Monday, December 19, 2005

A foot on both sides of the bed

One of my favorite clients is sick, very sick. I have lots of complicated clients, since I'm a case manager for children with special health care needs only. And this little one is no exception: complicated, congenitally different, precariously clinging to life at the best of times. This is not the best of times.

I go up to visit her at bedside in PICU, sometimes standing next to mom but often just alone, silently watching. I'm praying, really, but maybe I don't want everyone to know. Even though my office is in the children's hospital, I'm community-based and don't get to PICU too often (thank goodness). So none of these nurses know what to make of me, and give me sort of wondering looks. Probably they think I'm a social worker, but I'm used to that. Sometimes I try to impress them and throw in a medical term or two, but it's been a long time since I took care of central lines or suctioned an ETT. Probably it shows.

But what they don't really know about me, most of them, is that I'm also a mom and I also have a very complicated child who once laid in PICU for awhile, recovering from something. And my baby looked an awful lot like this baby. Same almond eyes. Same wispy blond curls. I know there's an inevitable "quality of life" discussion coming up soon, one in which I will, as usual, hold a minority viewpoint.

It's hard to have a foot on both sides of the bed. I say my prayers, and go back to work.



Blogger Arevanye said...

How is she doing, Mary? Dare I ask?

I've been laying awake worrying about one of my students. Can you explain this to me, since I've not had this happen before? Why can't we stay all detached and professional with these little ones?

8:31 PM  
Anonymous Anonymous said...


Good luck. Thank goodness you do NOT hold that professional distance and let yoru heart lead. If our hearts led more often than our theories and studies, who knows where that "quality of life" question would lead us?

Genuine interest and concern for my *child* has been the single most effective strategy I've seen. It consistently works.

And this little one will know she was loved.

11:30 PM  
Blogger mary said...


She's "holding her own", which is not really good news, since she has not improved.

You asked: I've been laying awake worrying about one of my students. Can you explain this to me, since I've not had this happen before? Why can't we stay all detached and professional with these little ones?

Well, I've been nursing for 30 years, now, and I'm not "detached" and probably never will be. I don't think, when it comes right down to it, that we ever get detached, not really. We get perspective, I think, from experience. We get insight into our own attachments and become able to make difficult decisions in spite of those attachments. That's what professional experience gives us. But under our metaphorical white coats, we remain human beings who become attached to others. And in fact, I don't believe we would be effective professionals, if we didn't have that ability.

So I can't guide you on how to become detached. :-) But you can practice becoming able to accept the boundaries around your role as teacher, in the way nurses and doctors have to understand the boundaries we practice under. As much as I would like to (and actually, try to) "save" every child, I am that child's nurse and not some omnipotent goddess with a magical wand.

Your little student probably has a chaotic and complicated life, or you wouldn't be losing sleep over him. But there is only so much of that life you can change, the part that is within your classroom--and maybe, perhaps, the part that gets internalized by that student and carries over into the rest of his life. But you're in that child's life to be the caring teacher, and you can do that to the best of your ability and still not "save" this particular child.

That's the sadness I can't make go away.


7:43 AM  
Blogger Arevanye said...

I'm glad you realized that my question was somewhat rhetorical, since I don't want to particularly be the kind of person who always remains professional and never takes a child that isn't hers into her heart. Some of these little ones have so many strikes against them before their lives even get going. It just isn't fair, is it?

Bless you, Mary, for doing the work that you do. I hope your patient improves soon.

6:26 PM  

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