I have a very intense job, with no closing hours or “downtime.” I am part of a 24 hours-per-day, 7 days a week organization with no consistent schedule, constantly shifting priorities, and client population. I work in a pediatric cardiac intensive care unit in a children’s hospital, a satellite program that is growing rapidly and where new initiatives are taking place almost daily.
There is a continual flow of activity, unpredictable hours, and a life-and-death balance I observe for 12 hours at a time. I sit at the bedsides of the sickest children, preparing for or recovering from intricate surgeries on their tiny hearts, and I care for families living under clouds of uncertainty. Massive emotional, spiritual, mental, and physical fluctuation occur within seconds to minutes, and it is a moment-to-moment existence for patients and families.
Different interdisciplinary visitors come to the room. The various machines and tubes and wires provide readings and measurements, beeping at any time with a chorus of different sounds for a myriad of reasons. Children and parents are startled out of the limited rest they can receive with the constant noises that transpire. I collaborate with fellow nurses and other providers regarding patient care questions and subtle changes. I talk and teach and listen and question and advise for my entire shift.
Needless to say, there is never a moment of silence. Even when it’s supposedly quiet at my patient’s bedside, noises and sounds happen in the background. Whether it be dialogue, alarms, laughter, moving carts, footsteps, another patient crying, or the whirring of machines, there is always noise.
I’ve been at a point that it’s difficult for me to voice my prayers these last several years. I am a much better writer or listener than a verbalizer when I am praying. Most often, I offer my upcoming shift, meeting, or project as a prayer or my act of worship because my work is all-consuming, and I offer so much of myself during my stretch of days on the unit.
A deep-feeling, sensitive soul, I am always thinking about every component of a patient’s care, during discussions with providers and my colleagues. My thoughts continue to revolve around how each person is doing throughout the day, what brought them to be where they are at this moment, and how their brains are working and processing the days and situations they are encountering. I am hardly ever still, as the expectation is that we are always “on” in our professional lives and are responsible for our patients’ safety while in our charge.
In 1 Kings 19:11-13, there is a story about the prophet Elijah. While in the wilderness, he received a word that the Lord would pass by and speak to him. There was a great wind, then an earthquake, then a fire. But the Lord was not in any of those events. After the upheaval, there was a silence. In the silence, Elijah recognized the voice of the Lord and prepared himself to hear it.
So, how is the Lord present in a never-ending, busy shift? Where is the stillness amidst the noise? How is it possible that in the course of 12 hours at a bedside, there can be depth and peace?
The moments are there and often come just at the time I need them. A few months ago, I was the primary nurse of a young patient I lost after many months of hospitalization. I cared for this young girl and her family during days and nights, when she was very ill and when she was improving. Throughout a shift when I was performing the many patient-care activities involved, she often placed her hand on my arm or wrapped my finger with hers. The smiles were transient, but they were there, and they were precious. I got to be present when her mom held her for the first time in over three months and hear the deep questions from her parents, which informed me that I was a trusted provider. They were not native English speakers, and to be able to communicate with them in their first language provided an additional element to our relationship.
Tragically, the patient experienced a life-threatening event that caused the need for life support. After a few days, it became evident that she would not survive. At the end of my last shift of that week, I was able to spend a few minutes at her bedside alone. In those minutes, there was quiet and peace, and she was held in the space between life and death. That was a sacred space. I knew it was the last time I would see her, and the world fell away for a time while I sat in that room and said goodbye to her.
Very rarely, I get a few minutes to sit and hold a baby while feeding them or settling them. During night shifts, I have gotten to rock little ones to sleep as they adjust (or simply cannot adjust) to an environment that is so radically different from what is familiar. The stillness is there, the chance to just be one person loving and comforting another.
There are other moments, like the connection with parents who asked me how to navigate situations where their children were hospitalized with complex defects, and the future was radically uncertain. I am able to spend time with families and validate the importance of self-care with them as they wrestle with conflicting emotions and exhaustion. I am able to share from my own experience. There is recognition, compassion, and willingness to be vulnerable. That is the stillness that I crave, and in the quiet, a relationship is born.
It is in the conversation with the mother of a newborn whose diagnosis was not known until after birth. It is in the process of grieving what was hoped for, realizing that the future will be different than imagined. It is in the meeting of the eyes and smiles we can only see through those eyes since the remainder of the face is hidden by a mask.
It is in the few minutes of connection with a new nurse as he or she grasps a task and can take ownership of it for the first time. It is when a parent gets to hold their child for the first time since surgery. It is in the laughter that breaks the tension. It is in the vigil at the bedside and in the moment of a patient’s death. It is in a shared language, a thorough answer that demonstrates thought and understanding. It is in the reading of someone’s story and in the follow-up questions. It is in the few minutes walking down the hall approaching the unit, and in the walk back to the car. It is in the return the next day to the bedside, the recognition and the gratitude on the face of that parent who sees me again and is glad to welcome me back into their space.