Night shift and paying it forward

On a cold Monday night in late winter I pulled on my scrubs, packed my lunch and quietly crept into the small, cosy room my children share. My  daughter was lying rumpled and skewiff  in her big bed, covers thrown back, her little nappy clad bottom  in the air.  I moved to the cot where my son was safe and snuggly in his baby sleeping bag, little hands balled into tight fists  by his face, fair head turned to one side, breath soft and rhythmic. Then I kissed my husband, patted our dogs and went to work, staying up all night to treat other people’s families while mine slept. I was back on the grindstone of the ED registrar roster, where nightshift is as inevitable as breathing.

Six months earlier, late in the afternoon of his due date, my son Tom entered the world and took his first breath. But when the warm slippery bundle was placed upon my chest he simply lay, still and blue, his initial mew of surprise followed by silence. The paediatrician went to work, suctioning his trachea before gently inflating his lungs with tiny, quick bursts of the toy-like neopuff. Oxygenated blood now circulating again, Tom gave a few tentative cries then settled into steady, if slightly fast respirations. The crisis had passed and we all relaxed a little. Except my husband, the only non health professional in the room, who still had the sick feeling of something being very bad. His human intuition turned out to be more accurate than the accumulated knowledge and experience of the rest of us.

The next time I saw him, my now two hour old son was lying prone, grunting, tachypnoeic, the muscles retracting deep between his ribs as he desperately tried to move air into his little lungs. Thick, toxic meconium sludge was clogging his air passages, delicate alveoli tissue becoming progressively more  inflamed and waterlogged. A weakened patch of his right lung had overexpanded and perforated,  the growing pneumothorax further compromising his efforts to breathe. The special care nurses were quiet and serious. Perhaps still unsure of the situation and my role within it, I asked to see his gas. It was not reassuring. My boy was sick.

Events progressed. A solemn talk with the paediatrician. The wait while he was intubated and “plumbed” for  transfer. A midnight departure for Elsewhere. I was not well enough to accompany him but by mutual agreement my husband left my side to be with our new son. To advocate for him, to hold his little hand so he never felt alone, and, we both felt but didn’t articulate, to ferociously fight off death if it circled. That the separation felt so unnatural as to be outside the laws of physics didn’t concern me; If Tom were to survive he needed more than cuddles and his mother’s breast.

Born elsewhere in place or history,  Tom would have died in his first twenty-four hours. And if our son had died that night he would be simply one of the almost two million babies who die on the day they are born each year. Our personal story, however, would have changed profoundly, sadness and loss seeping through to wash a little colour out of our days. Despite our beautiful daughter to hold close, and the possibility of more children to come, we would have joined the ranks of the brave parents who live with empty arms.

But Tom survived.  After five days on ECMO,  another seven ventilated and a total of three weeks in hospital, we strapped our tiny bundle into his capsule and, driving slowly and carefully, took him home.

There are many reasons why Tom didn’t die during that first night. The paediatrician on call  recognised his early deterioration and organised a timely transfer. The retrieval system worked, and Tom was taken to the right hospital at the right time. The retrieval staff maintained his standard of care en route, and his receiving hospital was a paediatric centre of excellence with a strong ECMO culture.

But Tom also survived because caring and experienced clinicians left their homes and families at bedtime and went to work. There, they made difficult judgement calls and performed challenging  procedures at hours during which they had every right to be sleeping undisturbed.

And that is why I don’t mind working night shift anymore. Because it would be an honour to be the alert and skilled doctor whose actions overnight changed the course of someone else’s personal story. Because I have a hell of a lot of paying it forward to do. And because at the end of my shift, I go home and I see my Tom.

Tom ECMO with Kristin red top

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Comments

  1. Helen says

    Oh my goodness, as a nurse and Mum of a paramedic this has brought a lump to my throat. We need to be reminded of these times so often to avoid being hardened. Thankyou!

