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Intimate Strangers

Sato, Hui-Wen (Alina) MPH, MSN, RN, CCRN

AJN The American Journal of Nursing: August 2017 - Volume 117 - Issue 8 - p 72
doi: 10.1097/01.NAJ.0000521982.43662.83
Reflections

A PICU nurse writes of walking with parents in their pain.

A PICU nurse writes of walking with parents in their pain.

Hui-Wen (Alina) Sato is a pediatric intensive care nurse in Southern California. Her blog can be found at http://heartofnursing.blog. Contact author: hui.sato@gmail.com. Reflections is coordinated by Madeleine Mysko, MA, RN: mmysko@comcast.net. Illustration by Lisa Dietrich.

Figure.

Figure.

We were intimate strangers. I received report and within minutes I knew intimate details about her tragic childbearing history and recent life. But to her, I was a stranger, her son's nurse, entrusted with walking intimately with her through the most devastating hours of her life. These were the hours in which I would check her baby's last vital signs. Confirm, as the team had been saying, that there was no longer any response to the outside world. Talk with her about how we would prepare to withdraw life support from her baby, overtaken as he was by a most sudden and mysterious disease.

How do I talk about these things with a stranger unless I know how to be intimate? We see death and dying more frequently than I would ever wish in the PICU, and yet I approach the parents with apprehension and reverence every time. By the end of my time together with this intimate stranger, I would find myself responsible for playing an active role in her baby's body shutting down. I would be the one who pushed the buttons to stop the medicines that kept that heart beating, kept the blood flowing into those little feet that she could not stop kissing. She was the most tender of mothers, kissing her sweet baby's feet. I am a nurse, a caregiver, and all I want to do is help give some little lives another day, another chance. Does my work on days like this also make me a life taker? In my head, I know it doesn't. In my heart, it's a little less clear.

She knew his soul was no longer with us, but as his mother in his final hours of physical life, she was compelled to snuggle into bed with him despite all the tubes and lines, and sing to her boy in her native tongue what must have been a familiar childhood song. Her singing began, steady and lovely. I quietly did my work in the room, a stranger beholding this moment of connection. The music took us past the barriers of brain death and a baby's motionless arms, transporting a mother back to a place where she snuggled her squirmy baby at home and sang this song until his arms grew quiet—not with death, but just for a night's sleep, ready to reach out for his mother's arms in the morning. Her voice quivered, and I imagined her heart aching for those carefree nights. Her singing stopped; it's not possible to choke with tears and sing at the same time. She took a deep breath, and then began singing softly again. I was a stranger, so I left the room to give her full privacy in this intimate time.

She was his mother, and so she asked if we could put him in his own clothes so he was not just a dying child hooked up to machines and medicine, but instead the boy she dressed every day. As we quietly moved his arms together through the sleeves, I had to tell her, “You are a good mommy.” I had heard that she blamed herself, though I was a stranger and she didn't know I knew this about her. But I had to tell her, “You are a good mommy.” She dropped her head and shook it back and forth. “I am not a mother anymore.” I felt the weight of her grief, and I had to tell her, “You will always be a mother.”

When it came time to withdraw the life support, it was too much for her to watch. She pleaded with us through tears to please be gentle with him, and then left the room, broken. When it was all done, she returned to hold her baby in her arms one final time. It was the strangest act for me, putting her deceased child in her arms, as if I was all at once giving to her a beautiful but most terrible gift and then leaving her alone to figure out what to do with it. All I could do was whisper, “Take as much time as you need.”

As she prepared to leave, she asked me to keep his blue blanket over him. I didn't have the heart to tell her he would be shrouded. I never want to be the one shrouding anyone, but tonight this was my final act for her child. I hope she never knows this about me. I hope she remembers me as the one who kept her child tucked into his familiar blue blanket until the end. I tried to be gentle. And then I wept for him, for her, and for me.

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