My patient, Alexandra Smith I will call her, fourteen years old, died in January.  I want to share her story and my story with her.

     Alexandra had a connective tissue disease and was sick off and on for the previous two years.  Although her disease was serious and complicated, she and her parents thought that this disease was manageable, treatable.  But in late spring, 2007, Alexandra was admitted to the hospital.  After spending a few weeks there, she was gratefully given a pass to attend her eighth grade graduation in May.  She looked beautiful and had lots of pictures taken that day – a young lady dressed up, wearing make-up and jewelry, surrounded by family and friends and her special little cousin.  As she went back to the hospital that evening, I wonder if she had a sense that she would never go home or go to school again.  Did she have any sense of what awaited her?

     I first met Alexandra on July 1.  I am a nurse in the Pediatric Intensive Care Unit (PICU) of a pediatric hospital. This particular day, I was assigned to care for “Smith, A., bed #8.”  I received report that Alexandra had been transferred from the floor to the PICU overnight and intubated for “respiratory distress.”  We did blood work, adjusted ventilator settings, and started a narcotic drip.  I met her parents and a lot of extended family that day.  A difficult day for all of them, I did what I could to care for Alexandra and keep everyone updated on her plan of care.

     Alexandra’s PICU course was a rocky one, and she lived with us for the next six months.  Our days included managing her respiratory status with high ventilator settings and eventually a tracheostomy, frequent blood products, infections with many antibiotics, open wounds with many dressing changes, narcotic drips, blood pressure drips, diuretics, sometimes paralytics.  We talked to her, turned her, kept her clean, and put on her favorite television shows.  She would gradually improve and stabilize then relapse.

     She eventually improved enough that plans were in place for her to go to a rehabilitation center.  Even as these plans were being made, however, Alexandra started to complain about abdominal pain.  Something was found on a test, and she needed surgery.  She had her abdomen opened yet again, had a drain put in, and narcotics that had been painstakingly weaned were restarted.  Alexandra was not to recover this time.  She became septic, turned jaundiced, her kidneys slowed down, and her blood pressure was dropping.  More drugs, more blood products, increased ventilator settings, epinephrine...   Mom and Dad were asked how much should be done.  “Everything” was their answer, so everything was done.  But after awhile, even that was not enough, and Alexandra died early one morning, surrounded by her family.

     I was Alexandra’s nurse her last two days in the PICU.  The first day was not too bad, and I had a few really nice talks with Alexandra’s mom.  The second day, however, we could tell she was becoming sicker, and I never stopped running for twelve hours.  Nothing we did seemed to help.  By the end of the day, I was exhausted, worried about her, and felt overwhelmed and helpless.  As I drove home, a song came on the radio, “In the Arms of the Angels” and I cried and cried.  How much can Alexandra go through?  She has been fighting for her life for eight months and she has had enough.  I am tired, and perhaps I have had enough.  I received a call early the next morning that Alexandra had passed away.  I actually felt relief and a sense of peace after hearing that Alexandra died.  It was finally over for her.  A song that my husband and I had heard that we like is, “Fly to Jesus.”  I let my husband know at his work, “Alexandra flew.”

     Yet another song I kept thinking about was Rod Stewart’s, “Forever Young”:  “When you finally fly away, I’ll be hoping that I served you well…”  Alexandra, I hope I was a good servant, a good nurse, for you and your parents.  How much you had to go through.  How much you had to suffer.  Jesus, thank you that her suffering has ended, that she is at peace and healthy and with you now.  But now, hold her family.  How do you bury a child?  How do they go on as a family without her?  What a hole they’re left with in their hearts.

     How good it was to get to know Alexandra and her parents.  And all the extended family, especially her brother, grandma, aunts and uncles, and all the cousins.  What a privileged place to be welcomed into their family during such a difficult time.  What a privilege to be Alexandra’s nurse.  I feel like I’ve gotten a lot of support from them over these months.  Week after week after week went by, and we started greeting each other with, “Happy Sunday to you!”  If I was not taking care of Alexandra that day, I would ask how she was doing and about how they were holding up.  Some days I could tell her parents were having a tough day and I would give them a hug.  Some days they returned the kindness when they could see I was struggling.  One day while caring for Alexandra on a really busy day, I must have looked tired or discouraged and I still had a few hours left in my shift.  It was Grandma who reminded me, “Ask the Lord for strength.  He’ll help you.”  I was happy on the days that I was assigned to care for Alexandra, and I think her parents were happy when they saw that I was her nurse.  The days could be exhausting, but I liked Alexandra, I liked her family, and I felt like I made a difference by being there.

     Sometimes I wonder how long I can go on as a PICU nurse, though.  Child after child after child.  Some days are good.  Some are incredibly hard.  Some are even fun!  Some days I think, “I can’t do this anymore.”  Jesus, I offer all this to you.  Jesus, I offer myself to you.  Use me, as you will.  One day, I had to take my sons, ages nine and seven, into work with me for a meeting, and they met Alexandra’s dad.  He told them, “Your Mom’s very good at what she does.”  What a kind thing to say!  If that is true, which some days I know to be so, then I want to stay, and help where I can and serve where I can.  This truly feels like a vocation.  But some days it’s awfully hard on me.  So I come home and lean on my husband for support.  And I hug my husband and each of my sons.  We never know.  I have them today, and I’m grateful for today.  Jesus, I trust you with tomorrow.

     My husband and sons and I went to the March for Life in Washington, D.C. this year.  The first part was really emotional for me, I think because it was within days of Alexandra dying.  But one of the speakers said that perhaps when we die, we’ll have a chorus of people calling out to welcome us home, and it will be the voices of all the babies for whom we spoke up, to put an end to abortion.  But I saw the March as pro-life with a bigger picture.  For me, could it be that I’ll hear the voices of all the children I’ve cared for?  The Joshua’s and Lindsay’s and Noah’s and Brittany’s and countless others…and now Alexandra?  Jesus, hold me as I care for your children, and today, cry for your children.  Amen.