When our kids were in elementary school and studying anatomy, Mark received permission from his work to bring in a brain from the medical school to show their classes. I went along on those days and gamely donned gloves and held the brain while the curious kids came up to take a closer look. Thinking back, I can still feel the weight of it in my hands and remember marveling at the idea that it contained so much of the makeup of the person in whose skull it once rested.
But that was not the first time I held a brain in my hands.
When Mark and I were first married, we moved to Nashville so he could complete two years of additional training as a Fellow in Sports Medicine at Vanderbilt University. I was ready for a change from the ED, so I applied for and was offered a job in the Pediatric Intensive Care Unit at Vanderbilt University Medical Center. My two years there were intense, and the learning curve was sharp. In addition to trying to get up to speed on the intricacies of caring for the pediatric population, I was pregnant with and gave birth to our oldest, Owen. I wasn’t prepared for the personal toll it would take on me—caring for precious little ones at work and then getting to go home to my own healthy baby. I would have expected gratitude to be the predominant feeling, but when I look back, that wasn’t it. It was grief. I loved my time as a bedside nurse, and especially the privilege to care for people in what might have been the worst time of their lives; I was always aware that it was holy ground. But I did have a hard time leaving work at work, so when our two years in Nashville was coming to an end, I knew I was ready to move on from the PICU.
I arrived at work for one of my last overnight shifts before we moved to St. Louis, and I remember the charge nurse seeking me out when I arrived with an apologetic look on her face. I was being assigned a single patient that night; a little girl, maybe 7 or 8 years old, had found her dad’s gun in a shoebox under his bed and accidentally shot herself in the head. She had no brain function and was being sustained as an organ donor while awaiting the arrival of family from out of town. Her dad was in custody, so for the next twelve hours, she was alone–aside from me.
When trauma happens to our body’s tissues, they swell. When the brain swells, it causes a whole host of issues, including an inability to maintain vital signs, like heart rate and blood pressure and temperature. So oftentimes, once a person has been declared brain-dead, interventions are utilized to decrease pressure in the brain in order to keep things going while waiting to harvest organs for transplant. For this little girl, though, it wasn’t necessary. Some of the specifics are hazy; I can’t remember her face. What I do remember is wishing I had a picture of her that I could see so I could picture her like that, instead of the swollen little face in front of me, swathed in white bandaging. At least there wasn’t a lot of blood anymore. That wasn’t the reason for all of the bandaging. The bandages were there to keep her brain from spilling out onto the bed. I don’t even remember where the bullet had entered. I do remember holding my hand to the left side of her head–seeing and touching the gray matter of her brain–as one of my colleagues wrapped yet more fluffy white kerlix bandage around her head. She didn’t need an artificial pressure outlet placed through her skull because the bullet had taken care of that.
I don’t remember much about that night, but I literally recall how it felt under my gloved hand, and glimpses of what it looked like, how it smelled, and the sad silence of a young life ended.
I don’t remember much more about that shift except for the occasional dressing change and intense grief as I imagined the circumstances that had led up to her presence in the hospital; it just seemed like such a waste of a young life. And then I just went home. I don’t even remember if I told Mark much about it or not? I definitely know that I have thought of that little girl over the years as I see news coverage of children dying from gun violence.
In any case, it’s one of the reasons I am so grateful for the show The Pitt on HBOMAX. I was attracted by the ads which featured actor Noah Wyle, who I had watched for years on ER. But as I watched the first couple episodes, I realized that The Pitt was more than just a typical medical drama. Mark and I looked forward to each episode, appreciating the depiction of fast-paced medical care as well as getting to know the different characters at different points in their medical careers. But it was episode 8 that really informed what, for me, has been the most meaningful part of the show. Watching the staff experience the two incredibly emotionally devastating cases–the exit of the young man who was donating his organs after an accidental overdose and the death of a young girl from drowning–moved something in me that I didn’t know was present. Like a cracked door, and then a floodgate, I began to recall some of the many people and situations I experienced over my years of nursing “at the bedside.” There were so many situations that I have been reflecting on and realizing, “huh, that was a really big deal, and so hard, and even traumatic.” I love how the show models the intentional debriefing after a death. I don’t recall that specifically happening during my tenure, but my coworkers and I certainly leaned on each other, and I know I never felt “alone” in the most awful of moments.
I wish I could remember who it was who joined me in trying to clean up the trauma room after we unsuccessfully tried to save a young man who had been stabbed. We had housekeeping, for sure, but there were these carts at every bedside with metal basket-drawers full of supplies. This case had been so bloody that not only was it on the floor and the bed, but the carts had been splashed with it. My colleague and I spent some time in the quiet after the patient had died on our hands and knees trying fruitlessly to clean it all up. I distinctly remember trying to stop the sobs from coming out. I wonder now, why? Why didn’t I allow myself to express what were certainly valid emotions? Did I think it would make me less tough and somehow a “weaker” nurse?” I know better now.
The word “trauma” has been in my vocabulary for as long as I can remember. It took on a different meaning when I started working in the ED in a literal “trauma center,” and again as I have gotten older and understood that trauma is more fully understood as “a deeply distressing or disturbing experience” that doesn’t just encompass physical injury. Watching The Pitt has helped me connect the dots between the literal trauma I saw and the sort of secondhand trauma I experienced as a result of being present in any number of intense and tragic situations. It’s been so helpful to reach back into my memories and recognize the job that I did. And it has provoked a feeling of intense gratitude for those who work in the healthcare setting in ALL the capacities and keep showing up, especially after experiencing the COVID pandemic.
It’s not an easy watch (especially for the squeamish–be prepared to cover your eyes at some points…), but I believe it’s an important one if you want to understand a bit more about our healthcare system and the people who work within it.
