The Letting Go

1977

It was a beautiful spring afternoon in Atlanta. Green sprouts of flower bulbs peak through the ground. The pink and white dogwood trees are in bloom and a rainbow of azalea bushes make a lovely portrait.

Spring is my favorite season. The seventy degree temperature is perfect and I love to sit outside with a book and and a cup of herbal tea.

Leaving my husband and four-year-old son for work is never easy. As I give hugs and kisses to my energetic redheaded son, it never occurred to me how much he would be in my thoughts that evening.

I was a relatively new nurse, having been out of school for only eight months. I recently discovered that I had passed my nursing exams. So now I was a " Registered Nurse" and not just a graduate. My husband and I had celebrated by going to our favorite Italian restaurant and he had surprised me with tickets to the Broadway play “Cats".

There was a critical shortage of RN's on both evening and night shifts in hospitals. I had been rushed through orientation by working on day shift from seven in the morning to three in the afternoon. I was working with experienced nurses, trying to learn how to organize my time better . Everything happened so rapidly, I prayed I could become a safe and efficient floor nurse.

Actual hands-on nursing at a hospital was quite a bit different from my experiences in nursing school. That was when I had two patients to care for in four hours. Now, myself and another new graduate each had 10 of our own patients. There was no time to document how many green beans a patient consumed for dinner (in school you really had to do this) and the doctors didn't read nurses notes anyway, other nurses would if they needed essential information. You only document the most important details about a patient. Most documentation is done with computerized flow charts.

I was working on a surgical unit. We stayed busy sending and receiving patients back from surgery. We made sure they recovered as expected without complications. We inserted catheters, IV's, observed tubes, cleaned and packed wounds, removed sutures and changed bandages. We gave them medications for pain, antibiotics, and attempted to do these things with both skill and tender loving care.

I did enjoy my job and even when things were hectic, I could laugh with patients and hold their hands when they were frightened. I was learning by doing. Not only about medicine, which I loved but also, about people.

It was about five in the afternoon when we received a call that we would be getting a patient with severe burns from the emergency room. I was completely caught off guard. I was used to caring for surgical patients.

I tried to remember what I had learned about burns. I knew they needed intensive care and I had nine other patients. We quickly readied the room. I realized we must be getting this patient because we had a private room near the nursing station and it was a Isolation room, which meant it had a sink area right outside the room itself. This area would be used to change gowns and masks plus use precautions to protect a burn patient from infection.

Emergency Room personnel pushed a gurney towards me. When I saw the person that lay on it, my heart rushed into my throat. He wasn’t moving, was swathed in bandages like a mummy, and I could see singed hair and a tracheotomy tube in his throat.

They didn’t even try to put him in our bed, just pulled it out of the room, soon I would discover why. I hooked the oxygen up to the tracheotomy tube in his throat that goes into his lungs to help him breath and put the two intravenous bags on poles. He wasn’t talking and his eyes were bandaged. I picked up his slender hand and felt for a pulse. It was there but weak. He didn’t react to my touch.

I walked out to the nurse’s station to get a rapid report from the ER nurse.

“Johnny Isham, 18, driving his VW Beetle home from work ... apparently lost control. Car slammed into a concrete wall, burst into flames. No alcohol or drugs involved, and no other vehicle. He has 80% partial and full thickness burns and no hope of survival. We are to keep him comfortable with IV steroids, sedatives and Morphine."
"He hasn’t regained consciousness and isn’t expected to. We tried to clean him but he's burned so badly ... clothing is adhered to skin. We've been suctioning his tracheotomy tube frequently, thick and bloody."

The ER nurse grabbed a cookie from a box a patient's family had sent us. "Thanks, first thing I've had since shift change. It is crazy down there!".

She continued, "His family's been notified. Unfortunately, they're out of state...can't get here til' morning. He probably won’t last that long. His girlfriend and a couple of buddies are here. We told them you'd let them in when you could."
She took a discouraged sigh.
"He needs cleaning up but if you disturb him I'm afraid it will cause more pain. To see him is going to frighten them anyway. Here are orders from the ER doc.”

I looked over the physician’s orders about what he wanted done. Two words jumped off the paper, NO CODE. I knew what that meant; we were to let him die without trying to revive him. Was I relieved? I wasn’t sure at the moment but later I knew what a blessing they were.

This was a first for me. The only other patient I had watched die was a ninety year old woman from a nursing home.

How selfish you are, Kathie. Here's an eighteen-year-old kid about to lose his life. Get a Grip!

