1. Cates, Melanie RN, HBScN


What a badly burned child taught me about perseverance.


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Every once in a while we meet a patient who helps to reaffirm our desire to stay in nursing. For me, that patient was a badly burned 3-year-old named Grace.


Grace had tripped and fallen into an open pit campfire. She had extensive second- and third-degree burns over 30% of her body, including her face. When I met her at the trauma room entrance, she was conscious but mostly quiet, vocalizing in a small, hoarse voice.


Distances in northern Canada are vast, and it took more than an hour from the accident to get Grace to the busy emergency department in the trauma hospital where I'd worked for 21 years.


Airway management was our first challenge, as Grace's airway had already started to swell. Ventilating her was difficult too; her chest had sustained third-degree burns. The surgeon did an emergency escharotomy to assist with ventilation.


We needed to start replacing fluids fast. When we couldn't find a vein to start a peripheral intravenous line, the surgeon performed a cutdown procedure.


Clearly we couldn't give Grace the treatment she needed at our facility; she needed specialized care for her burns. A large burn unit at a hospital 621 miles (1,000 km) south of us accepted the transfer. Air transfer was arranged, but the flight staffing office couldn't find a nurse to fly with Grace.


With flight time rapidly approaching, the charge nurse asked me if I could fly out on this transfer. I quickly contacted my family and made arrangements for the care of my own son, who was the same age as little Grace. Then I helped transfer Grace to the ambulance, and we headed to the airport. From my position in the back of the ambulance, I watched Grace's parents wave as we pulled away.


Grace was to be met at the hospital's burn unit by her grandmother, who lived nearby. Grace's mom was to fly out later that evening, but wouldn't arrive at the hospital until almost midnight. Eight hours would pass until she could be reunited with her daughter. I prayed that Grace would survive and that her mother would be able to hold her baby girl again.


The transfer crew consisted of myself and a respiratory therapist who maintained Grace's airway. During the flight I was busy administering sedation and controlling the fluid replacement.


When we arrived safely at the hospital, Grace's grandmother thanked me for taking care of Grace. I left with a heavy heart, knowing that Grace was being prepared for the first of many surgeries.


The flight back home was quiet. I tried to sleep but couldn't put the vision of Grace out of my mind. I arrived back at the hospital and eventually made my way home. I tiptoed into my sleeping son's room and watched him for the longest time, tears rolling down my cheeks. I said a prayer for all of the children who were suffering and in need of comfort.


Days passed into weeks and months. I asked the surgeon if he'd heard anything about Grace. He'd spoken with the burn specialist and reported that Grace was doing well.


In time, the Christmas season rolled around. In the mail one day, my unit received a Christmas card from Grace and her family. They provided a detailed report of Grace's progress and included pictures: Grace riding her bicycle, Grace playing the piano, always with a big smile on her face.


More than a year after that card arrived, I was at work one day when triage paged me to come to the front desk. I was expecting to receive information about an incoming patient, but to my surprise I had visitors: A mother and little girl were waiting for me at the front desk. The little girl asked if I was Melanie. When I said I was, she said, "I'm Grace. I just wanted to come and thank you for everything you did for me." She asked if she could give me a hug. I bent down, and she reached her arms around my neck and gave the biggest squeeze that she could give. This amazing girl beat the odds-and helped me remember why I wanted to be a nurse.


Melanie Cates is clinical educator of emergency and mental health services at Thunder Bay Regional Health Sciences Centre in Thunder Bay, Ontario, Canada.