I started my nursing career six years ago as a neonatal nurse. Most seasoned nurses would probably advise a new grad to start out as a nurse in a much more general field and then move on to something specialized like the NICU. I guess I just knew that it was the place for me. “My unit” has become a second home for me – my coworkers, like a family to me. It’s where I learned to be a nurse. It’s where I struggled through feeling incompetent and learning to thrive. In this past year, it has become the one of the places where I feel most comfortable. In the times when I don’t find myself in West Africa, I know it is where I belong. All that to say, I am a neonatal nurse – through and through. Give me a 600gram baby and I know what to do.
This week, in the Africa Mercy ICU, I have been taking care of Aminata who weighs a whopping 9 kg - which, incidentally, is double what she weighed when she stepped into the world of Mercy Ships about three months ago. Aminata is two years old. As far as taking care of ventilated ICU patients go, two is my maximum, so she made the cut. Her diagnosis, on the hand – cystic hygroma – made me slightly more uneasy. The only patient I have ever taken care of with a cystic hygroma was Baby Greg from Liberia. He was the first African baby to steal my heart and take it to heaven with him. I knew that Aminata’s diagnosis was by no means a life threatening condition, but it’s funny the effect that one significant experience can have on a person.
Aminata spent about a week after her surgery intubated and ventilated. As children tend to do, she lost her ET tube on Monday and bought herself a trach, which will serve as a temporary solution to her lack of airway due to excessive swelling dilemma. By Tuesday, it seemed that keeping her ventilated was causing her more distress than it was worth, so, the decision was made that it was time to wake her up (as it is referred to in the ICU) and give her a shot at breathing on her own.
At this point, it is important to keep in mind that my ideal patient size = 1/10th of Aminata’s.
Tuesday morning, we stopped the Ketamine and Midazolam infusions. We cut the Fentanyl by half. And we waited for it to happen.
And that is when the term “wrestling with an alligator” bounced around in my head for quite a few hours. Aminata went a little bit squirrelly. We tried different combinations and doses of drugs. We watched her closely. We sang, and held her head and rubbed her back and turned the lights down. We wrapped our arms around her and told her that she was safe. And she squirmed all over the bed. We finally won, but she didn’t go down without a fight. (I am fully aware that any nurse who has any experience with larger children, let alone adults will consider my sentiments to be somewhat exaggerated, perhaps even humorous…but keep in mind that I am usually able to contain my patients with one hand and use the other one to chart)
By yesterday evening, in just the way that makes me ever so happy to be part of this whole thing – she had come around. When her night nurse came to get report, Aminata was sitting up on the lap of one of our day volunteers, breathing room air, and maybe, possibly, even trying to force a smile through her impossibly swollen neck, tongue, and lips. When I leaned over to tell her goodnight, she reached both of her arms up at me in a purposeful motion and grabbed at my neck. She didn’t seem so much like an alligator anymore. She seemed a lot closer to a healthy, on-her-way-to-happy two-year-old; whose life I was blessed to be a part of for a short season.
Still, I hope that a 9kg alligator is the largest I ever have to face.