dreaded phone calls

i'm not a parent, but i know about every parent's worst nightmare - that something has happened to their child, that they are ill or in danger, or god forbid, dead. i know about dreaded phone calls because when i was 12, my mom got one. it was harborview (the best hospital for the worst cases - trauma) and they called to have my mom come and identify her daughter. it was a friday night. my mom and i had been watching the miss america pageant. my sister was headed to her high school's soccer game. sadly, she and her three friends never made it there. two teenagers died that night; thankfully, my sister survived (she was intubated at the scene of the accident and had brain swelling). and although it was over 18 years ago, i will never forget that phone call. and neither will my mom.

this week, i made that phone call. and it sure felt horrible.

a 21 year old patient on my unit was in the midst of his transplant. well actually, he had been transplanted 6 days prior. but he was in the midst of the worst part. the previous days of chemotherapy and radiation were catching up to him. without an immune system, his body could not heal any of the damaged and dying cells. the lining of his entire GI tract - from his mouth to his anus (that's how i always describe it to patients) - was raw with mucositis (inflammation, ulcerations, and pain that is difficult to treat). and for some unknown reason, he began to have difficulty breathing. it's likely that his airway was so swollen that he could not safely or easily pass oxygen. and within minutes, he was in a very dangerous situation.

i was not the boy's nurse (i say boy as if he is some little thing, but as a 30 year old, 21 now seems so young - too young for cancer). but i was helping his nurse - drawing STAT labs, finding doctors, getting emergency medications, and of course, making phone calls. with one glance at the patient, it was obvious that he was terrified. he was gasping for breath. he could not sit upright enough. he was restless and i swear the pathetic, terrified look on his face said, "i need my mom." i asked his nurse if his parents were somewhere in the hospital and she said no. so i asked if i should call them.

i didn't realize what i had offered until i left the room to go dial his parents' phone number. what would i say? what does one say to a parent as their son is on the brink of crashing, requiring intubation, and possible CPR? how do you tell a parent that their son is dying? and that he is alone? i didn't have much time to think. and likely a rehearsed conversation wouldn't sound any better than a non-rehearsed one. so i dialed and his mom picked up.

i don't remember exactly what i said. but it went something like this:

"are you Cs mom?"
yes

"hi, my name is christa. i am a nurse on the oncology unit where you son is a patient. i am not currently his nurse, so i have very limited information. and i am so sorry to be making this phone call. but i wanted you to know, that C is having difficulty breathing. we are moving him to the intensive care unit to be more closely monitored. he is surrounded by doctors and we are working very hard to keep him safe. i think you should be here. do you have someone who could drive you?"
i can drive myself; i'm on my way

it was a quick conversation - a minute, maybe two. but it was the most difficult phone call i've ever had to make. sometimes, i hate the phone.


*** for once, my story has a happy ending. well, at least it's happy so far. after many, many drugs and many, many interventions, the 21 year old boy ended up NOT getting intubated. his swollen and bleeding airway somehow managed to stay open. and he continued to breathe on his own. he is now 11 days post transplant and closer to healing, closer to recovering from transplant, and closer to remission! ***