PICU is my favorite unit in the hospital followed closely by Pediatric ER.. But nothing about PICU is easy. What I like most about PICU is the variety. I can literally have neonates and practical adults all at the same time. It constantly challenges my brain and I really like that. I’m not often assigned to PICU, but do try to spend some part of every shift soaking up the knowledge with the hopes that after intern year, I’ll get to work in PICU.

Last week, I had a really challenging case and I was talking to Chris about it.

My patient was a 16 year old boy who had cystic fibrosis. I had taken care of Corey a couple of times before so when he saw me come into his room, he smiled. At 5’5″ and 116 pounds, Corey seemed smaller lying in the hospital bed.

“You’re still here” Corey beamed. 

“Yeah, where else would I go?”

“Oh I don’t know. I thought maybe you had retired or something.”

“Corey, I’m only 24. I’ve got another 40+ years of <cue me wildly gesticulating> this. Or more! Anyway, what are you doing back here? You just had your tune-up”

Cystic fibrosis is a condition that affects the lungs and pancreas. In peds, CF patients are frequent patients. When seemingly innocuously events like the change in weather occurs, it throws the fibrotic lungs off. And we had just had our first real cold snap of the season.

“Oh you know, my lungs are being real jerks right now.”

I begin my assessment and Corey’s lungs ARE being total jerks right now. He’s hardly moving any air at all. I check my order and give Corey his meds. And his vest,. We watch a little basketball and shoot hoops from the bed. Corey has the better angle so he scores more points than me. Or at least that’s the story I tell myself. Truthfully, I haven’t picked up a basketball or even a wadded up piece of paper since my dad died. It gets me feeling maudlin and I try to hid my feelings, but Corey notices.

“Hey, you’re not sad because I beat you in basketball, are you?”

“That’s not it at all. I’m just remembering. That’s all. Anyway, I’m finished with you until the morning. Good night, Corey.”

***** ****** ******* ******** ******* ******* ******* ******** **********

At 2am, the rapid response beeper went. off. It was to Corey’s room. I was the first one there and saw Corey struggling to breathe.

“Can’t. Breathe.” Corey struggled to get out.. I grabbed my stethoscope and listened to Corey’s lungs, They.Were.Silent. That’s not good. About the same time the rest of the team arrived. We grabbed the AmbuBag and started ventilating him meanwhile preparing to transfer him to PICU.

We got Corey somewhat stabilized in the PICU, He was using the vest to help break up the secretions and. was able to breathe a little easier.

***** ****** ******* ******* ********* ********** ********* ******** ******** ****** ******

At 5am, I stop by to check in on Corey.

“ElizaMarie, I think I want to go on the ventilator. It’s just getting so.hard to breathe. I just want to rest.”

“Corey, do you know what that means? Have you talked to your parents?”

“yeah, they said it’s my decision.”

“That’s a lot of pressure to put on a 16 year old.” I. mumble, but loud enough that Corey overheard even though that wasn’t my intention.

“I’m not a kid! “Corey exclaimed. “You don’t know what it’s like to fight for every breath.”

“You’re right, Corey, I don’t. I’m sorry. Only you know how much you can handle. You have dealt with this your whole life. You are certainly capable of making this decision.”

I hope Corey didn’t suss out *why* I said what I said.

“Hey, Corey,–I got next”

He smiled then closed his eyes as then team got ready to intubate him.

I swung back by the PICU at the end of my shift to check on Corey. He looked so peaceful as the mechanical sounds of the ventilator hummed along rhythmically breathing for him.

Kelly Clarkson: Stronger

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