The year was 1981. I was a new graduate working the night shift in a Pediatric Intensive Care Unit (PICU). My most memorable patient was 6 months old and recovering from his third lobectomy. Brady was born with dextrocardia and right pulmonary sequestration that led to chronic infections, necessitating the need for removal of his right lung one lobe at a time.
With removal of his last lobe his mediastinum shifted laterally bending and kinking off his left mainstem bronchus. The only thing keeping the bronchus patent was positive pressure, leaving Brady ventilator dependent. With no facility close by that would accept a ventilator dependent toddler the PICU became Brady’s home and 25 nurses his “pseudo-moms.”
The nursing staff realized that Brady’s growth and development was as important as his physiological needs, so we proceeded to plan Brady’s care to keep his everyday life as normal as possible. Our priority was communication, since Brady had a tracheostomy. Collaborating with occupational and speech therapists Brady and his caregivers, along with his mother, were taught a rudimentary sign language.
We socialized Brady by taking field trips in his Red Flyer wagon loaded with oxygen, an Ambu Bag and portable suction. He would go to the cafeteria to have lunch with his “extended family” of respiratory therapists, radiation techs and others. We would then go to other familiar departments just to say “hi” before going back for his afternoon nap.
Brady had a wardrobe and picked out his clothes every morning and his pajamas every night. He took baths in the nurse’s station sink and spent TV time everyday watching Sesame Street. He had his meals for the day with the nurse caring for him. He even had a pet goldfish – until the infection control nurse flushed it. Who knew Pseudomonas was natural gastointestinal flora in a goldfish?
We potty trained him and saw his first step. We got him through ear infections and nightmares. We had birthday parties and Santa Claus even came. We read books to him and rocked him to sleep at night. We took lots and lots of pictures.
Then one day, when Brady was four years old, a surgeon came and built him a new bronchus using Brady’s own rib cartilage. After a very long recovery and several brushes with death, Brady went home. That was the best day and the worst day that I had taking care of my most memorable patient.