I don’t feel comfortable giving her real name so I’m going to call her Jennifer. She was eight years old the first time she was admitted to the ICU at Naval Hospital Camp Lejeune. Her mother had good intentions, as I think most mothers do, but the road to hell, and all that.
Lt. Sleigherton hung up the phone. “New patient, Byrd. You up to a pediatric case?” She was being witty. It didn’t matter if I was up to it or not, I was due to catch the next new admit, be it an eighty-year-old veteran, a post-op C section with complications, or an eight-year old who wasn’t named Jennifer, with sickle cell anemia.
She was wheeled into the unit on a gurney by the ER staff. We transferred her to Bed 6. Introduced myself to her and her mother and got her hooked up to the monitors. I noticed her IV wasn’t flowing. I checked the back of her hand where the IV catheter entered the vein. It had infiltrated. “Uh oh, looks like we have to start a new IV,” I said.
Jennifer was no stranger to hospitals or IVs. She wasn’t happy at this news. She pulled her hand away from me and said, “No!”
“Don’t worry, baby,” her mother said. “It won’t hurt. I promise.”
Jennifer and I both looked at her lying mother. I try to make allowances for worried parents, and she had every right to be worried. Sickle cell is a dangerous disease. I felt bad for her, but she wasn’t my patient, Jennifer was. I said, “It most certainly will hurt. But just a little bit. And just for a few seconds. That’s what I promise.” Jennifer looked at me in surprise. I returned her gaze and said in the most reassuring voice I could, “And I never make promises I can’t keep.”
As I said, she was no stranger to hospitals. She knew I was going to start a new IV no matter what. She knew her mother’s promise was bull. I think she wanted to believe me. I don’t know why she didn’t. She must have had hundreds of IVs before. But clearly, she was scared. I told her I’d be right back and left to get the IV tray.
Outside the cubicle I read her chart. Yes, she’d have dozens of IVs but was a combative patient. It took two nurses or corpsmen to hold her down while a third inserted the IV. What should have taken less than a minute took at least five, sometimes twenty. What I wouldn’t give for an eighty=year old veteran or a post-op C section right now.
I went back into the room with the IV tray, a red box with assorted size needles and catheters and tubing packages; different pairs of gloves and alcohol wipes. I smiled at Jennifer and reminded her that it would hurt, but just a little and not for more than a second or two. “Ready?” I asked.
That seemed reasonable. “Lt. Sleigherton!” I called. She stuck her head in.
“Will you start an IV in me, please? I want to show Jennifer how bad it hurts.”
Lt. Sleigherton, God bless her, didn’t ask a single question. She pulled up a stool and I sat on the bed next to Jennifer. Lt. Sleigherton put a tourniquet around my arm, donned a pair of gloves and began tapping the back of my hand. I kept up a running commentary for Jennifer’s benefit. “This is pretty snug around my arm but it doesn’t hurt. It makes my hand and fingers feel tingly though.” The lieutenant opened an alcohol wipe and swabbed the back of my hand. “That’s cold but doesn’t hurt.” Lt. Sleighterton opened a small gauge needle/catheter combination. “Now this part is going to hurt.” She pulled the skin on my hand taut and positioned the needled. Jennifer’s eyes never glued to the back of my hand.
“OUCH!” I said, louder than necessary, when the needle pierced my skin. Lt. Sleigherton withdrew the needle, leaving the plastic catheter inside the vein. She kept pressure on the vein with her right thumb and released the tourniquet with her left hand. When she moved her right thumb, blood trickled out of the catheter. She connected IV tubing and inserted the other end into a small bag of saline solution which she held up over my arm. Saline dripped into the tubing and from there into my vein.
“That’s it,” I said. It only hurt when I said ‘ouch’. That was the only time it hurt. I promise. I’ll tell you what. I’ll leave my IV in while I start yours. Okay?”
Jennifer nodded dumbly. I kept up the same commentary on her as I repeated the actions on her that had just been done on me. “I bet this feels tight on your arm . . . do your fingers feel tingly? Okay, get ready to say ouch. See, it doesn’t hurt any more, does it?” Once her IV was flowing I had Lt. Sleigherton remove mine.
Jennifer was in the ICU for just under a week that time. She was admitted three more times over the next two years.
Lt. Sleighterton heard me tell hundreds of patients, “it’s going to hurt but only for a while.” Or “it’s not going to hurt at all. I promise.” Or “This is going to be really bad, but there’s no help for it. It will be over soon, though, I promise. And I never make promises I don’t keep.”
She was also there when Mrs. Fioriti came in. Mrs. Fioriti was very sick. She was admitted with Hepatitis and went downhill from there. She developed jaundice and the sepsis. The doctors were optimistic when she was first admitted but as the days went by it became clear that she wasn’t going to make it. Because of her hepatitis diagnosis. She was on “contact isolation.” Staff and visitors had to wear gloves when they were in contact with her.
One day after her son left her, taking off his gloves as he left the room, she turned to me and said, “I feel so dirty.” She started crying. I’d been inoculated against Hepatitis B and my tests for the antibodies had come back positive. The gloves were protocol and overkill. I was breaking the rules, but I didn’t care. I took my gloves off and held her hand, assuring her she was not dirty, just sick.
She was also frightened. “Do I have cancer?”
“No. I promise.” I told her. “I and I never make promises I can’t keep.”
The next day she told me she couldn’t find her rosary. When the day shift had changed the sheets on her bed, the rosary had been accidentally caught up in the sheets and sent to the laundry. There was no way it would ever be found. I promised her I’d get her another one and reminded her that I never make promises that I can’t keep. After work I went to one of the larger Catholic churches in town and got a rosary for Mrs. Fioriti.
I gave it to her when my shift started that night. She thanked me. Her son was in the room and said, “Mama, I could’ve brought you one from home, if you’d told me you needed it.”
“I don’t want to be a bother.”
They fussed back and forth about being a bother versus not being a bother at all. It ended with her telling him she would love some coffee it wasn’t too much bother, and him leaving to go to the cafeteria to get some, even though they both knew she wasn’t allowed to eat or drink anything.
When he left, and it was just Mrs. Fioriti, me, and Lt. Sleigherton in the room, Mrs. Fioriti said to me, “Bob, am I dying?”
I’d been doing this long enough that I could tell when patients were ready to go and when they desperately wanted to live. Mrs. Fioriti was not going to get better. She was septic. Her very blood was poisoned by now. But she wanted so badly to live.
“Mrs. Fioriti, you’re going to be fine,” I said. “I promise. And I never make promises that I can’t keep.” Lt. Sleigherton cast a sideways look at me but didn’t say anything. She understood the importance of telling the truth when it was needed. And of lying when it was needed.
And the truth is, I never make promises that I can’t live with.