By 
As I began pediatrics training toward my RN degree, I was well aware that of the three clinical instructors available, a former military nurse who I’ll call Ms. Smith was not the one most students would wish to learn under. Rumor had it, that she was too strict and was of the mindset she should ” break us down” and rebuild us in her image of a no-nonsense professional. She had reduced some of the students to tears and most tried hard not to gain her attention. It was said she would surprise you with questions or demands you were unprepared for and taught bedside techniques and procedures not in the textbooks or practiced in lab.
All this did not discourage me when I was assigned to report to her group on the first day of clinicals, but I will admit it certainly raised my stress levels another notch.
I was working full time as an orderly in the local hospital and since I knew obstetrics and pediatrics would be my weakest area of experience I arranged to shadow some of the experienced nurses on those units on my days off. I resolved to redouble my efforts to arrive well prepared, impeccably groomed, and made an effort to exude confidence and a professional demeanor. I wanted to learn as much as I could before graduating, gain the maximum exposure to different ideas and teaching techniques, and be totally prepared for the challenges ahead.
An incident occurred the very first day on the pediatric unit which paved the way for me to succeed beyond my expectations.
A winter storm Sunday night left the roads snow clogged and difficult to travel, so I left an hour earlier than the normal twenty-minute trip called for and was the first to arrive.
As I exited the elevator to the pediatric unit Ms. Smith was at the nurses’ station perusing the charts. Out of nervous habit, my hands went into my pockets and to my chagrin discovered two small plastic swords left over from an after class wind down some weeks before. They had survived the washing machine but I was not at all sure they would survive my instructor’s ability to detect something awry.
I had the unreasonable thought that she would make me turn out my pockets in front of those gathering for shift change like a schoolboy caught with a toad in his pocket. She glanced up and I hoped she thought my reddening face was from the cold I’d come in from.
I smiled my hello and she directed me to the conference room for pre-class assignments and a twenty-minute presentation of her expectations for the day. The three students that arrived late were held an extra ten minutes for additional counseling. I did not ask, and they did not tell what transpired. No one in our group was ever late again.
I was assigned two patients to work up a detailed plan of care for, prepare and dispense their medications, bathe, perform any needed treatments, then report to the conference room at one p.m. for post-conference. No break, no lunch.
By eleven o’clock I felt caught up enough to carry out the part of my care plan that provided play time for my young charges. So far that shift Ms. Smith had peeked in twice saying nothing, her face unreadable. She had also approved my care plan with a perfunctory nod and joined me for medicine dispensing.
To begin playtime I chose the patient I felt needed it the most. Born with spina bifida and other co-morbidities, ten-year-old Robbie weighed 42 lbs. His body was universally wasted with vestigial legs forever folded under him. Listlessly peering out from dark rimmed hollow eyes he would break your heart just to look at him.
He had put up with my exams and care without protest, took his medications and showed no interest when I mentioned I would return later so we could have some fun.
I had experience playing with my young nephews and pulled out all my best knock-knock jokes, offered puzzles or coloring, even inked two eyes on my knuckle and folded my thumb under for an impromptu puppet conversation. I was getting nowhere and getting desperate.
Then I remembered the contraband swords hidden in my pocket. “Well Robbie, I said, I guess I will have to challenge you to a duel”. This made his eyes widen, and when I offered him his choice of red or yellow, he gleefully chose the red one, an ominous sign for me.
With a terrible French accent, I said “We always begin with crossed swords and yell En Garde. We must yell Attack! or Parry! or Thrust! or Pirouette!”It sounded good at the time… and French. “Aha! or You got me! loud Oohs and groans were acceptable too”.
So the mighty battle began, and with us both yelling and skirmishing, clicking tiny swords, not doing any real damage but having a ball, neither of us noticed his mother arrive and peek in the crack at the door. She soon swooned against the hallway wall, quietly sobbing uncontrollably.
As I heard later from a startled student, Ms. Smith stormed down the hall drawing the interest and shocked looks from everyone in the vicinity. Luckily, Robbie’s mother was able to arrest her entry and could barely gasp out her amazement and gratitude for what she was witnessing. In his whole short, difficult life he had never shown such animation and sheer joy as he felled me again and again, his tiny soft voice piping as loud as he could. He especially liked yelling “Pirouette!”
Supporting each other, the two spectators retreated to the visitors lounge. He finally let me win a couple of matches and by lunch he was tiring noticeably.
He had his mother bring “Mr. Patricks’ boss” in, then pleaded with her to let me join him for his meal, and with shining eyes said we would use our swords to eat with. Her eyes were red-rimmed as she said, “You are to stay with him and assist with his lunch and be in post-conference at 1300 hours… I will see to your other patient”.
His mother marveled at the amount he consumed, stabbing at vegetables and tiny meat slices, his voice and energy winding down. I’d be exaggerating to say he ate three ounces. Exhausted after our battles and my promise to return for a rematch in the future, he fell asleep clutching both swords but looking happy and contented.
I attended post conference with a noticeably wet collar from his mother’s goodbye hugs and expressions of gratitude. Not a word was said during that hour long conference about what transpired, but Ms. Smith wasn’t the only one whose eyes were red.
As we stood to file out she stopped me, saying “Mr. Moran… a word”. I slowly turned, red flags waving. With a small smile, she said,” PIROUETTE?, REALLY”? I smiled back, shrugged, and replied: “Good day Ms. Smith, I look forward to seeing you Thursday”.
I never was able to fulfill my promise to Robbie as he peacefully passed away two days after our encounter.
At the end of my pediatric rotation during my exit interview, Ms. Smith presented me with a letter from Robbie’s mother forwarded through the school office. Thanking her with a lump in my throat, I said I would open it later, and I could feel a single small hard object inside.
She also paid me the highest compliment she could award. She said the only thing that troubled her about my future was the fact that she could not find a thing that troubled her. “I think you will be a wonderful addition to our profession and a fine nurse”.
Robbie was buried with the red sword in his hand, ready to defend the very gates of Heaven itself, if the need arose. His mother also revealed that anyone entering his room would hear “En Garde!” and would be handed the yellow sword for a duel or two. He had more fun and more company in his last days than ever before.
Now, forty-four years later, though I have never worked a day in Pediatrics, many of the things I learned under her tutelage became hard and useful habits that helped me in my chosen field of critical care.
I still work full-time, and I’ll never forget Robbie, Ms. Smith, or that extraordinary first day. All nurses have stories like this and recalling them reaffirms why we chose this field. Making a difference tops just making a living any day.
Patrick Moran RN, CCRN
I currently work full time in the ICU at Oak Hill Hospital in Brooksville, Florida. I began my career as an orderly at St John’s Hospital in Detroit working my way through school getting my RN degree in 1978. I started on a neuro unit quickly transitioning to ER and critical care.
