the number is a reliable prognostic factor in predicting mortality from sepsis.

This will to survive—this overwhelmingly powerful and physical defiance of death—is one of the reasons I’ve always loved working in children’s intensive care.

Instead he curls around me as if he is two weeks old, and I hold the bottle to his mouth, staring down at him. It is the only time he gives me eye contact. The only time he feels safe. I feed him so many bottles, until he literally pops out of his Onesie like the Incredible Hulk: I figure that eye contact is more important than anything else at that time.

to have the capacity to love complete strangers.

“You don’t see this in other countries. Elderly people with nobody next to them. Living alone. Being cared for by strangers.”