Macy Arn

Listen. Sirens are blaring through the ER’s doors. An ambulance is rushing to Riley Hospital’s Emergency Room in Indianapolis, Indiana with a 7-month-old child in cardiac arrest. EMS personals come running, while giving constant CPR compression escorting the African American child to an empty patient’s room. Unfortunately, many already know that this poor, young child will most likely die, since they were in contact with EMS before arrival. Everyone begins working on this case and then minutes later a physician says, “I pronounce this child dead at 2:59” before being admitted into the hospital. Sadness came across everyone’s face.

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“I pronounce this child dead at 2:59”

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This is my first time in the Riley Hospital’s Emergency Room in Indianapolis. And this day is different. These cases come in about once a month. It is rare for a child to die at the Riley’s Children Hospital’s Emergency Department. Today there are tears. Sadness. From the nurses, technicians, and physicians.

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Everyone involved in the case went to the debrief room and began discussing what is next. They must decide who is filling out the death certificate, taking an X-ray of the deceased child (to ensure there was no abuse to the bones and tissues of the body), and informing/discussing with social workers and coronal office. This process took the whole shift because the paperwork requires many details, signatures, and discussions for those involved in the case.

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About an hour after the child passed, the parents and grandmother of the child arrived at the hospital. Due to miscommunication, the child and the family were escorted to different hospitals. This time when the Riley hospital double doors automatically open the parents and grandmother walk in. The social worker rushes to the family, trying to discuss the child’s time of death; however, the family continues to walk into his room with absent facial expressions. There laid their 7-month-old child. Dead. The family’s screams of sorrow. Pain and sadness is felt by many healthcare workers in the hospital that day. Once a month. This sorrow will never get old. Once a month a child passes away in the ER at Riley’s Children Hospital.

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While sitting in the desk area of the A pod in the last hour, a buff, tall African American man walks into the room of the deceased child with a gurney and a black body bag. The nurses jokingly say, “This is the body man, who we think is a vampire” because he is the only person the nurses have ever seen carry the deceased patients out of the hospital. The body man shows no emotion, went to the room, put the child in the bag, and left. The poor child just sat in this black bag strapped onto a gurney and left the hospital.

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Unlike physicians, nurses spend so much time with their patients with getting medication, checking vitals, and checking in on them many times a day. About every 5 minutes throughout the shift, a nurse would check on patients checking vitals, medication, and ensure the patient is informed with treatment and the timeline of their stay. This causes nurses to feel emotional and physically attached to their patients, which makes situations like I just mentioned very hard. According to New York Times' writer, Marni Kellogg, states, " Four common themes of feelings were identified: 1) grief and sadness, 2) helplessness, 3) compartmentalization of feelings, and 4) lack of preparedness for dealing with situations involving the death of a pediatric patient" (Kellog 3). With the 7-month-old patient whom no one got to know too well, every nurse still felt all four common feelings when the family walked in to see their dead child one last time. Most nurses at Riley’s Children Hospital say, “The day I get used to watching family’s grief over their critically ill or dead child, is the day I will quit”.

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Throughout the shift, most patients coming into Riley’s Emergency Room were common cases like the flu, pink eye, burns, and fevers  (accommodated with preexisting conditions). About 2 hours after the death of the child, a young girl that immigrated recently from India with her mother had a burn from India with a skin graph irritation. The mother did not speak English, so nurses used a translator iPad-like device to communicate and discuss the problems/treatment plan for the little girl’s burn. Looking at the burn, there was already skin graph done on the area, however one 2-inch area of the skin graph had pus coming out of it indicating an infection. The little girl’s burn was on most of her thigh, but the irritation was located on her inner thigh. Because of the irritation, the child refused to wear clothing on her legs. When the physician goes in to evaluate the child, nurses must follow to help the translator understand the situation before going into the room to discuss the issue in another language. This is a common task nurses do daily along with delivering medication to patients’ room, checking vitals and filling out paperwork.

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              One task that is very strict is obtaining and delivering medicine/drugs. Nurses must follow specific guidelines and rules to obtain medication. First, the nurse must use her badge to have access to the dispensary. Then, they must use their fingerprint to login into the kiosks. After login is complete, they must click the patient and the kiosks will have all the medication with times for nurses to be able to access that specific medication. Once the nurse clicks the medicine they needed, the kiosks opens the correct drawer, telling them the row and column of the medication. Once the drawer is open, the nurse has about 30 seconds to enter the previous amount that was in the drawer, how much their patient needs, and how many will remain in the kiosks. After this is complete, the nurse logs out and gets a cup of water if needed to deliver the medication to the patient.

