The Fascinating World of Pediatrics

When I was a child, I often had severe asthma attacks that required trips to the emergency room. I would be the type of kid that would delay seeking care, convincing my parents I was fine until my airways proved to them otherwise. I didn't want to be a bother as I knew we would be spending a couple of hours in the ER, waiting for the Ventolin nebulizers to finally take effect. My usual hospital visit would consist of being triaged very quickly (the system of prioritization used by healthcare professionals involves the ABCs - airway, breathing, circulation), having my lungs listened to at multiple occasions, wearing an uncomfortable face mask that would produce mists of bronchodilators, and finally getting to eat arroz caldo that my dad had prepared for me when I was able to take a nice full breath of air.

One day, when I was 10 years old, I remember lying in bed and feeling a slight tightness to my chest. Given it was winter season, the cold weather at times triggered my asthma. I took my puffers and resumed my usual activities. As an hour passed by, I realized that I did not feel as much relief I normally did after taking my pumps. So, being the stubborn child I was (and still am!), I put on a strong front and pretended I was breathing just fine. Four hours later, when I was able to take my puffers again, I gave myself another dose hoping this time it would work. It didn't. Throughout the day, I remember getting more and more worn out as I would try to breathe in as much air as I could through my near-shut windpipes. Exhausted, I could barely keep my eyes open. I took rapid shallow breaths. My wheeze became difficult to hide, and it was loud. My mom looked at me and asked me if I wanted to go to the hospital. I told her I would be fine (I knew I was lying). Mom tried to convince me to change my mind. I said I would try to take my puffers again and see in an hour. After a half an hour, my chest further tightened. Tears began trickling down my eyes as air barely entered my lungs. It was time to go to the ER.

When my parents brought me to the triage area, I remember the look on the nurse's face. She immediately jotted down the history from my mom and assigned us a room within two minutes. I was put on a stretcher and a face mask was applied on me. As another nurse assessed my lungs, he asked me, "Did somebody sit on your chest?". I nodded no. Everything else became a blur. It was the first and only time I had to stay overnight at the hospital for my asthma exacerbation. Although it felt like I was dying, I remember feeling safe and taken care of. When I was discharged the next morning, I thought to myself "I want to do that when I get older - take care of people."

---

Fast-forward nearly two decades later, here I am, a nurse who finished her orientation period at a pediatric intensive care unit (PICU). I must say, when I first began nursing, I told myself that I would only work with kids near the end of my career, preferably in oncology/palliative pediatric care (I know, bold choice). However, when the opportunity arose to transfer to the PICU, I decided to take on the challenge. When I announced the news I would be working in this department, the response I would get from most would be: "Aw that's so sad, working with sick kids", or "I could never work with sick kids, it would break my heart". After a month and a half of experience taking care of this new patient population, here is what I have to say.

PICU nurses are a different kind of breed. Not only do they require to be mathematicians and dilution experts (medications are weight-dependent), they possess an insane amount of knowledge, patience, calmness and thoroughness. From dealing with newborns all the way to teenagers, they seemingly adapt their communication styles to fit the age of their patients. They also are able to be a reassuring presence for parents who are anxious out of their minds for their little ones. They can bottle feed, burp, swaddle and rock babies to console them. They have exceptional bargaining skills with toddlers and schoolchildren (stickers, popsicles, games, you name it!). They can do whatever nursing skills done in the adult world, with smaller-sized equipment (IVs, blood draws, suctioning, etc.).

The young patients, however, are what brings the biggest joy to the hospital setting. Although there are many heart-wrenching cases in the PICU, it's the resilience of the youth that keeps the pediatric healthcare professionals going. Despite being ill, the children can still smile, laugh and play. Some come up with witty responses that become reassuring signs of improvement in their health. Overall, the saying "small but powerful" speaks a thousand truths on pediatric wards.

As a newbie to the pediatric world, I must say that I am in complete awe and admiration for these kids. Right from the get-go, I have witnessed many things that I was aware existed in the medical field. However, seeing these conditions and treatments used on children felt surreal. Heart surgery on a month-old baby, mechanical ventilation in a two-year old, myocarditis in a six-year old, ECMO on a thirteen-year old … Yes, these diseases do not discriminate. Still, just like adults, these children fight through their ailments one day at a time.

---

One particular patient I took care of reinforced my preconceived notion that kids are capable of understanding difficult situations much more than we, adults, expect them to. She was a four-year old girl diagnosed with Guillaume-Barré syndrome. She was paralyzed from the neck down and intubated due to inability to use her respiratory muscles to breathe. She had no cough or gag reflex, which required thorough and frequent suctioning to manage the accumulated secretions in her lungs. She would raise her eyebrows, nod or use her eyes to communicate with us. We would explain to her what we were about to do, whether it was to change her position, suction or use the "cough assist" machine. She understood and give us consent to suction as she knew it was best for her. Occasionally, she would be teary-eyed, but we continued to reinforce how strong she was.

Once during my shift, I wanted to change the position of her oxygen saturation probe. As a little test, I asked her "On which hand do you want me to place the sticker, left or right?". To my surprise, she wiggled slightly the fingers of her right hand, something she was only able to do with her left hand before. Delighted, I told her "Let's show mom what you can do". I called her mother over and repeated the question. She repeated the gesture. Her mom, overfilled with joy, kissed her child on the forehead and announced the news to the respiratory therapist, and the doctors outside of the room. I asked the young girl "Do you want to show the doctors what you can do?". She looked at me, and nodded no. Fair enough haha.

One sweet moment that I witnessed during my shift is when the little girl halfway throughout the shift started becoming more awake. Although mildly sedated, it seems that the frequent suctioning and cough assisting helped her regain some energy. Her mom, at her bedside, stated "You are much more awake my dear. Do you want me to play a video for you on my phone?" The girl nodded no. "Do you want mom to just talk to you?", her mother asked. The child nodded yes as she gazed deep into her parent's eyes. It was one of those instances where the youth's wisdom and maturity shined through.

Overall, although I am only at the beginning of my journey as a pediatric nurse, I have already learned a handful from being around these tiny (or sometimes big) human beings. No matter the age, there is always something to learn from one another: resiliency in times of vulnerability.

Toodles!