  2. Hannah says

    Fantastic piece Kristin, thank-you, gave me goosebumps. As above- really gives a great mindset to go to work with. It can be very easy to loose sight of the fact that what we do makes huge impressions on peoples lives.

  3. yassine says

    I swear i was just bothering of my night shift which i had yesterday in My medical school hospital in algeria to keep a patient in my sight in a intensive care dpt for more 16 hours. But i feel better when i read ur words

  4. singh says

    As a grumbling medical registrar I will always remember this when I’m on nights. Thank you for sharing something so personal. It’s made a difference, at least to me and my work ethic

  5. Gav says

    Lying in bed, feeling jet lagged and sorry for myself after my stretch of nights as I have several times month every year for 15 years now. Tears in my eyes, puts it in perspective. My little one, emergency c.section 7am after my wife’s 3 day labour, staff at end if their shift, not at there best, baby O.P transverse. Not as grave a situation as yours, but life is always in a balance, could so easily have been different. I’m going to get up have some grub in remember I have payed a little forward today myself.

  6. says

    Incredibly moving. I cried while reading it. Neither my wife, nor I are health professionals and we went through a near-death situation with our daughter born 24 years ago. That emotional scar still reminds us of the frailties of new-born’s. Our daughter is now a Doctor and aspiring to become a surgeon. She is paying it forward right now and for the next two weeks by being one of three Doctors on night duty at a large cancer hospital. I am so proud of her and am truly grateful for every Doctor, Nurse and Aide everywhere in the world looking after other families while their own sleep. They deserve a standing ovation every night and morning.

  7. Jo says

    Beautifully written, thought provoking and tear inducing. Paying it forward is such an important principle and so easy to forget on a busy shift. Parenting and working ( especially on a training registrar roster) can be a really difficult balance but i think it does help us to bring another level of humanity and understanding to our work. And being able to kiss your beautiful, sleeping children at the end of a long day is reward and blessing enough.

  8. Eleanor Donelan says

    Beautifully put, Kristin. You’re clearly a wonderful doctor and mother -- and a fine writer to boot. I’ll remember your words next time I find myself dreading another night on call.

  9. Sheryl says

    You pulled on a few hearts strings Kristin,as an ED reg with 3 young children of my own, your story is so close to home. An excellent reminder of how privileged we are do what we do.

  10. Sarah Gordon says

    This is so beautiful! On night shift as I speak and now having a moment’s reflection on the utter privilege we enjoy as doctors. Thank you!

  11. Jules says

    As a paeds registrar it is easy to forget that what we do changes the lives of a family. So often it feels routine and we forget what it actually means. Thank you for sharing your story. It has reminded me that there is a reason for all the awful shifts and antisocial hours and what an incredible privilege it really is.

  12. says

    Kristin, you made me smile and almost cry in the cafe were I’m sitting having breakfast, having just finished night 6 of 7 in ED in Melbourne and missing my family. Thank you for reminding me why we do this -- I had almost forgotten.

  13. Glenn Mathieson says

    Brilliant piece of writing Kristin. Thanks Holly for sharing it so I could read it. A great reminder to inspire us on the difficult days. Lovely to hear all is well with you!

  14. diana says

    Beautifully simple. As a health professional and mum to the surviving twin of my babes born at 23 weeks in the middle of the night, I couldn’t agree more.

    • nicola says

      I work in an emergency room and i also work night shift. I grateful everyday for two healthy children and i work tirelessly to save so many children that come through our doors sick and in need of our help in the middle of the night.

  15. Ruby Bunwaree says

    A fantastic story from a great doctor and a mother who never ever complains about juggling life and work. You are an inspiration to us all Kristin -- always an immense pleasure working with you.

