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What a crooked thumb taught me

Giammarinaro, Nicole MSN, RN, CPXP

doi: 10.1097/01.NURSE.0000585900.67367.4a
Feature: SHARING

A nurse gains a new perspective on nursing care during her daughter's surgical experience.

Nicole Giammarinaro is director of education and research in the Corporate Office of Patient and Customer Experience at Northwell Health in New York, N.Y.

The author has disclosed no financial relationships related to this article.



WE ARRIVED AT the ambulatory surgery center early and I parked the car. In my rearview mirror, I saw my 3-year-old daughter, Natalie, sleeping beautifully. As I carried her across the parking lot and navigated through two sets of doors, I felt overwhelmed with nervousness. I filled out a stack of papers on a clipboard and took a seat in the waiting room. It looked like a train station, so sad and bare. I chose a chair in a row near the wall. Natalie was getting surgery on her thumb.

For over a year, Natalie could not straighten her thumb due to a congenital condition known as trigger thumb, also called stenosing flexor tenosynovitis.1 For over a year, we would giggle when she gave us a crooked “thumbs up.” For over a year, I massaged the base of her thumb every night, hoping and praying that it would be less crooked when she woke up. For over a year, I dreaded this day.

I am a nurse who works primarily in telemetry and nursing leadership. I have walked alongside patients and families through life's most difficult moments. I have experienced great joys and woes. I've participated in codes, complex family meetings, and root cause analyses. I recognize that I certainly have dealt with more grave situations than trigger-thumb surgery. So, why was I such an emotional mess?

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Putting on a brave face

The surgeon met us in the presurgical area. Natalie was excited to don a patient gown, hair net, and “sticky bottom socks.” I tried to keep a brave face. I didn't want her to see the tears in my eyes or the lump in my throat.

We walked hand in hand to the OR, her little fingers wrapped so tightly around mine. I picked her up and placed her on the table. I was dreading this part; the part where I had to keep her calm as they placed the triangular anesthesia mask over her nose and mouth. I heard her say in a muffled voice, “Mommy I want to leave,” as I assured her that I was here and she was okay. I forced out a meek smile. Her eyes closed and she was asleep. She looked so small.

The OR nurse was kind, caring, and patient as she placed her hands on my shoulders to help guide me out of the room, just like I would do for my own patients' family members. I kissed Natalie's forehead and walked out of the room and down the hall. My legs felt weak and I immediately began sobbing.

Somehow, I found myself back in that dreadful waiting room. I picked yet another uncomfortable chair and sat down. After calling my husband, I felt better. He reminded me that after today, Natalie would be able to hold a crayon correctly, turn a doorknob, and be adventurous at the playground. He was at home with our other daughter, Audrey. I told him to hold her tight for me until I got home. I really wanted to go home.

An hour later, the surgeon said Natalie's surgery went well and she was recovering. Her thumb was fixed. I hurried to her bedside. As she woke, she was confused and disoriented, trying to take her gown off and remove the bandages. My instincts made me climb onto the stretcher. In total “mom mode,” I embraced her with my whole body and kept saying, “You're okay. You're okay.”

The nurse in me was scanning everything: the splint, the I.V. pump settings, the nurses' faces, the other patients in recovery, then back to her dressings. I held her hand as a mom but was checking her capillary refill as a nurse. I kissed her head as a mom, but as a nurse I was alert for the first signs of an infection. This constant back-and-forth was emotionally exhausting. It felt as if I had two minds controlling one body. Being on the other side of healthcare was a tough reality for me.

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A new perspective

That day I received two incredible gifts—not only was Natalie's thumb completely fixed, but I also gained a new perspective on the patient and family experience. I often reflect on the high points—how I got to hold her hand into the OR, how the surgeon sat with me when reviewing her case, and how the nurses guided me through the process and made Natalie feel like she was a movie star. I also recall the low points—how horrible it was to fill out a thick stack of paperwork when you are on the verge of crying, how the cold stark waiting room deepened my anxiety, how unprepared I was for Natalie's post-op confusion.

This experience has completely impacted the way I do my job as a nurse and, currently, as a patient experience professional. Every time we talk about “patients,” I immediately picture Natalie. Every time we talk about “family,” I think of myself and how I felt throughout Natalie's continuum of care.

Now I consciously practice with deep empathy and compassion for the lived healthcare experience. I am more aware of body language cues, the importance of true human connection, how we must intentionally design for optimal experience, and why individualized care is critical.

Being a mom and a nurse are both absolute privileges. And yes, there are days when I cry and feel depleted. But those days are completely outnumbered by the days spent watching my babies grow into kind, smart, and fun-loving young girls; bearing witness to life's most sacred moments and having a positive impact on a patient and family's healthcare experience.

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1. Blazar PE, Aggarwal R. Trigger finger (stenosing flexor tenosynovitis). UpToDate. 2019.
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