First, I had to go and assess him. Usually you explain to a patient what their doctor had ordered for them. Then you answered any questions they had. Plus you did a physical exam on them. Of course this was usually a give and take conversation. Johnny wasn’t going to be able to talk to me.

When a patient has burns, we use gloves, gowns, and a mask to keep them from being exposed to bacteria. This takes time to don the gowns required and it is a block between you and your patients since you can’t have skin- to- skin contact, which I think, helps a patient feel cared for.

I walked to Johnny’s bedside and busied myself adjusting the IV solution as I counted his respirations. I talked to him, telling him my name and what I was doing. I assured him that we would keep him comfortable. I was assessing his level of consciousness by removing the pads from his eyes and checking to see if his pupils reacted to a flashlight, they were slow but constricted with the light. This meant there wasn’t extensive brain damage.

His eyes were brown and beautiful, the long, lush eyelashes and brows were singed. I put drops in them to lubricate. I hated to put pads back over them although I knew it was best to keep them moist. His nose was not burned. It looked like it had been broken at some time in the past and I could imagine him playing football. He had swollen lips. I knew that he had breathed in a lot of smoke and the inside his mouth was swollen also. They hadn’t been able to get a tube into his nose or mouth. His face did have some fine cuts on it that looked like it might have been from glass.

You could tell that his hair was brown and had been long but now it was patches and beyond combing. I picked up his hand from the bed and tried to get him to squeeze mine but he wasn't able to. His right hand wasn’t burnt but the left and both arms were and pieces of shirt fabric were still there. In a burn unit he would have been lowered in to a whirlpool and then the clothing could have been removed.

His breath sounds with a stethoscope were very noisy and I knew I needed to remove some of the mucus in his chest so he could breath easier. I suctioned it with a catheter and all that came back was bloody soot. I pulled the sheet down and he had a catheter that was draining a tiny amount of urine from his body. Across his chest and most of his abdomen was bandaged. Areas that were open were black and bloody and the smell was awful. I looked at his legs and one of his boots was still on a leg, burned to the flesh. He had an intravenous line in his groin.

I covered him back up. I mumbled, “Johnny, I will be right back”.

I fled the room and headed for the nearest bathroom. I vomited what little was in my stomach and then I cried and prayed.

“How am I going to take care of this young man? How can I even clean him up so his friends can see him? How will I know if he is in pain?”

This was too much of a challenge. Johnny needed and deserved an experienced private duty nurse. I dried my eyes and tried to pull myself together.

When I emerged back into the hall, I was told that several of my other patients needed pain meds. The other RN was taking her dinner break.

I placed a call to our Nursing Supervisor. Our supervisor for the evening was Susan Blake, Super Nurse; if anyone could help me it would be her. She was about fifty years old and wore old cotton uniforms with her starched cap and heavy orthopedic shoes. She expected excellence. We all snapped to attention when we heard her coming.

I was glad to see her, for once, thinking she would solve my problem of what to do to help this patient. I took her in to see him and she told me to just try to make him comfortable.

Her words of wisdom were, "There isn't any way to wash him off or change this terrible thing that has been done to him. This you can't make better. Try to help his family and keep him comfortable."

When I asked about getting a nurse or nursing assistant to sit with him, she said, “I must worry about those we can save."

I was feeling defeated and disheartened. A picture of my young son came to mind. There was a woman in another state who was trying to get here. She had held this boy in her arms many times and was hoping to be able to do it again. I didn’t have the time to even think about that right now, as other patients needed me too.

I took care of the most important matters and then went back into Johnny’s room. His breathing was much worse. There was no need for a stethoscope, he sounded like a freight train.

I spoke softly to him. “Johnny, I am going to let some of your friends come in. First, I am going to give you something for pain.”

I gave him some Morphine. I pulled the covers up across his burned legs and torso. My tears slipped silently down my face. I took the pads from his eyes so his friends could see him and smoothed the singed hair from his face. I was so happy that his face wasn’t badly burned but now it was filling up with fluid under the skin. This was changing his features.

I went to talk to his friends. They had been crying. There wasn’t even an adult with them. This would be a time in their young lives that they would never forget. His girlfriend, Sheri, was petite with shoulder length blonde hair.

“You can see him two at a time for fifteen minutes. He has a lot of tubes and doesn’t look like himself but it is very important that you talk to him like you normally would. I will go in with you. It is okay to cry, hold his hand, but don’t uncover him, okay? I might have to leave so if something changes, let me know.”

