Drilling into a child"s leg left me thinking about empathy in nursing

I take a breath to steady myself. I’m about to drill into a child’s leg. She’s awake.

I’m part of a team who are desperate to get intravenous access into a eight-year-old. We need to be able to administer anaesthetic drugs and sedation so that we can put her on a ventilator because her oxygen level is dangerously low. Normally, we’d do this by injecting into a vein, but when you’ve had as many intravenous lines as this young girl has, there comes a point when your veins can’t take any more.

This is a procedure I have done many times, always because we have run out of other options. So why is it different today? This is a family I have known over a number of years in my professional role. I have seen this child grow from a baby into a girl of eight. Life is tough for them; she has multiple complex medical needs, she is unable to do many of the things most of us take for granted. I have seen this family through many ups and downs, hospital stays too numerous to count, admissions to the paediatric intensive care unit in the double digits. They cope. They just get on with it, and somehow they keep a sense of humour.

For all that, however, I know they don’t want this. Watching someone drill into your child’s leg with something that looks like a gun with a 5cm-long needle on the end of it in order to place an intraosseus cannula (a drip into the bone marrow) is not OK.

I tell the mother that we don’t have any choice. We need to be able to give the medication urgently and this is the last resort. She knows. We look at each other and she tells me, “OK”.

This is a procedure normally reserved for people in cardiac arrest or unconscious. There’s a good reason for that: it hurts. I do what I can in the short time I have to reduce any pain as much as possible. I use cold spray and some local anaesthetic under the skin.

Her oxygen levels are dropping rapidly. If we can’t improve them, her organs will suffer damage and she’ll get worse. The situation will become life-threatening in around 10 minutes.

This isn’t a particularly difficult procedure but everything is harder when you’re under pressure, when it really matters, when all eyes in the room are on you, including the child’s parents. As I inject the local anaesthetic, she moves. I know she can feel it and I feel a rush of emotion on her behalf. I tell her what’s coming and I can hear her parents reassuring her, kissing her, stroking her hair.

One more deep breath for me and the needle is through the skin. I depress the trigger to start the drill and am aware of the sound it makes as I enter the bone. No parent should have to witness this. In a second or two it’s done. Success. Relief. I have a rush of adrenaline and my hand shakes as I disconnect the drill from the cannula.

I say sorry to her and I look at her parents. They nod. It’s OK. One of my colleagues says, “Good job” and I know that he means, “I get it.”

We give the medications she needs and are able to pass the breathing tube into her windpipe without a problem. Her oxygen level starts to come up.

I’ve been in this job a long time, and I am still caught unaware by a rush of feeling sometimes. It’s important to remember the human aspect of this job. Although I’m here to do a job, for some families on the receiving end of the treatment I give, this is the biggest thing that’s ever happened to them. If I can’t recognise how it makes them feel and be a part of that, then I can’t do this job. I think for a moment about what I tell my junior nurses: “When you stop feeling it, it’s time to go” and I know that for this, and so many other reasons, I’m exactly where I should be.

Some details have been changed

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Drilling into a child"s leg left me thinking about empathy in nursing