A Little Luck

This girl is lovely. She is kind and beautiful and sick. She is from Egypt and hasn't been home in over a year. The first time I met her I spoke slowly and loudly, knowing that doesn't make my English any more Arabic, but at a loss of what else to do. She let me finish, patiently, and responded in plain, quiet English, her cheeks briefly blushing soft pink where a nauseated pale green would soon take over. I spent months with this girl and her mother, both so far away from home. I happened to vacation to Egypt, where I couldn't help but think of my patient. I brought her a small purple bracelet I found in a bazaar in Cairo. A beetle bracelet. It's meant to bring luck. I knock softly on her door, and head to her bed. Her eyes are shut tight, blocking out the world as best they can. I whisper her name and she opens her eyes to let me in. She smiles and winces. I tell her where I've been and place the bracelet in her hand. She doesn't move for a minute. And then she does. She pulls herself up to sit. Her face lights up and her eyes fill with tears. She hugs me with all the strength she has. The sores on her tongue make it hard for her to speak, but she mouths Thank You to me and she doesn't need to say another word. She holds out her wrist, and I slip the bracelet on. She runs her fingers over the little beetle stone. Luck, she says, and looks to me.

The Show Must Go On

My patient is just about my age. We look at each other carefully, unsure why our positions are not reversed- why I'm not the one in a hospital gown, held to the bed by nausea; why she's not the one trying to comfort me. She found out about the cancer when she was pregnant with her now (almost!) 4 month old son. The baby is on his belly on the bed, striving to push-up, while her seven year old daughter dances around the room, practicing for the school talent show tomorrow. She twirls and skips and shimmies, somehow avoiding the bed, the IV pole, and the general somber atmosphere of the hospital. My patient asks about her counts and I tell her. Her hemoglobin is 7.5. Her platelets are 4. Her white blood cell count is less than 0.2. Our tiny dancer doesn't pause as her mom closes her eyes and sighs. She will need blood and platelets. She is neutropenic. She's not going anywhere. She will miss the talent show. The baby continues his quest to pull himself up. Her daughter finishes the routine with a grand curtsey and bow. Her mother and I applaud. The show must go on.

Good Girl

She repeats everything you say. "Nemo," I say as I point to a sticker in her crib. "Nemo!" she squeals. "Dora?" I ask as I pick up her doll. "Dora!" She laughs. "You're a good girl," I coo. Later that night as I'm drawing her labs she holds perfectly still, but tears wet her face. "I'm good girl," she cries, "I'm a good girl." "Yes," I hum quietly as I smooth her damp hair from her forehead, "you are." "Bye-bye, love" I say to her as I leave her room. "Bye-bye, angel," she replies, which might be the loveliest thing anyone has ever said to me.

Going Out With a Bang

I’m sitting at the bedside of a patient I’ve only just met and I’m wondering what weird twist of fate has made it so mine will be the last face she sees. As her heart slows, mine quickens. As she takes her last breath, I find I’m holding mine. There are fireworks in the distance. I’m sure, in the history of things, lots of people have died on July 4th at 11:20pm. This is just the first time anyone has done so while holding my hand.

Where the Heart Is

She peers around the corner. She sees me and her face lights up. She squeals my name as she runs toward me. She crawls into my lap without hesitation. She opens her clasped hands to reveal an old broken keychain—a small purple heart with the words Las Vegas written in faded cursive across the front. She pushes the purple heart into the palm of my hand. She is so serious I nearly forget she’s only a child. She leans in, lips to my ear, “be careful,” she whispers, “don’t lose it.” “I won’t,” I shake my head and wrap my hand around it tightly, “ I won’t.” She smiles, satisfied at my two word response. She takes my free hand with hers and pulls my arm around her little body. She settles into me. She sighs. And she falls asleep: heart safe in my hand, head heavy on my chest, rocked by the beat of my breath. How could anything else matter?

Cone Shaped Hats, Cake and Chemo 101

It’s my patient’s 13th birthday. She is propped up in a wheelchair, cone shaped hat on her bald little head, mask on her pale face. She seems nauseated and in pain. She looks tired and miserable and I wonder why we’re having this party. Then I look at her mother, beaming as she’s taking pictures and dishing out platefuls of cake to everyone she sees. She claps with such love and joy and pride when we finish singing Happy Birthday– I realize this is one birthday party that isn’t for the birthday girl. This is it. This is her baby’s sweet 16, her high school graduation, her wedding, her baby shower all rolled into one. This is every milestone she’ll never get to have. She may not fully comprehend this, but her mother does. What do you do for a 13 year old at her last birthday party? What do you do for her mother? You take a piece of cake you don’t really want, you sing happy birthday as loudly as you can, and you smile even though you want to cry. They don’t cover this in nursing school.

At A Loss

I think before I speak, always. I self edit. I search for the right words. When I can’t find the right ones, I choose not to use any. I’d rather sit in silence than wade through words that don’t belong. So when I’m with this girl who’s going to die, I can’t find anything. I’m sorry. I have no idea what you’re going through. You have no idea how strong you are. When you cry in pain I feel a knot in my stomach and a lump in my throat and I can’t even begin to imagine how your mother feels. I wish I could do more for you. I think you’re funny and beautiful. I am angry for you and scared for you and sad for you. This isn’t fair. None of this is right. So I sit down, hold her hand, and breathe with her. I’ll forget about finding the words for now, and focus instead on finding the breath. It’s harder than it sounds.

