Working with Death Wednesday: Pediatric Surgical Nurse

Today I'm starting my new feature where I talk with people who work in a profession that encounters death.  I am pleased to welcome Jessica Salyer to the death writer blog! Jessica is a pediatric surgical nurse with over twelve years of experience. When not nursing, she can be found with her husband and three children. If she has any free time it's spent on her laptop where she is busy working on her first YA novel or blogging. 

DW:  So, why did you want to become a nurse?

Jessica:  Growing up my mom was in and out of hospitals. I saw the impact that nurses and doctors made on my mom's and my life. I realized that the time when people are in the hospital is a scary out-of-control time and the nurse's are the ones that can make or break the experience.
DW:  Did you realize in the beginning of your professional journey that you would be dealing with death?  I  know this seems like a ridiculous question, but I have to ask it.

Jessica:  Death has always been a reality in my life. When you grow up with a mother who has had multiple kidney transplants and on the brink of death multiple times, you grow up with a different view of death. Instead of it being a mysterious thing you know nothing about, you grow up with it. You know that it's always a shadow there in the background. I've never had any illusions about death or what I would be dealing with as a nurse. It's part of why I became one.
DW:  Did you have personal experience with death before becoming a nurse?

Jessica:  Before becoming a nurse I had a few family members die. My Great-grandma and Great-grandpa died when I was younger. Then when I was in nursing school my two uncles died within six months of each other. This was a very hard time for my family. Especially my Grandmother.  She lost her two sons and then less than a year later we lost my mom. My grandmother lost three of her four children with in a year and a half of each other. It was hard enough for me losing them, I can't imagine what my grandmother went through. She is the strongest woman I know.

Losing my mom was hard for me on two levels. First, the fact that I lost my mom and my best friend. Second, I had just become a nurse when she went into rejection the last time. Suddenly, I had all the answers and made all the decisions. I picked her doctors, signed consents, decided if and when she would have surgery, and when the time came decided they should let her go. I questioned my ability to make those decisions for many years after that. Questioned whether I made the right ones. Questioned that if I had made different ones she would still be here.

DW:  Do you remember the first person who died?

Jessica:  (note: In order not to give any patient identifiers I replaced her/him with them/they and changed the patients name to Patient.) Certain patients stick out in my mind and will always be with me. I do a lot of congenital heart defect surgery so sometimes the outcomes aren't so good. (Very technical terminology I know.) When I first started doing hearts there was this little baby that we operated on quite a bit, that baby sticks out. A few years later there was this patient who had a heart transplant. The patient did fine during surgery but after had some complications and never regained consciousness. I took that patient from the parents. I was the last person that saw that patient alert, smile, and say good bye to their mom and dad. I did not deserve that privilege. I've done organ procurements and those are never easy. I try to remind myself that they have died anyway and now they're saving someones life. However, when the anesthesiologist turns off the machine and walks out, it's very surreal. There's another one that sticks out lately. This patient hasn't died yet. I say yet because Patient has osteosarcoma (bone cancer) with tumors that went to the lungs. Patient had to have their right leg and pelvis removed. They also have had their tumors in their lungs resected (taken out) multiple times. The last time we did surgery, we only did it to let Patient live through the summer. Patient wanted to live long enough to go on a road trip this summer with a family member. Hopefully they'll make it that long. I admire Patient. The positive outlook they have is refreshing. Although they know they are going to die, it doesn't stop them from living.

DW:  How did you deal with that?

Jessica:  Death is inevitable. I cannot control which one of my patients live or die. What I can do is make sure that the interaction that they have with me is the best that they can possibly have. I remind myself that if they are going to die, they would die whether I was there or not, but maybe I could impact it, maybe I could make it a little bit better.

DW:  What kind of nurse are you?  

Jessica:  I'm a pediatric surgical nurse. I don't have a lot of patient interaction while my patients are awake, but I feel like what I have is very important. It's a very stressful time in their lives. Parents have to give their children over to a perfect stranger, to who-knows-what is going to happen to them. I have a small window of opportunity to gain a rapport with the family. To make the parents and child comfortable with me; so, maybe it won't be so hard.

DW:  Do you find yourself keeping some sort of emotional distance from your patients?  

Jessica:  I'm a very emotional person, so I have a hard time separating. I do try and remind myself that whatever happens to them is meant to happen. I just try to make it better. 

DW:  Is there any sort of support for your staff after a particularly sad or challenging day?

Jessica:  There are people who we can talk to and sometimes if there is something very traumatic they have a debriefing.

DW:  What is the most uncomfortable part of your job?

Jessica:  Taking the patients from their parents. It's not so bad with simple cases, but with bad cases or complex surgeries where the outcome might not be so good, it gets hard. Also when the dads cry. I expect the moms to cry, but when the dads cry, I almost start. 

DW:  As a nurse, is there any advice you have for people who read this blog?

Jessica:  Be your own advocate. Don't be afraid to ask questions or for second opinions. You have every right to know exactly what's going on with your health care. Also organ donation. You don't need your organs when you die, but someone else might. Think about this... my mom had her first kidney transplant before I was born. She had me and my brother. I had three kids and my brother had one. That's seven people that one person saved from their one kidney. Not to mention my future (much in the future) grandchildren.

Thank you so much Jessica for sharing your story with me today.  And thank you for the work you do.  Nurses are the greatest.  And I couldn't agree with you more about organ donation.  My brother-in-law is on the heart transplant list.  If anyone out there is feeling generous, you can donate to Jason's heart transplant fund.  New hearts cost a lot of money.