Pediatric Dream To Pediatric Nightmare

I went to nursing school for one reason. I wanted to be a pediatric nurse for the rest of my life.  I loved my pediatrics rotation in nursing school, and the time I spent volunteering on the pediatric floor on Sundays (also during nursing school).  I babysat a lot as a teenager, and worked in the church nursery for 11 years. Then the real world and real life happened.

I moved away from the Midwest to Texas in late 1985.  The hospitals there didn’t have pediatric floors at that time where I lived, so whatever the kid had wrong with them, they went to the floor that dealt with that problem.  I worked in neurology/neurosurgery, so I got the kids who were neurologically impaired/sick.  A four year old near-drowning was my first ‘real’ sick kid.  She’d never recover.  At four years old her life was over.

The next 16 years, I worked with various types of patients, including adolescent psych and general medical surgical patients in a community hospital.  In adolescent psych, it was rarely the kid who was the train wreck, considering what they came from.  I timed contractions on a 12 year old who was carrying her dad’s baby.  She was terrified (understandably) and would never be able to erase that part of her life.  I also worked with a kid whose step-dad bit his finger off because he got upset with the kid.  The kid was remarkably pleasant, and didn’t have a resentful or  defiant personality.  Wow. Survivor.

When I moved back to the Midwest for family reasons, I was thrilled to be offered a full-time job on a pediatric floor.  Once I’d finished orientation, I’d be floating to the Pediatric Intensive Care Unit (PICU) for any critically ill child, and also Neonatal Intensive Care Unit (NICU) with the preemies.  I couldn’t wait to get started.  After 17 1/5 years of being a nurse, I was finally getting to do what I’d really wanted to do.  My previous experience was incredibly helpful, so it wasn’t a wasted 17  1/2 years. Not by a long shot.

I hadn’t anticipated the horrendous circumstances surrounding the majority of babies and children I encountered.  The congenital limb deformities, ambiguous genitalia (can’t tell for sure if they were girls or boys), organ failure (and the skin color literally that of Kermit the Frog in bright sunlight), the horrendous abuse cases on babies as young as a month old, and other terrible accidents and neglect.  We did have the ‘routine’ tonsils and appendix removals, but those weren’t the norm- most of them don’t get admitted for those surgeries anymore.   Most of the kids that came through there were going to be permanently disfigured or chronically ill.  Some ended up in the local children’s nursing home.  And those NICU babies that had permanent disorders from being premature had to go somewhere when they got sick. Again.

A ten week old baby shouldn’t have a broken leg (in a tiny cast) because mom’s boyfriend got mad and tossed it off of the couch after twisting its leg.  A six pound, one month old baby who had weighed more at birth, and gone through heart surgery, shouldn’t be left in a room, tended to mostly by the household pet who would react differently when the baby smelled too much, thus alerting the ‘parent’.  A fifteen year old shouldn’t be twisted in muscle contractions, in a vegetative state due to some fluke illness years earlier.  A first-grader shouldn’t have the skin tone of a kiwi fruit because of a failing liver. A toddler shouldn’t have part of its scalp torn off from a very random accident involving a hot tailpipe, and not being seen when the car was backing up. That kid actually was lucky in a bunch of ways… staying alive with no permanent brain damage was pretty significant.  If it was on the news, I met the baby/kid in the story.

Babies shouldn’t be born three months early.  They shouldn’t be considered ‘big’ at four pounds (but considering the babies that weighed 1/4 of that, they were huge in that NICU environment). They shouldn’t be born with only parts of their heads formed, and not visited by their parents like the ‘normal’ preemies. They needed to be held and cuddled, too.  Even if they’re a mess.  They still can respond by calming down, and nestling into the arms of a stranger called a float nurse.  Don’t they deserve that?  Why did the charge nurse thank me for just treating that little partially-formed headed baby like a b a b y ?

A two year old shouldn’t have scalded genitals and buttocks because another boyfriend of the mom decided to dunk it in hot water, and hold it there. That two year old should have cried during dressing changes. The kid had no skin left on that part of its body.  The kid had already learned that crying was pointless.  That kid should have been laughing and smiling when interacting with adults- not looking for some sign of impending abuse. At least that kid was loved by the staff- and before leaving was guzzling juice and eating all the Cheerios he/she could eat.  The kid was very good at hollering and directing traffic in a high chair at the nurses’ station before being discharged to foster care.  That was a good thing. The kid got some ‘normal’ before leaving.  It’s sad that ‘normal’ didn’t happen until being in the hospital as a crime victim… at age two.

I hated when I got a call that social services was bringing a mom up for a supervised visit. This would be a mom that allowed her boyfriend to abuse her baby.  This would mean I’d have to be there to defend the baby. I hated when she showed up and was not much more than a kid herself, and had the ‘deer in the headlights’ look on her face.  She didn’t really know what was OK to do to a kid, or what her boyfriend was capable of doing. She’d probably been raked over the coals when she was a kid. That never excused anything, but it could explain some things. And for those moms, there was usually more hope in that she was teachable.  The interaction with the babies I saw was positive, when the moms bothered to show up at all. But mom was damaged as well.  It was lousy all around. I hated that my anger wasn’t justified by some monster showing up.  I just had more ‘kids’  to be angry about.

I ended up leaving for many reasons (one was my own declining health; another  huge one being the cut in hours in the summer when the kids weren’t in school giving each other all sorts of contagious diseases).  The abuse was a factor.  Injuring a child just didn’t mesh in my head.  I got very protective of those little kids.  Their crime was existing, and that’s not good enough to justify their reasons for being hospitalized. Nothing is good enough to explain hurting a kid.

Pediatrics was a good experience in that I got the experience, but overall it was a tragic mingling of chromosomes run amok, congenital mayhem, and sociopathic people in the kids’ lives.  I’m glad I worked there, and saw what is out there.  But my dream job ended up being a horrific showing of the worst of things that can happen, either biologically or by psychopathy, with an innocent baby or child on the receiving end.

I have a lot of respect for the vast majority of the nurses I worked with on that pediatric floor, the PICU, and the NICU.  It tore me up.  I know those other nurses cared as much as I did, but they handled it differently.  Most had their own families.  I was single and didn’t have kids, so there was no ‘balance’ of how kids should be, living at home.  I didn’t have distractions to make my life less one-sided.  It was all about those babies and kids.

Something for the nursing students and new nurses out there: You don’t see the full job when you are a student.  When you are new, everything feels crazy for up to several years (there is a LOT of information to put together to make you a fully functioning, competent nurse).  Don’t judge what you think you want to do based on what you think it really is.  Wait until you know your strengths before deciding what is the best place for you.  I spent 11 years working in a church nursery, and went to nursing school wanting to take care of precious babies.  I just hadn’t anticipated how they got to the hospital.  Keep an open mind about where you fit in the nursing profession.  It’s never how nursing school shows it.  I hated geriatrics in school, and loved my nursing home jobs as an RN.  I didn’t think much of drug and alcohol rehab or psych when I was in school, but truly enjoyed my five years combined of both.

You don’t know what you will like until you really know what it is you’ll have to do. 🙂

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