the night(shift) before Christmas, working holidays, and bravery in small packages
Early on, I was warned about "those patients" - the ones that get to you. In nursing school, they made sure to caution us to both the harsh and beautiful reality: no matter how great you ever are at maintaining distance, there are always the names and faces and stories that stick with you long after discharge or death, the ones who - days, months, years later - become the ones who remind you why you do what you do on the days that make you question it the most.
I wish I had more liberty to share some of the stories about the patients who have been significant to me, in one way or another, over the past few years. I’d love a public platform to process through certain situations, the happy and the sad and the confusing, that have taught me something about medicine, or about life, or made me see the world a little differently. The lack of ability to do so in the US is one of the things that makes me most grateful for Mercy Ships and Madagascar, and I’ve been meaning to write this out for a very long time. Mostly for myself, because of these details I know I never want to forget, the ones on my mind a lot now as Christmas approaches and we’re in the throes of the holiday season that a year ago was spent on the other side of the world, but also because I want the world to know the story of a boy named Claudio.
[December 23rd, 2015] I walked onto the ward a couple minutes before my night shift was scheduled to start. Coffee in hand, my bag was stuffed with books and movies and snacks and whatever else to get me through an ironically, but seasonally-appropriate silent night. Surgeries had been on hiatus for almost a week at this point, my coworker had been given the night off due to low census, and our patient population had dwindled to really only the long-term patients who we expected to be spending Christmas with us from the start, so I was relatively surprised to see an unfamiliar little face filling the bed closest to the nurses’ desk.
This is Claudio. A fourteen year old boy with a face much younger but the courage of someone far beyond his years, a trait that would serve him well in the upcoming months. That afternoon, his tumor had started bleeding from a superficial artery while he was at home, and despite efforts to stop it, he’d had to be taken to the OR for an emergent procedure to cauterize the blood vessel.
A girl from the screening team immediately pulled me into the corner to offer some hushed background on the situation. He’s still a screening patient, she told me upfront, meaning that he was still undergoing tests to determine if he was a candidate for a tumor-removal surgery for a various array of reasons I won’t get into, but the outlook was grim from the start and surgical team wasn’t confident they’d be able to offer him much hope.
So what do I do if it bleeds again tonight? I asked, my eyes probably growing three sizes as I looked from the offgoing nurse who had since joined the conversation, to the patient who was nearly mummified in a pressure dressing, and back to my coworkers. I was not a peds nurse. I was barely even a surgical nurse.
Hold pressure and yell. You’ll be fine.
That night was, without doubt, one of the longest and most nerve-wracking shifts of my life. (even though, spoiler alert, it turned out to be entirely uneventful PRAISE THE LORD.) I’m pretty sure I kept gloves on for at least the first half of the shift, certain that the second I took them off and allowed myself to relax I’d jinx myself into a bloody crisis. I spent a lot of time praying, even more time questioning (also probably a significant amount of time watching Netflix and spinning around in circles in the desk chair to stay awake, full disclosure). He’s fourteen years old. He’s so young. His tumor is more than likely inoperable. We probably can’t help him at this point. Why are our options so limited. Why was he born in a country where healthcare is so inaccessible. [I won’t elaborate more on this here, you can read more of my thoughts on this subject in previous blogs, BECAUSE TRUST ME I HAVE LOTS OF THOUGHTS HERE.]
His mother stayed awake for most of the night, alternating between lying on a thin mattress slid underneath Claudio’s bed (as most of our patients’ families did), and sitting in a chair at his bedside. She was as restless as I felt, and I wished more than anything that we didn’t have such a significant language barrier and our 4am conversations weren’t limited to the occasional eye contact and a smile.
Around 6am, the ward started coming back to life as I woke our patients up, one by one for morning doses of antibiotics and paracetamol. Claudio’s mom came out of the bathroom and immediately came up to me and began rattling off words far surpassing my comprehension of Malagasy, so I grabbed a translator.
She’s saying she needs to leave.
Yes. Now. She needs to go home.
In hindsight, I could and should have asked more questions and sought to understand just why this need had come up so urgently, but instead I explained that we still needed to keep Claudio until the doctor saw him later that morning and that he was too young to be left alone. She accepted that without much debate, and I honestly didn’t give much more thought to her request. I finished up my last bit of charting for the night, gave report to the oncoming nurses, and set out on my long commute home (a whole eleven seconds) to sleep away Christmas Eve, more than grateful that we’d all survived.