  16. Carley Harper says

    What an amazing piece of writing and an heartwarming story! You are an inspiration kristin… I agree with ruby always a pleasure to work with

  17. Michelle Smith says

    I am a trained ICU nurse, many night shifts under my belt too; mum of 1 beautiful 2 year old daughter, and 1 beautiful son who we lost 4 months ago; 3 days old. Your words, your story has touched me more than you can know. I wish our journey had the same outcome, but I feel such happiness that your Tom is with you, and how lucky your patients are to have you on their side.

  18. Leon says

    After the loss of our youngest daughter at 6weeks old and the medical team doing there best to help save her, a year later our youngest daughter was born and started having seizures at 6 hours old, both happening in the early hours. By luck and chance it was the same peadiatric consultant on nights and thankfully our little girl is now 3 years old thanks to the doctors and nurses who cared for her on the nights we have spent on neonatal icu and peadiatric icu since her birth. A masive thank you from our little family to all the medical staff who give their care and love to look after other people’s family’s all over the world. Leon. Uk.

  19. Yvette Monaghan says

    Kristin, such a beautifully and bravely written article. You’re amazing, at doctoring and being a mum. Thank you for sharing xx

  20. Selina Brack says

    Kristin this is heartbreaking & beautiful…you have amazing strength. Makes me very grateful to come home to my beautiful, healthy, smiling boy…xx

  21. Kate says

    What a touching story Kristen. Thanks for reminding me that our children are precious gifts that we should never take for granted.

  22. pennoes says

    Beautiful Story, so aptly shared. Know the feeling well as a medical colleague, but don’t know the personal feeling when it happens to you. Must be quite an ordeal. Thanks indeed to those who help others during the night.

  23. Dawn Martin says

    Kristin!! I think of you often, it has been a long while. Congratulations on your two beautiful children. How life has changed since I saw you last.
    So very well written and a sentiment I completely share. I feel privileged to work night shift.

    With love to you and your two healthy bundles of joy, Dawn, from Gosford.
    Now also mother of two!! Xxxx

  24. Anna says

    Wow very powerful and uplifting ! I will think of your story when I am next on nights on my Neonatal unit x Anna

  25. Louise says

    After over 10 years of working in a NICU I gave birth @ 33 weeks to a profoundly ‘flat’ baby. Thankfully the neonatologist I had worked with promised to attend my delivery whatever the time. At 3:30 he was vigorously reuscitating my precious daughter and took her to NICU. Rapid and efficient resuscitation has allowed her to be the dux of her school 16 years later. I am ENORMOUSLY grateful for sleep deprived doctors like you Kristin! <3

  26. Dr Momia Teariki-Tautea says

    Lovely story, yes I remember my days as Nicu registrar at the Mercy women’s hospital as well as been on call for NETS, I loved my job then and was always happy to do my nights! Dr Momia Teariki-Tautea

  27. Pamela Brunswick says

    Absolutely magnificent, “heart-rendering” personal stories shared !
    Thank You especially Kristin, for reminding us All, how Precious and Short Life can be in just a Moment of Time!
    God Bless you All !
    As a Health Professional I “Relish” every moment of my Life,as I have seen so many lives disappear in a “Heartbeat!”

  28. jane says

    What a beautifully written piece, straight from your heart. Thank you. My “bundles” are all grown up but nothing wipes the memories of their precious first few hours, days and weeks. We only needed a little bit of help, but it meant the world at the time and I continue to be so grateful for devoted medics like you.

  29. Cindy says

    What an awesome and inspirational story! This piece is beautifully orchestrated and illuminates the importance of the role in which health professionals play in nursing the critically ill child. Similarly, my own experience persuaded me to train and qualify as a children’s nurse, so that I too could give a chance to families, just as those doctors/nurses did for mine.

  30. imran says

    Oh God,, 12 yrs of night shifts,,,,,,just returned home from another busy one , and you made me cry…..
    Kirsten,,,I thought once I become a consultant , I will not do naymore nights,,,,I “hate” u for changing my mind……

  31. Bonnie says

    Loved your story. Our family has to thank anyone who has worked night in PICU, NICU, ICE and recovery. We are very thankful to have our beautiful daughter here today. Always believe in miracles and always have a positive attitude. Again, thank you to all who have worked night shifts.

