I replay over and over in my head what I will do in each possible scenario to help this brave, little one make it through their first night.
I have worked in two very different areas of nursing now, but both with a surgical emphasis. And I’ve felt in both areas that caring for your first post-operative patient who just underwent surgery that day is almost like a universal “rite of passage”—a crucial moment of professional growth as a nurse. It is a moment that arrives generally after several months of experience on the unit with other patients first, and only once you and your trusted nurse mentors feel you are ready for this next challenge.
I currently work in the world of pediatric cardiac critical care. The small patients who have just gone through open-heart surgery (which is generally six or more hours long) are of the highest acuity and critical status on our unit. It can be incredibly overwhelming and difficult for caregivers to see their child hooked up to so many different machines, drains, pumps, and monitors, but it is our duty as nurses to try and ease that fear through education. Most importantly, we need to help families see that beneath all the wires and tubes and heavy sedation, their child is still there and still needs their love.
I thought I was ready. I thought I was brave until I experienced a baby battling valiantly through the shock of open-heart surgery. That to me is one of the many forms of pure bravery.
“Even the darkest night will end and the sun will rise.”
-Les Miserables
I arrive at your bedside. Your current nurse is exhausted. She sent you off to surgery, awaiting your return many hours later. Then there was the flurry of activity in your first few hours back in your room—stabilizing you, cleaning you up, and organizing the mass of tubes, wires, and drains protruding from your tiny body. And here I am to explain to your family that beneath all of that is their tiny baby.
I see you, caregivers. I see it in your eyes, and I hear it in your voices—the worry, the yearning to just be there, but overwhelmed by emotion and uncertainty, no matter how much you’ve prepared for this day. Try to trust us. Try to go and get some rest. Try to sleep. Try to replenish your energy. Take care of yourself, tonight especially. Your baby has been through so much today—but so have you. We realize that. Try and find some peace for tonight, and hear my promise to you, to your baby: This is not just any night, it is the FIRST night. The first night is going to be difficult, but we will not leave your baby’s side. She will not be alone, brave caregivers. You will not be alone, my brave little one. We are going to make it through the night.
It’s just you and me now, little one. I set to work, organizing, documenting, and assessing. No detail is too small to be acknowledged. Temporarily paralyzed and heavily sedated by medication, I look to the nuanced ways your tiny body communicates with me. Beneath the veil of medication, I know you are still in there. I know you can still feel pain, fear, and discomfort.
Am I hurting you? Are those little tears I see leaking out from the corners of your eyes? Why aren’t you breathing comfortably anymore? Is it because you don’t like laying on your left side? I know you don’t like it as much as your right side, but we have to try, just for a little while. How about if I move your little arm like this and your little pillow like this? Is that better? And now here comes a dose of extra medicine to ease that extra discomfort.
My goodness, you are so brave, little one.
Over the hours, I stare at the monitor screens in your room, vigilantly, as though I am engrossed in a captivating film. I watch the numbers change in real time, watching closely for even the slightest deviation from your baseline, repeating over and over in my head what I will do in each possible scenario that may arise tonight. Planning. Preparing.
Other nurses and doctors float in and out of your room. They ask about you, and they stand with me in silence watching the monitors. The solidarity of their presence strengthens me. They offer to relieve me, so even when I temporarily leave your side, you are not alone, little one. Just as I promised.
The hours tick by. I perch on the edge of the armchair in your room to give my aching feet a moment of reprieve. Not even on the chair by the desk just outside your door. What if something happens? It’s too far away, and she needs me.
I see your blood pressure drop. One point. Two points. Three points. A new baseline is established. Is this acceptable for her? Will her body tolerate this? I alert the doctor. He arrives at your bedside. We stand together, eyes shifting back and forth from the monitors to you. We pause, watching for another change, wondering if we need to intervene. Over and over we do this routine as the hours pass by. You wobble on a tenuous tightrope of physiologic stability. I see you, little one. You are fighting. Fighting through this night so valiantly.
It's 5:00 a.m. I am exhausted. My head aches from the mental exertion I’ve engaged in all night: making sense of the numbers and the changes, why they’re happening, and what it all means for your little body. I remind myself of your heart’s original physiology, how exactly it caused you to struggle in those first few days of life, and how your heart has been repaired by skilled hands and sharp minds.
But we’re almost through the night. Morning is coming, at last. You are stabilizing. I pick at, primp, and rearrange your tubes, wires, and drains, adjusting your position in the crib. A swipe here and a swish there, like a painter touching up their masterpiece. You are my greatest masterpiece, little one.
I should sit down. Relax a bit. But I can’t. Not just yet. We’ve almost made it through the night.
And now that moment is here. The sun has risen. Your new nurse for the day has arrived. To them, you look comfortable, peaceful, and stable. There is a sense of calm and transient serenity in your room. But you and I know better, little one. We know what it took to reach the morning.
You are small, and you are mighty—the bravest little soul I ever did see. Each night you are in my care, I will marvel at the new strides of recovery and healing you have made.
But for now, in this moment, we have done enough, little one. Together, we made it through the night.
Isabelle “Izzy” St. John, BSN, RN, CCRN, is a pediatric intensive care nurse at Children’s Wisconsin and is currently pursuing her DNP. She is a member of Sigma’s Eta Pi Chapter at the University of Wisconsin Oshkosh in Wisconsin, USA. A version of this article originally appeared on her blog, The Wordy Nurse.