If I’m being honest, Christmas week in Madagascar was a struggle for me. I was 7,000 miles from home. Sick with whatever plague-of-the-week was making it’s way through the tin can of a living arrangement I shared with 400+ other people. Frustrated that I still had to work when so many of my coworkers had been granted shifts off due to to low census. But what I ended up gaining from that week, despite my closeted bad attitude, selfishness and self-pity, was far, far more than anything I could have expected.
I came back to work that night to see that Claudio had already been discharged, sent home that afternoon to spend Christmas with his family. I was surprised, but thankful to return back to the low-key smooth sailing that I’d anticipated from my solo holiday night shifts.
I didn’t know this part of the story until a few days later, when a friend who had worked the next morning brought up the situation in casual conversation. Do you know why Claudio’s mom was so concerned about leaving? In a combination of the excitement of the night and the dimly-lit room, I hadn’t even noticed the blood. everywhere. On her shirt, and her skirt, and especially on the pile of Claudio’s clothes in the patient belonging bag. Evidence that when he’d started bleeding, she used whatever accessible to control it as she frantically tried to get him help.
She just wanted to go home to wash their clothes.
That night, I’ll confess that was not a happy camper, although i hope desperately that was never made evident in my actions. I missed home. I missed the holiday traditions that had been a part of my life since I could remember, and working alone even made me miss my PCU family that had made the previous three years of holiday shifts more than just tolerable. And three feet away from me slept a family that was just trying to live through another day. A kid that wasn’t concerned with presents or holiday plans, and a mom that likely lived every holiday in fear that it may be their last together.
Talk about a bit of a belated reality check, and I’ll always remember that: It’s hard to work the week of Christmas sometimes. But it’s nothing compared to being on the other side.
Despite the odds, Claudio had surgery a month later. They had booked out the OR for the entire day, had 8 people on call to donate blood, and staffed the ICU for the evening and night shifts in preparation. I’ve seen the power of prayer in hospitals time and time again, but have never seen it manifest itself in the way that it always did on the ship. Claudio was out of surgery by 2pm, returned back to the regular ward, and was awake, smiling, and hitting a balloon from his bed in a makeshift game of volleyball barely an hour later. A medical miracle if I’ve ever seen one.
I was there the evening we changed Claudio’s bandages for the first time too, when we handed him a mirror and set it up so that he could see the back of his head, tumor-free. I saw that grin that spread across his face, and his excited Malagasy chatter that we all understood without even having it translated. I remember grabbing the first thing I could find, a scrub cap with dinosaurs on it, and plopping it on his head in celebration of the first time in his life he could wear a hat. He ended up adopting that cap as his own, which was unintentional and kind of a no-no when it came to hospital rules, but in hindsight I’d do it a thousand times over.
[And yes, that’s a Clemson paw on his cheek. These pictures were taken the day of the national championship, and yes, I *might* have had something to do with that.]
I left Madagascar at the end of February. At that time, Claudio had been discharged, was following up with outpatient wound care, and was thriving far beyond the limits we’d imagined for him a couple months before. There’s a lot of details I still don’t, and will probably never know, and others that aren’t my place to share on a public forum. What I do know is that Claudio’s tumor grew back, this time deeper and more vascular than before, and ultimately ended up sending him Home to meet Jesus far earlier than any fourteen year old ever should a few months later.
To those of you still reading - sorry for that bombshell. It’s a hard one to swallow even still. But I don’t like to look at this story as a sad one, although I still wish more than anything that it had turned out differently. Rather, it’s one that challenges me and motivates me. From what I’ve heard, he was the subject of significant ridicule throughout his life, as politeness and political correctness don’t have much of a place in the third world. But he never let it stop him. He didn’t spend his life shut inside his house. He kept going to school. He lived his life and didn’t allow fear to have a stronghold. And in a situation that would have granted ANYONE a reason to have a bad attitude, he remained one of the most joyful kids I’ve ever had the privilege of knowing, which I’ve heard didn’t change even towards the end of his life. I think about that a lot in situations when I’m tempted to have a attitude of selfishness and self-pity... even when it comes to things like working the holidays.
This year, I’m working Christmas Eve again. (but full disclosure; it’s by choice.) And while some would consider that one of the more unglamorous parts of the nursing territory (and it still is), I’m excited to do it with the open eyes and thankful heart that I gained from such an unexpected place.