  32. Barbara says

    I’m returning to work soon after bub No. 2, with much less enthusiasm than I expected. After reading your incredible story, you’ve inspired me to be the best that I can be on my night shifts too. Thank you :)

  33. Fellon says

    Coincidentally I am a nurse and although I no longer work night shift I so thankful for those wonderful health professionals who leave their warm beds and families behind to care for others. I read this article on my phone siting in my rocking chair nursing my sick little 15 month old with tears running down my cheeks thanking my lucky stars that it’s only a cold and unlike so many sick little children he will get better. Thankyou for that inspirational piece and for all the hard work that you do night after night and day after day

  34. HJL says

    Shame the government think its right to not pay the incredible hard working life savers properly and instead allow the bankers who caused the recession and mucked up everything for everybody enormous bonuses.
    Beautifully written. Thank you for all your hard work.

  35. JR says

    As an ECMO specialist and neonatal and pediatric flight nurse, I have held the hands of many “Toms” while their mother was still hospitalized. Thank you for sharing your beautiful story that reminds me why I Love my job so much :)

  36. Patricia says

    Wow thank you. It is difficult leaving my children at night to go to work but this made it a little more bearable and shows that it is definately worth it.

  37. Lu says

    I too am an ECMO mom. I thank all of the doctors and nurses who helped my baby boy (now 3). Many risked their lives to pick him up for transfer b/c of ice and snow conditions! Nobody understands or appreciates all the things nurses and doctors do until they have experienced it themselves! My health kept me from going with him right away and my husband is paralyzed and couldn’t go either. Thank you for being with our babies when we can’t be!

  38. Jean Cassidy says

    Thank you for sharing this and I hope all others who read it, understand the vast amount of people who make hospitals and services so valuable to us.
    I am an ECMO grandma whose precious granddaughter caught chicken pox which shut down all her internal organs. Without the efficiency of a GP, three hospitals and a Pediatric Transport System (NWTS) she would not have survived.
    Thank you to each and everyone of you who work all hours for little money. You truly are angels.

  39. says

    Kristin,
    Thanks for sharing your fears and your gratitude. As a flight nurse who sometimes feels too old to still be working night shifts, I will adopt this ‘pay it forward’ attitude. It is an honor and privilege to work for a progressive neonatal flight program that safely transports the most critically ill babies to an ECMO center.

  40. kes, png says

    touched by all your testimonies. keep up the good and work of saving little precious lives out their .

  41. jelli says

    Touching. As ex-neonatal tranport coordinator I was blessed to organise ECMO it was impressive what the medical professionals do with so much compassion

  42. Charry Taylor, RRT says

    From a ecmo specialist/ transport RRT….thanks for your brave story….and many thanks for the kind words. It reminds me WHY I do what I do….and love ALL the tiny babies to the big kids that we treat!. I ask God everyday to give me knowledge, and help me make the right decisions to take care of these fragile little people! God bless!

  43. Jenn says

    As an ex NICU/PICU RN and now pediatric flight nurse who still sits ECMO as part time job, I have held the hand hands of many “Toms” and hoping the I did my best to put the families at as easy during this time of extreme distress. There good days and days you feel like no matter what you did to help save the child the outcome was the same. So thank you for posting this because it made me remember that good days far out way the bad ones!! And why I love doing what I do!!

  44. Amber says

    Thank you very much for sharing your story it is exactly what I needed to read to be reminded of why I do what I do!!! I was just sitting here feeling defeated after a long rough shift in an ER as an RN thinking im not sure how much more I can take off these nights not sure if I really want to continue down my path as a night nurse…. This story renewed my love for what I do in my time of defeate Thank you!!! And best wishes to you and your family!!!

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