Worth A Thousand Words

I am in a bit of a rush when a patient’s mother stops me. She doesn’t speak English, but she says my name so warmly I forget I’m in a hurry. She says her daughter’s name and makes a camera with her hands. “You want me to take a picture?” I ask. She nods and smiles. We round the corner, and for a moment I cannot move. The two of us watch proudly as her daughter, my patient, inches down the hallway toward us, what little body weight she has left pressing against the strong metal legs of a walker. Days before she could barely open her eyes when I called her name. This time, she calls to me. I try to take the camera from mom, but she shakes her head. “No…you two.” It takes a second for me to understand that she wants me in the picture. “Oh, no, I’m a mess,” I tug at my scrubs and am suddenly very aware of the messy pile of hair I have resting on top of my head. She, my lovely little patient (who no longer has the luxury of worrying about messy hair, or hair at all) grins at me, grabs my hand, and strikes a supermodel pose. I try to smile as best I can, because fingers crossed, this girl’s going to have this picture for a long, long time.

It Was Good While It Lasted

I was sitting with two fellow nurses and one cute little patient. One of the other nurses was talking about how she was nervous about something. The little patient said, “What are you, a scaredy cat?” And then she meowed. The nurse laughed. “Natalie, The Scaredy Cat!” The girl chanted. “Hey,” I chimed in, “what about me?” She paused briefly, “Julie, The Good,” she said. Wow. Well, she’s obviously brilliant – a terrific judge of character. Julie, The Good. I’ll take it. My pride was short lived, however, when the other nurse became Danielle, The Goodest. Damn. It was good while it lasted.

Julie The Vampire Slayer

Just in case you were wondering, stem cells smell like garlic. Well, I don’t know if fresh they do, but after they’ve been harvested off your kid and are being re-infused during a bone marrow transplant, they smell like garlic. You’d think something that’s saving your life would smell like peppermint or lavender or something, but you’d be wrong. Turns out it’s garlic, rotten, putrid garlic. Go figure.

Heart to Heart

This kid is 15 years old. Doctors told him for two years not to worry about his reoccurring rash. They gave him ointments and creams and sent him on his way. Turns out he has cancer. Oops. You can tell he’s a real badass around his friends, but he’s polite to me, even though I can hear him cursing under his breath in Spanish every now and then to his mother. He has a portacath in his chest, chemo infusing. It’s 3am and I need to draw blood from that port. Nothing’s coming. I’m struggling. I have him move his arms above his head. I have him hold his breath and cough. I have him lying on his side, upside down. I’ve used heparin and tPA (a super clot buster). I’m quickly running out of tricks. I look at him, obviously exasperated. If I don't get any blood return, I can't be certain placement is right. And if I can't be sure about the placement, I can't infuse the chemo. He knows if I can’t get any blood I will have to de-access his port and re-access him again. This involves a fairly large needle and is probably not something he looks forward to doing at all, let alone in the middle of the night, yet here we are. He throws his hands up, “my heart’s bein’ stingy with the blood,” he says, and I can’t tell if it’s a question or an explanation, but he smirks at me and I laugh. In this moment, there is nowhere else I’d rather be than with this kid, his stingy heart and his generous sense of humor.

Character Study

This boy breaks my heart. He knows every staff member by name: the guy that cleans the rooms, the lady that passes out meals, the therapists, the social workers, the nurses, the doctors. He tucks his t-shirt into his shorts, which sit high on his waist, and his hair is always combed. He is quiet and polite and looks at you like handed him the world when you sneak him chocolate milk off the dinner cart. His sister has a combination of acute myelogenous and lymphocytic leukemia, which in laymen’s terms, sucks. She has been here about a month. Today was the first day I didn’t see him. It was his first day of 6th grade. His sister was pretty out of it most of the day. I entered her room quietly with her late afternoon medications. He was standing by her bed in his crisp school uniform whispering to her softly in Spanish. He didn’t know I had entered. I watched as he, without thinking, untangled her IV tubing, straightened her covers, and moved the thin wisps of hair she has left off her face. He finished talking and kissed her brow. I slipped back into the hall, embarrassed to have intruded upon such a tender moment. If character is who we are when no one is watching, this kid’s got it.

In the Night

It’s my first time working nights at my old job. All the kids here have HIV. During the hustle and bustle of the day, I almost forget this. Medical stuff aside, these kids have issues. They are loud and tough, and the things that come out of their mouths can make me blush. They are old beyond their years. They give me a hard time. They try my patience. But at night it’s a little different. When I have to wake them up in the middle of the night to take their medicine, they are sleepy eyed children. They are babies. They cuddle up against me. They quietly swallow pills I don’t think I could manage and large amounts of liquids that are intolerable before falling back to sleep. They will do this for the rest of their lives. Every day. Every night. It’s no wonder they need the tough act during the day, because they are so very vulnerable in the night.

Day One: Lesson Learned

First day at work, I’m walking a kid back to his room because it’s time to start his chemo. He’s dragging his left foot because he had a stroke when he was born, but it’s not slowing him down. I’m supporting him and his oxygen tank and dragging his IV pole where his morphine drip hangs and the blood I’ve been transfusing has just finished. He’s making me laugh, and then tells me if we were racing I most certainly would have lost. I tell him that’s not fair – he’s much younger than me and my hands are full. He pauses, only briefly, looks right at me with kind eyes, and says with a shrugging smile, “Well, life’s not fair,” before finishing the race back to his room. Yep.