Fight

“He’s three years old. The mom is non-compliant. Keeps stuffing him full of chips and pretzels even though he’s on a sodium restricted diet. They don’t speak English; they’re from somewhere else.”

I know where they’re from… the chart clearly said. Didn’t you look at the chart?

“If his kid sister is in there, she speaks English and might translate for you. It’s hit or miss.”

…YOUAREUSINGACHILDTOTRANSLATEMEDICALINFORMATIONOHMYGOODNESSWHATISWRONGWITHYOU?

“I guess maybe you could try the translation line if you want to bother with it."

I am struggling to like you in this moment.

“He doesn’t like us very much. I think because we’re white. He’ll scream the whole time you’re in the room.”

Been there, done that. Challenge accepted.

I just got home from clinical. I am somewhere between heartbroken and livid. Details must be suppressed and changed to satisfy privacy laws and protect the precious family I was privileged to serve tonight.

They are refugees. Mom is a single parent with half a dozen children. Dad died. The littlest child is sick with a chronic congenital condition of the kidneys. They’ve been Stateside for 2 years.

I took report from the nurse, shook it off, and went to the room in the corner. Sure enough, as soon as I opened the door, the beautiful three-year-old boy on the bed began to whimper and withdraw. I immediately dropped to my knees to be on his level and began playing with my penlight. Within about 30 seconds, he stopped crying and reached out to take the light from me. He shined it on the sheets. And on his hand. And on my hand. And then he chased me around the room with the light, trying to keep it pointed on me as I dodged out of the way. Then he hid it behind his back so I would look for it. I peeked around to find it, and when I did, he laughed. This wonderful, beautiful, gem of a child laughed, from deep down in his soul, and his coal black little eyes disappeared into his scrunched up face.

Then he banged the light on the bed and broke it, but I really didn’t care. That laugh was worth millions more than some silly penlight.

He listened to my heart with the stethoscope and gaped up at me in wide-eyed wonder, both hands pressed solidly over his ears, as if the earpieces of the stethoscope would suddenly leap out and run way if not secured. Miraculously, the stethoscope was not scary anymore, and now he let me listen to his chest without screaming bloody murder. He pinched my finger, and then I pinched his to check his capillary refill. His 10-year-old sister helped me by letting me take her blood pressure. Then she took my blood pressure. Finally, she pushed the buttons on the machine to take his blood pressure. And his reaction? A smile. A toothy, slightly drooly smile.

The little girl would not make eye contact with me. “What’s your name?” She told me. I couldn’t pronounce it, but my attempt earned me a crooked grin. “Do you like to draw?” No. I draw ugly. “Do you like any board games?” No. “What do you like to do?” I don’t know.

Sigh.

With that first set of vitals over, I used the translation hotline to try and find someone who spoke their dialect. No luck. I am now frustrated beyond belief, because I know there is a pretty decent population of these people in the city, and I absolutely cannot believe that a major Nashville hospital has not laid out a means for translating vital treatment information. This child’s kidney function is severely compromised. He has massive generalized edema that could quickly lead to pulmonary edema. The low salt diet helps prevent that. He’s been here three days. How is it that in three days, no one has communicated the importance of restricting sodium to this family? Because within 5 minutes of interacting, I can tell it’s not noncompliance. It’s knowledge deficit and utter bewilderment. They have no idea. This should not take three days. And it shouldn’t be a nursing student who finally steps up and does it.

Nonetheless, it appears that I too must use a child to translate.

I have some charting to do now, so I have to leave the room. I wave to the little boy. He waves “bye-bye” and blows me a kiss. His mother smiles for the first time.

The next time I go in, I notice his lunch is still sitting on the counter. He wouldn’t touch it. I’m frustrated. I speak with the sister again.

Do you like this food? “No.” What do you eat for breakfast usually? “We don’t have food for breakfast.” What about lunch? “Rice and fish.” And dinner? “Rice and fish.”

I order more food for him. Rice and fish this time. He eats some, then falls asleep. I am not surprised. He’s been crying and screaming all day. His sister is eyeing the tray, but her mother says something in their language, puts the lids back on, and shuffles away tiredly. She looks exhausted, and worried. The girl looks at me. “If we eat the food, will you make us pay for it?” No honey. Please, eat the food.

She excitedly speaks to her mother, and the two of them pounce on the tray and nearly inhale the leftovers. It hits me that the mother probably has not been eating much if at all since the child was admitted. It’s been three days.

The hospital has a partnership with a catering company that donates one meal a day to families that can’t pay for it. We work it out so they can get a tray for dinner. The little girl lights up. I bring a board game, a stack of paper, and some markers into the room and ask if she happens to have changed her mind about games and drawing. What do you know?! She has. She begins plastering the room with portraits of flowers and butterflies and families playing together. We start playing a board game on the floor, but the little boy gets upset that he can’t play, so we move it outside to a bench in the hallway. She talks the whole time we’re playing—about fifth grade, and how math is her favorite subject, and how boring the hospital can be. But then she mentions how I let her hit the buttons on the machines as long as I’m standing right there with her, and she says she thinks she wants to be a doctor someday. I tell her to hold onto that dream, and fight for it, because so many people will tell her she can’t.

One of the things I’m supposed to chart is the family’s religious practice. Statistically speaking, I know they are probably one of two religions common to their background. I ask her where they go to church. “Oh, it’s an English church.” Do you know it’s name? Is it this religion? Or this one? “Nope. It’s just an English church.” Alright then.

She wins by a landslide. I might have let her. Then we clean it all up and take it back to the room. I show her how swollen her brother is and explain that salt makes it worse. We go to the nutrition room, and she helps me pick out which foods he can eat. Then she “shows” me which ones he cannot eat, and we review that several times. She’s going to be a good little doctor. Finally, she translates all of this for her mother, who becomes upset that he cannot have chips and pretzels—not because she wants to feed it to him, but because she did feed it to him earlier and didn’t know she wasn’t supposed to. She asks if he will get sicker now. I tell her I’m going to take really good care of him to keep that from happening. And my heart breaks, because if he does get worse, she will blame herself. And this was NOT. HER. FAULT.

He’s still asleep, and has been since 6pm. Mom says he will sleep through the night and wake up really early in the morning, before dawn. I bring some breakfast cereal and milk into the room for them so that she won’t have to wake the girl up to act as translator if he wakes up hungry. The little girl sits and talks with me while we draw together, and she teaches me how to say all of the colors in her language. She says she is surprised how quickly I learn it. Now it’s my turn to smile.

All the student nurses go downstairs for dinner. I grab my bag. A friend of mine spent a summer working with the very people group that this family is a part of, and he brought this bag back for me. I hadn’t even thought of it. The mother drops what she is holding, exclaims something that I can’t understand, and smiles as tears run down her face. My heart is full.

I check in on them just as my shift is ending to say goodbye, but they’re all asleep. Mom is curled protectively around her son in the bed. He is still fast asleep, one arm flung listlessly out over the bedrail. His sister is asleep on the couch, buried under blankets that rise and fall slightly with her even, peaceful breaths.  My eyes fall one last time on the little boy

I don’t wake them up. I hope they know that I care, and more importantly, I hope and pray with all that I have in me that someone steps up to care a little extra for this family when I’m gone. I hope that someone fights for him.

I’m still praying as I pull the door closed and walk away. I have never, in four years of nursing school, been this attached to a patient. Everyone always tells you not to get attached. But you know what happens then?

You forget to fight.

I will not do that.

Because sometimes, no one else will.

May God forever send me to those precious children that no one else will fight for.