Senior Nurse Mentor

My Nights with Leukemia

I can’t begin a book about nurses as mentors without mentioning the wonderful nurses who mentored me when I needed it most—when I first began to work on Hem-Onc with only the woefully inadequate ‘scoop and run’ training of a medic.

That story begins with an odd twist. Mountain climbing in the Pacific Northwest taught me the importance of knowing emergency medicine. Anything could happen in the mountains far from assistance. As a result, I took Emergency Medical Technician (EMT) training at a community college. I thought about becoming a medic-volunteer with a mountain search and rescue team.

Then my life took dramatic U-turn. Headed for bankruptcy, the energy management firm where I worked laid me off. A friend suggested I apply for a nursing assistant position at a nearby children’s hospital. I was accepted for a position on medical unit’s night shift that would start after a month of orientation on days.

I soon wondered if I’d made the right choice. Day shift meant endless busy work that I found dull. I’m simply not cut out for linen changes and the like. I like challenge. But I hung in there, hoping night shift would prove different.

I also knew what I did not want to do on nights. There was one challenge I did not want. I did not want to work on Hem-Onc. The hospital is different now, with two independent units dedicated to childhood and adolescent cancers. But at that time children up to their tenth birthday were handled on one cluster (seven beds) of the three-cluster, children-from-one-to-nine medical unit. Elsewhere in the hospital, teens with cancer were mixed with the general population of the adolescent unit. Later I would work there.

Why didn’t I want to work Hem-Onc? I explain why in another book, My Nights with Leukemia: Caring for Children with Cancer. Here, I’ll just state that looking at Hem-Onc from mere yards away horrified me. The children being treated—most of them had leukemia—looked like the survivors of a horrible concentration camp. They were thin and pale, with only a few wisps of hair. I breathed a sigh of relief when I looked over at them, stumbling slowly alongside a parent who was pushing an IV pole festooned with bags and pumps. Hem-Onc was nurse-only, I reminded myself. I would never work there.

Then my orientation ended. I appeared for my first night shift and discovered that I was assigned to Hem-Onc. Night shift wasn’t all-RN. It paired a nurse with and an assistant. I was to be that assistant. Later, the hospital’s chief nursing administrator would tell me that my EMT training had given me what was probably the most demanding assistant position in the hospital. To staff it seven days a week, it had two assistant slots. I shared the night position with Cala, a student at a top-notch nursing school nearby.

Fortunately, my situation soon turned from fearful to positive. I discovered that I loved carrying for those children and came to believe I had a knack for the work’s many stresses and emotional complications. Alas, Cala loved the work as much as I did, and three nights out of fourteen we were both on duty. We clashed until we reached an agreement. Whoever had been working Hem-Onc would continue to do so when the other returned from break. That gave those children continuity. When I came back, she continued to care for them. Three days later, when she left, I’d learned enough from her to take over and vice-versa.

There was another hitch, an enormous one for me. Cala was in her third year of school and thus almost a nurse. I only had a couple of mountaineering first aid courses and that EMT training—three hours on three nights a week for three months. That was roughly a hundred hours in emergency medicine. I knew how to stop serious external bleeding, temporarily splint broken bones, and deliver untimely babies. I’d been taught nothing about childhood leukemia.

Fortunately, I arrived at the perfect time. Three experienced nurses took turns filling the Hem-Onc night nurse position. That’s when the mentoring began. They taught me well, as I explain in My Nights with Leukemia. At the time, I didn’t appreciate just how vital their mentoring would be. Children’s lives would soon depend on what I had learned from them about good nursing.

Here’s what that work was like. On days, two Hem-Onc nurses divided up the patients, with one nurse caring for four children and the other for three. On nights, the division was based on the work done. The nurses complained that night shift meant carrying for IV pumps rather than children. They were right. Seven children meant seven complex IVs to manage—that I’ll discuss in more detail later. Treatment went on around the clock, so night shift got its full share of IV care. As a result, night shift meant a nurse was constantly moving between IVs, wrapping up chemotherapy with one child while giving antibiotics to another.

That left the hands-on patient care to Cala and I. We were the ones who checked vital signs, looking especially for a temperature spike that indicated an infection. We made sure that, with so much fluid being pumped into a child, their urine output remained high. There was also time to built relationships with the children during those scary nights when we took over so their parents could get much-needed sleep. Caring for the same children for weeks at a time and getting to know them was why Cala and I loved what we were doing. 

A humorous incident a couple of months after I started illustrates how well they trained me. My favorite among that first set of nurses was giddily happy married to an officer on a USCG cutter, and he had just come back from a six-week cruise. She was spending so much time with him, she arrived at work one evening almost falling asleep. 

After she began her 4 a.m medications, she told me that she’d be napping during her break. I thought nothing of it. The kids were stable, and if a crisis came up, I could always call in the nurse on the next cluster. I didn’t even notice that she didn’t give me a time to awake her.

Doing both her work and mine kept me so busy that I wasn’t aware of the passing time until the head nurse arrived almost two hours later. “This isn’t good,” I thought. “She didn’t intend to sleep this long.” As unobtrusively as possible, I slipped over to the next cluster and asked its nurse to cover any alarms that might go off on Hem-Onc.

Then I began searching for Sleeping Beauty. Fortunately, she was in the mostly likely place, a couch in the nursing locker room. I woke her and hurried back. She arrived a couple of minutes later, doing her best to conceal that she’d just awakened from a deep sleep. For once our head nurse’s thick head served us well. She noticed nothing.

That bit of fun illustrates how well I’d been taught. In about two months I’d gone from being terrified at the thought of working on Hem-Onc to being able to handle its routine work so calmly, I hardly noticed when I worked as both nurse and assistant. The work had become as natural as breathing. Just keep in mind that what I knew well was the routine care for one particular nursing specialty. There’s no real substitute for years of nursing school.

My new-found ability would severely tested when a major crisis hit Hem-Onc shortly afterward. When it struck, Cala and I would become Hem-Onc’s de facto nurses for several long and terrifying weeks. We take that up next.