When I was in my last year of NP school I volunteered at a weeklong sleepaway camp for kids living with HIV. This was in the days when “living with” was a euphemism for “dying from.” What was I worried about going in? Not contracting HIV. Not even seeing kids who were very sick. I was concerned about the night shift.
Having gone straight through nursing school to graduate school, I hadn’t worked as an RN. Many new RNs start out on the night shift. Somebody has to do it and it’s viewed as paying your dues. In the camp program I was in, everyone was assigned one night shift, and we were partnered up so noone was alone.
Of course the night shift per se should have been the least of my worries. We were taking care of some very sick kids with j-pegs, and kangaroo feedings and weak lungs susceptible to Pneumocystis pneumonia. My nursing experience was all academic at this point. I could ace a test, but maybe not save a life.
But what I was worried about was staying awake.
In this particular program, there were mostly inner-city kids. HIV knows no demographics – anyone can contract it. But these kids were all born with it. Their only risky behavior was being born. Many of their parents had drug problems at some point. Many of the children were orphans and many whose parents were still living, were in foster care. This I knew going in. What I did not expect was to see how happy the kids were, getting off the bus. All seemed to be excited to have a week of camp, whether they were six or 16.
The facilities were not impressive, but there was a lake for swimming, basketball courts, and plenty of room to run around. The kids stayed in cabins with a counselor, and while not fancy, accommodations were adequate. The counselors told me the kids were not used to the lack of traffic sounds and were at times frightened of the sounds of the natural world. We were not technically in the country, more like an ex-urb, but to these kids, it was very remote.
We nurses spent our shifts keeping everything stocked, treating bug bites and minor scratches, and of course, giving meds. The kids were all on a lot of meds. There were a number of ICU nurses there who easily took care of the parenteral feedings and med administration. The rest of us took care of the oral meds. The kids were stoic, having grown up taking lots of nasty-tasting stuff and swallowing large pills. They just wanted to get it over with, anxious to get back to the fun.
Our team was led by an ER doc who had done this a number of years. His mantra was to just keep all the kids well enough to continue camp. Cellulitis? Medicate and cover up to avoid transmission. Toothache? He just injected procaine as often as needed so the little boy could enjoy camp. I felt so sad that he could get this kind of a toothache at this age, but of course, he was one of the ones in and out of homeless centers without regular dental care.
My scheduled night shift was in the middle of the week. I polled the experienced nurses to see if they recommended napping that day in the afternoon. No consensus. I tried, but it was very noisy and I wasn’t able to sleep. Finally it was time for my 7 o’clock shift. I had coffee with my dinner but was already feeling tired. The other nurse had just gotten off the night shift at her job in a small community hospital a few months ago so she was an old hand. We chatted. Listened to music. Played tic tack toe. This was in the days before smart phones.
Around 2 am we heard the crunch of footsteps on the graveled path leading to the door of our makeshift clinic. The screen door slammed as one of the male counselors came in, carrying a boy who looked about six, piggy-back style. He informed us the boy had fallen out of his bunk bed. We both knew Victor (not his real name). He was kind of like the camp mascot. He always seemed to be having fun and giggling. He had skin the color of tea with a drop of milk, blondish, nappy hair, and the sweetish smile imaginable. He melted hearts wherever he went and that was before you heard his story. Both his parents were addicts. His father had died of HIV when Victor was two. His mother had been living with the disease until last year, when she relapsed and died of a heroin overdose. Now he was in the foster care system and had had some bad placements. You would never know it from interacting with him.
Victor looked like he had been crying but was smiling and cooperative as I examined him. His counselor told us he had not lost consciousness. He had woken from a bad dream and had been in the act of trying to climb out of bed when he fell. Luckily, there had been s pile of rolled-up sleeping bags on the floor which had broken his fall. He had not hit his head and now he denied any pain. Nevertheless, I gave him a thorough neuro exam, checked his joints for swelling, his abdomen for possible internal injuries. Gave a good listen to his heart and lungs. His vital signs were all normal. We instructed the counselor on what warning signs to look for and they got ready to go, with Victor fully expecting — and getting — another piggy-back ride. The other nurse told them to “hold on” as she rustled around in the bag of stuffed animals we had and gave him a large plush snake to take back to the cabin. He was delighted.
The remaining time of our shift went rather quickly and then it was over. I had survived the night shift. My cohort and I were glad to see the day shift, chatted a bit and went to raid the camp kitchen before heading for a long nap. We had the whole day off.
Thankfully, there were no major calamities that week, but as can probably be expected, interacting with the campers was bittersweet. Whenever I saw Victor, he was clutching the stuffed snake, seemingly none the worse for wear from his early morning fall.
On our last night, a talent show was scheduled and the kids were very into this, even taking time from swimming and games to practice. The karaoke machine was enormously popular. The campers all seemed to know the latest music and could lip sync songs and dance like the original artists. It was impressive but heartbreaking when one of our older campers, a cachectic 16 year old girl on oxygen, gave an amazing rendition of a Selena song. The kids did enjoy the little number we nurses put together, dancing (after a fashion) and swinging our stethoscopes like feathered boas.
The next morning was a rush of packing up supplies. We had been told repeatedly at orientation not to give gifts to the kids to avoid favoritism and hurt feelings, but some nurses drove into town on their time off and did just that. I was assigned to gather up the toys to pack away for the next camp session. I went from cabin to cabin driving a golf cart and collected them. The kids had been told to deposit them in a box in their cabin. My last stop turned out to be Victor’s cabin. As I went to drag the box out, I spotted the plush snake’s nose peeking out from beneath a bare pillow. I reached for it and Victor came running in and hugged me. “Please nurse, can’t I keep him?” he asked.
And here’s what haunts me to this day. I said no. I explained we had to have all the toys back for the new campers next week. Victor didn’t cry or make a fuss. He just looked sad and nodded that he understood. This was what I should have been worrying about instead of the night shift: how I was going to feel about those children. Was my heart already hardening out of self-preservation? I had been relying on the rules to get me through this week, a week that took me way out of my comfort zone. Victor was dying, all the kids at that camp were. Why was I depriving him of remaining in his comfort zone, for just a little while longer?
#patientstories, #comfortzone, #HIVcamp