1. Antonio, Alazahe
  2. Catlin, Anita

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From Patient to Future Nurse: Carmen Casas, California

On February 1, 1999, Carmen Casas's mother's roommate was doing laundry. The roommate was using lye while doing laundry and had some left over. She placed the lye in a baby bottle, and the substance color resembled purple Kool-Aid. Four-year-old Carmen had been ill the week before, and her mother had given her purple Kool-Aid with liquid Tylenol in it at the time. Carmen was watching TV with her siblings, felt thirsty, and took the bottle off the laundry shelf within her reach. She had no idea that the bottle she had grabbed contained lye. As soon as she drank the substance, she fell to the ground and began having seizures. She threw up the substance, but it burned her throat. Her mother rushed her to the hospital, and the doctor told her mother that Carmen's throat "was just irritated." The roommate vanished after this event, and the family never saw her again.


In the ensuing days, Carmen was unable to eat because she could not keep any food down. Her mother took her to the doctors again because of this, and this time, the doctors diagnosed her with tonsillitis. A month later, she was still not able to eat and was becoming thin and malnourished. Her mother took her to the hospital again, and that was when she was flown to Oakland Children's Hospital. It took another month to diagnose her with esophageal burns and strictures. Because of her malnourished look, neighbors called Child Protective Services (CPS). CPS workers felt she was being abused, and she was removed from her family home. Luckily, her attending physician wrote a letter to CPS explaining her condition, and she was able to return to her family. Carmen then began the lifelong process of esophageal dilation under anesthesia. She counts approximately 200 surgical procedures-"more than I can keep track of."


From the age of 4 to 13 years, she had either an nasogastric (NG) tube or an implanted gastric feeding tube for nutrition. Her esophagus was still present, but because it was so badly burned, not much of it was functional. The first feeding tube went through her nose, and the long-term use cut her nostril, leaving her with a permanent scar. Then, a gastric feeding tube was surgically placed in the middle of her abdomen. Carmen states that, "Usually, as a kid with an NG feeding tube, you're only supposed to have it in for a month, but because this was a special case, I had it in for several years."


Having a child with a feeding tube at that time was very unusual in her school district, and thus she was restricted from various activities like swimming, playing on the playground, and even joining school field trips. Her surgeries affected her education because of extended absences. During school hours, her mother would come up to feed her or she would get pulled out of class every 2 hours to go to the nurse to get fed through her feeding tube. She actually had to be put in special education classes because of how much school she missed. She went through all 12 years of school, but because she was in and out of the hospital so often, she feels that she missed a total of 6 years. She was behind in every subject by 2 years. She was also bullied because she had the feeding tube. What Carmen would like to say to kids going through a similar experience is this: "It's hard at first. You may get made fun of or even bullied, but you have to go through this to become stronger." During her school years, she also experienced laryngospasm; her airways and lungs would shut down. This happened quite a bit, and she "passed away" a few times because of her having respiratory arrests.


When asked if she had ever met anyone else like herself during her childhood, Carmen stated, "Once before, I met a girl at the hospital about my own age. The girl was born without an esophagus. We both were going through similar problems and health issues. Unfortunately, the little girl passed away a year later." Carmen is older now, and she has not met anyone like her since then.


Carmen's mental health has had its ups and downs. When growing up, she would question herself, "Why me? Why can't I be normal?" This took her into a state of depression, and it got worse in her early teens. She would think about her future and how she was going to survive and wonder how long she would have to live. She was worried for her future, and some days, she felt as if she did not want to be here anymore.


During her late teens, she decided to turn her horrible experience into something beautiful and use it to help people going through the same thing. Carmen states that she is grateful for the experience and would not want to change it. It has made her become the woman she is today and set her career path. Carmen feels that her years spent at the Children's Hospital were amazing. She felt comfortable there and thought the staff was remarkable. When she was little, her doctor would rock her to sleep and put music on as her anesthesia was induced. The doctors and nurses played a huge part in making this process easier. They were a great support system and showed a lot of compassion during her journey. As a child, she was often frightened because she did not understand what was going on and she was scared to be approached all at once by "a whole bunch of doctors and tubes." As an adult, Carmen finds it enjoyable to visit the hospital now, because she gets to see the nurses and doctors who took care of her and they get to see how well she has grown up.


This experience inspired her to want to become a nurse. She knew from the age of 4 years that she wanted to become a nurse and to help people. At 14 years old, she decided she wanted to start pursing this career. She states that she would love to work on the surgical floor. Currently, she is 25 years old and is taking prenursing classes. She completed a certified nurse's aide course and works at an assisted living center(Figure 1). Her advice to pediatric nurses is this: "Make your patients feel as safe and comfortable as possible. Be able to let your patients trust you, because their life is in your hands." To other children, Carmen states, "As long as you have someone there helping you and supporting you, it will get better." Carmen thanks her mother for never giving up and always standing by her. As she transitions from being a pediatric patient to adult care, Carmen is sad to leave her home at the Children's Hospital. Her dream is to work at Oakland Children's Hospital and work alongside the nurses and doctors who took care of her.

Figure 1 - Click to enlarge in new windowFIGURE 1. Carmen Casas.