I escorted Sheri and Sam into the room. I asked them a few questions about themselves and Johnny. Both of them had gone to high school with him and they had all just graduated last year.

Johnny was staying with friends until he could start college in the fall and move into a dormitory.

I rushed the kids into the room and went down the hall to try to get caught up with my other work. My routine medications were almost two hours late. At this rate, I would be getting off work at two a.m. instead of eleven p.m. I scolded myself for thinking this way when a child was dying in one of my rooms.

All of a sudden, it was very important for me to hear my own son’s voice. I sneaked into the lounge at the end of the hall and dialed home.
Paul answered the phone.
“Hi, Babe, what are you doing?” I asked.

He answered in a sweet innocent voice,
“Watching Big Bird chase Grover. Grover took all of Big Bird’s story books and Boy, he is mad!”

I was relieved that my little boy was safe and happy.

“Well, Mommy just wanted to tell you how much she loves you, got to go and take care of people, okay?”

“Make them all better so you can come home soon, okay mommy?”
“I’ll try. You will be sound asleep with good dreams,” I said.

The other nurse, Karen, stopped me.
“Kathie, it's seven and you haven’t taken a break. Get off your feet for fifteen minutes, okay?”
She promised to check in on Johnny and his friends.

I put up my aching feet and tried to catch up with charting. I was very behind so with one hand I was writing and the other held a cup of lukewarm chicken noodle soup. In between charting, I was wondering why I had wanted to be a nurse so badly.

I heard the emergency light buzzing and threw aside the charts. I ran to Johnny’s room.

Sheri had pressed the light. Johnny sounded like he was drowning in his soot filled lungs. The noise was frightening. I couldn’t blame her. Trying to get the stuff out of his lungs seemed to only make Johnny more restless and I hated to suction him. It was the only time that he moved. It was a vicious circle, the more I sedated him with Morphine the worse his lungs filled up.

I encouraged Sheri to leave his room for a while.

Sheri’s Mom, Phyllis, had come. She looked at Johnny through the door.
"Why in hell would you people keep him here when there are Burn Units? This is Atlanta not a little town somewhere."

I tried to explain that I needed her to help give the kids some support. Johnny never stood a chance of living or else that is where he would be.

Johnny’s doctor had consulted with a Burn Specialist. I explained that now it is very important that we keep Johnny comfortable and let him know that he is not alone.

Since Johnny’s own parents weren’t there, maybe she could hold his hand and be a mother figure for him right now. She began to sob and said she couldn’t possibly do that and how dare I ask her. I believe she was more frightened than the kids were.

I went back in to see Johnny and things were definitely worse. His face was very swollen now and the unburnt skin that had been slightly pink was gray. He was losing ground fast. There was no urine in his bag.

Sheri looked at me with tears in her eyes and I asked how long they had been dating.
She smiled and said, “Two years, we were going to get married next June. I have my gown all picked out.”

We talked about their favorite song, places to go to eat, and some special times. She told me a lot about this wonderful young man. He had been a good football player, a student council member, wrote for the yearbook, and wanted to be a chemical engineer. She told me how much fun they had just last weekend flying kites at Stone Mountain.

Then Johnny had a seizure. It frightened all of us. I hadn’t expected this. I rushed for more Morphine but miraculously; he became quiet, his breathing slowed down and face relaxed.

Suddenly, what had been a terrifying storm became a quiet rain with Johnny’s condition.

Sheri and I invited all of his visitors in and I told them it was okay to take off their masks. They circled the stretcher. We really didn’t know each other very well but it didn’t seem to matter. We had all been thrown together in this place and situation and we would all leave here as different people connected by this day.

Johnny didn’t know, or maybe he did, that he was changing lives that evening. His breathing became very irregular and finally stopped altogether with a sigh. A sense of peace filled the room.

I called the ER doctor to come and pronounce his death, then the Supervisor did the paperwork. I walked back into Johnny’s room and prepared to remove the tubes and clean him up. It seemed so wrong for someone so young to be taken. The fact that his parents weren’t even there was a tragedy.

As I was removing the tube in his throat, I heard the wind against the window. I looked up and thought I saw a young man with long brown hair running in the wind, a multi-colored kite in his hand.

The wind caught the kite and the man became a little boy. The beautiful kite carried him into the clouds.

“Goodbye,” the wind whispered. As tears filled my eyes, I found myself smiling.

Johnny was at peace.


By Kathie Stehr

This is a true story and happened in 1977. Much has changed in medicine since then.