My hat will forever be off to the pediatric nurse. I knew from my very first pediatric patient while in nursing school, I did not want to work in that department. With small kids at home and identifying with the patient I knew that my emotions would be stretched “to the hilt” caring for “tiny people.” However, at times, those small little people did make it to our ICU and here is the true story of such an occasion.
Sunlight framed the tiny frail body of the little girl who lay in the bed of our ICU. The only sound in the room was the sound of the ventilator that allowed her chest to rise and fall and allowed her to stay alive. Her admitting nurse, Melinda, had washed away the dirt and grime that had been embedded in her skin, nails and hair. She had brushed out all the matting from her hair and the curly golden long hair now lay spread across the white pillow case like a halo shining around her head. She was ever so pale except for the bruises scattered all over her body but we had covered those up as best as we could except for the ones on either side of her tiny face.
We were used to teens and adults with only an occasional child when there was an accident of some sort and those were rare. We were all devastated at this turn of events in our unit and I am about to share a story that I hope not one of our colleagues ever has to endure.
For this true story we will call our tiny patient Angel and indeed, as I’ve said, she looked like one. Not when she came but now. When she came to us from the ED, so did her horrific story. It seems that Angel’s mother and boyfriend had a harsh way to deliver discipline and as we listened we heard that Angel, out of her siblings, was the scapegoat for all of the family’s problems. This tiny little creature had endured many beatings over the few four short years she had on this earth and on this occasion she was locked in a dark and damp shed in their back yard. For days the beating must have persisted and from her lab work the doctors drew the conclusion that she was given only salt water to drink. Her little body was riddled with not only bruises but tiny cuts and beneath the skin lay the old fractures that were healed or healing added to the new ones she had now. This beating, however, along with the diet of salt water had taken it’s tole.
Where was the dad in all of this you may ask and where were any family or friends. Well, the dad was incarcerated for a crime we knew nothing about and there was an elderly grandmother and the child’s aunt who was the dad’s sister. She had never really cared for the mother but she did care for her nieces and tried to stay in contact as best she could. She had visited several times and either Angel was playing at a friends, at a sleep over or some other excuse was made for her absence. The aunt had called social services several times and during those years long ago they had to call to make an appointment with the mother and give her notice before they could visit.
They had recorded cooperation from the mother and Angel was present on some occasions and at other times she was not there but at a friends. They were persistent but the house was clean, the other girls were healthy looking and Angel, when she was there, was tiny but looked well kept. All seemed in order and the fears that the aunt had expressed seemed just to be the ravings of a woman who did not care for the mother. Angel, it was recorded, seemed small for her age, shy and not as talkative as the other girls but in no way did she looked abused.
Well, it all finally caught up with them when the aunt went to school and they said that the mother had called her in sick several days ago and they had not seen her. On this occasion she bypassed social services and went straight to the state police and insisted that someone go and check on her niece. Luckily she was friends with one of the officers and having little ones of his own and knowing the aunt not to be daft went with another officer to check on Angel. Per the mother she was not at home. As they were leaving, they noticed the shed behind the house and went to investigate but the shed was locked. The boyfriend said they had lost the key to the lock but the police were insistent and they busted in the door. Just as they made their discovery, they heard a car starting up it’s motor and were able to apprehend the mother and boyfriend leaving alone without the other children.
There lay a tiny lifeless body of a child “crumpled” on the earth floor of the shed. When they rolled her over she was barely breathing. She looked like a toy doll that had seen it’s better days and found it’s home in a trash pile. She was filthy, her lips were dry and cracked and she was covered with bruises and obvious fractures from the positioning of her little arms and legs. With tears in their eyes, the policemen called for an ambulance to come quickly and they held her gently in their arms while the mother and boyfriend tried to say she had been missing in one breath and then blaming each other in the next. The officers were so stricken at what they had found they cuffed them both and put them in the back seat of the cruiser to await the ambulance.
Angel, by the time she got to the hospital and properly tested, had come to the end of the road on this earth. She was declared “brain dead” and a ward of the state until they could get the father to her bedside and hope that he left her go in peace. He came with two guards and sobbed so loudly that we had to shut the other patient’s doors. His sobs were that of any other parent who had lost a child and came from the gut. He blamed himself for not being there to protect her and even the guards eyes held unshed tears. “Let her go,” he said and turned around to slowly shuffle off sobbing the whole way out.
The ventilator was removed and within minutes little Angel moved on. I like to think that she had already moved on and was looking down at the empty body of a little girl and smiling because she was not in pain anymore. No more beatings, no more harsh words, no more pain. Her world was warm and sunny now and she was loved and cared for just like she had always wished. It took a very long time for us to push this memory behind us and I guess for some of us back then…it never went away.