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              Nurses across the nation think this is a huge help, so they do not make mistakes on their exhausting 12 hour shifts like this: “A former nurse at Vanderbilt University Medical Center in Nashville, Tenn., was arrested and charged with reckless homicide and abuse in February for making a medical mistake that resulted in an elderly patient's death” (Gordon 1). Giving the wrong medication is something this medical dispensary can prevent and save both patient’s lives and nurses’ licenses. Because the nurses’ have to “tie in with the pharmacists ... [the nursing supervisors] are able to show that medication to the pharmacist before they take it up to the floor for the nurses to give, and that pharmacist is also able to go into the [electronic medical records] and look at that medication and verify it” (Massmann 2). This reinsurance/verification from the pharmacist helps the nurse double check the medication for a patient, because without the verification, a nurse could make a vital mistake that could possible end the life of a patient, as mentioned above.

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              Overall nursing is a very stressful, demanding job. Nurses have emotional, psychological and social consequences of their patients’ treatment outcomes. Nurses must be there for their patients for better or worse, give them advise and hope, fill out all their charts, help doctors provide accurate care, and then follow up with them multiple times a day. These tasks are very emotionally and physically draining because nurses do these varied tasks on multiple patients a day on their 12-hour shifts. However, most nurses connect with this New York Times writer when she discusses why she became a nurse: "I became a nurse because I want to care for people and make a difference. Being touched in return is an added bonus” (Horstmann 2). At the end of the day, a nurse will always be viewed as a caregiver, unless you are the patient. Then a nurse will mean much more (Riley Nurse). As my shift comes to the end, I end up staying about 45 minutes longer than planned, discussing why they want to be nurses and how they got to Riley Hospital. The nurse whom I shadowed is from Ohio and fell in love with Riley because it was exactly what she was looking for as a career, a pediatric ER nurse. This gave me hope for my future as I walk through the automatic double doors exiting, where sadness came rushing in.

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Works Citied

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Gordon, Mara. When A Nurse Is Prosecuted For A Fatal Medical Mistake, Does It Make Medicine Safer?, NPR, 10 Apr. 2019, www.npr.org/sections/health-shots/2019/04/10/709971677/when-a-nurse-is-prosecuted-for-a-fatal-medical-mistake-does-it-make-medicine-saf.

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Horstmann, Sarah. "When Nurses Bond With Their Patients." New York Times, 13 Sept. 2013, doi:https://well.blogs.nytimes.com/2013/09/13/when-nurses-bond-with-their-patients/?searchResultPosition=1. Accessed 19 Mar. 2020

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Kellogg, Marni B. “The Lived Experience of Pediatric Burn Nurses Following Patient Death.” Pediatric Nursing, vol. 40, no. 6, Nov. 2014, pp. 297–300. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=eue&AN=110459657&site=eds-live.

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Very Rough Draft 3/4/2020

A Feature Narrative:  Shadowing an ER Nurse

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A 7-month-old boy came by an ambulance in cardiac arrest to Riley Hospital’s ER in Indianapolis, Indiana. EMS personals come running in, while giving constant compressions taking the African American child in cardiac arrest back to an empty patient’s room. A larger room where many medical professionals come running in, already knowing the case and know that this poor, young child will most likely die. As I felt in the way of everyone working on this case, I was looking at everyone’s reactions and then a physician pronouncing this child dead. Sadness came across everyone’s face.

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This is the first thing I saw while job shadowing Amanda, an ER nurse at Riley Hospital. These cases come in about once a month and it is rare for a child to die at the Riley’s Children Hospital’s Emergency Room. However, that day I went was different. There were tears. Sadness. From the nurses, technicians, and physicians.

​

The nurses came together with physicians in the debrief room and discusses what is next. Filling out the death certificate, taking an X-ray of the deceased child to ensure there was no abuse to the bones and tissues of the body, and finally talking to social workers and the coronal office. This process took the whole time I was there because the paperwork requires many details, signatures, and discussions for those involved in the case.

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As my shift goes on, about an hour after the child past, the parents and grandmother of the child arrived at the hospital. Due to miscommunication of the hospital the child arrived to, the family was escorted to the wrong hospital and took a little longer than normal for them to arrive at the correct hospital. When they walked through the door, you could see sadness in their face and tears coming from their eyes. The social worker discussed the child’s time of death and the parents continued to walk into there room. There their 7-month-old child laid. Dead. I was not in the room at the time, but you could hear the family’s screams of sorrow in the nurses’ desk area. I felt the pain and sadness as many other workers in the hospital did that day. Once a month. This sorrow will never get old. Once a month a child passes away in the ER at Riley’s Children Hospital and I was there.

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In the last hour of my shift, we were sitting in the desk area of the A pod, and this large, buff African American man walks into the room of the deceased child with a gurney and a black body bag. My body ached for this child in this moment. I saw the “body man” described as a vampire because he is the only person the nurses have ever seen carry the deceased patients out of the hospital. The body man showed no emotion, went to the room, put the child in the bag, and left. The poor child just sat in this black bag strapped onto a gurney and left the hospital.

 

Other than this patient, the job shadowing experience was just normal patients coming in with flu cases, pink eye, burns, and cancer fevers. Once patient, who was a young girl immigrated recently from India with a mother that did not speak English had a burn from her home in India came to Riley with a skin graph irritation. We had to bring a translator iPad like device into the room with us and use it to communicate and discuss the problems/treatment plan for the little girl’s burned area. Looking at the burn, there was already skin graph done on the area, however one 2-inch area the skin graph had pus coming out of it and looked like an infection has formed. The little girl had a burn on most of the thigh and was irritated in the inner thigh, causing her to not want to wear pants or any type of clothing on her legs. Because of this Amanda and I went in with the physician to help her set up the translator device to the correct language and then wait for the translator to accept the case. This process can take anywhere from a couple seconds to a whole thirty minutes, according to the physician.

            

For all patients, we would work under a physician, however only the little girl’s burn we went in with a physician at first. Sometimes due to the difficulty or any physician in general may ask you to go in with them to see the patient for the first time to help. With the little girl’s specific case, Amanda and I went in with the physician to set up the translator and help calm the patient down. Another very common task ER nurses do is giving medicine to patients.

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Obtaining and delivering medicine/drugs is a more controlled task than I thought before shadowing. First, Amanda had to use her badge to have access to the dispensary. Then, she had to use her fingerprint to login into the kiosks. Then she must click the patient and the kiosks will have all the medication with times for nurses to be able to access that specific medication. Once Amanda clicks the medicine she needed, the kiosks opens the correct draw with telling you the row and column of the medication. Once the draw is open, you have about 30 seconds to enter the previous amount that was in the drawer, how many you are taking, and how many will remain in the kiosks. After this is complete, Amanda logged out and got a cup of water to deliver the medication to the patient.

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FIRST DRAFT 2/28/2020

A 7-month-old boy came by an ambulance in cardiac arrest to Riley Hospital’s ER. EMS personals come running in, while giving constant compression taking the child back to an empty patient’s room. A larger room where many medical professionals come running in, already knowing the case and know that this poor young child may die. As I felt in the way of everyone working on this case, I was looking at everyone’s reactions and then a physician pronouncing this child dead. Sadness came across everyone’s face.

​

This is the first thing I saw while job shadowing an ER nurse at Riley Hospital. These cases come in about once a month and it is rare for a child to die at the Riley’s Children Hospital’s Emergency Room. However, that day I went was different. There were tears. Sadness. From the nurses, technicians, and physicians.

​

The nurses came together with physicians in the debrief room and discusses what is next. Filling out the death certificate, taking an X-ray of the deceased child to ensure there was no abuse to the bones and tissues of the body, and finally talking to social workers and the coronal office. This process took the whole time I was there because the paperwork requires many details, signatures, and discussions for those involved in the case.

​

As my shift goes on, about an hour after the child past, the parents and grandmother of the child arrived at the hospital. Due to miscommunication of the hospital the child arrived to, the family was escorted to the wrong hospital and took a little longer than normal for them to arrive at the correct hospital. When they walked through the door, you could see sadness in their face and tears coming from their eyes. The social worker discussed the child’s time of death and the parents continued to walk into there room. There their 7-month-old child laid. Dead. I was not in the room at the time, but you could hear the family’s screams of sorrow in the nurses’ desk area. I felt the pain and sadness as many other workers in the hospital did that day. Once a month. This sorrow will never get old. Once a month a child passes away in the ER at Riley’s Children Hospital and I was there.

​

In the last hour of my shift, we were sitting in the desk area of the A pod, and this large, buff African American man walks into the room of the deceased child with a gurney and a black body bag. My body ached for this child in this moment. I saw the “body man” described as a vampire because he is the only person the nurses have ever seen carry the deceased patients out of the hospital. The body man showed no emotion, went to the room, put the child in the bag, and left. The poor child just sat in this black bag strapped onto a gurney and left the hospital.

​

Other than this patient, the job shadowing experience was just normal patients coming in with flu cases, pink eye, burns, and cancer fevers. Once patient, who was a young girl immigrated recently from India with a mother that did not speak English had a burn from her home in India came to Riley with a skin graph irritation. We had to bring a translator iPad like device into the room with us and use it to communicate and discuss the problems/treatment plan for the little girl’s burned area. The little girl had a burn on most of the thigh and was irritated in the inner thigh, causing her to not want to wear pants or any type of clothing on her legs. Looking at the burn, there was already skin graph done on the area, however one 2-inch area the skin graph had pus coming out of it and looked like an infection has formed.

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