1. Nichols, Mary Jo BSN, RN

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"THIS LOOKS LIKE a tough one," said Lisa, my manager, as she handed me the referral paperwork for my new patient.

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"Acute lymphocytic leukemia, age 3," I read. As a maternal child nurse for a visiting nurse association, I care for many pediatric patients, and I knew that this disease is highly curable in children. Being realistic, however, I considered the many complications that could make the treatment ahead very rough. I wondered if I could make a difference for this child.


I visited Katie and her mother Nina in their home that afternoon. While doing the paperwork, I discovered that Katie was born exactly 1 year earlier than my granddaughter, also named Katie. Surely, I thought, this was a good sign.


Katie's mother Nina looked nearly as weary as Katie, who'd recently been hospitalized for treatment. A stay in the hospital is always exhausting for both parent and child.


As the visit unfolded I discovered more reasons for Nina's weariness: She and Katie's father had just separated, and she had two school-age boys to care for besides Katie. "My husband just can't handle the fact that his child has cancer," said Nina softly. "He moved out and the kids have seen him only one time in the month that he's been gone." The sadness in the house was pervasive. Again I wondered if I could possibly make a difference.


My teaching focused on infection control, medication management, emergency measures, and early recognition of reportable signs and symptoms. When Katie's brothers came home from school, I showed them how to wash their hands while crooning "Happy Birthday" two times-the pediatric way to count 30 seconds.


Nina quickly grasped the concept of metric units to manage Katie's medication regimen. Her care for Katie was meticulous and infused with love.


I visited twice more that week. Each time Katie was afebrile and had stable vital signs, but her appetite was poor. Nina was trying to tempt her to eat, but liquids, applesauce, and ice cream were all she could tolerate.


On Friday, my third visit, I mentioned the coincidence that my granddaughter was named Katie and that she was exactly 1 year younger than my patient with the same name. "That's a good sign," said Nina, "I've been looking for a good sign."


On Monday, I received a message from Nina. Katie had developed a high fever and was back in the hospital. On Tuesday, my pager beeped. I called our liaison nurse, who told me that Katie had died early that morning. Shocked at the suddenness of her death, I wondered why I hadn't been able to make a difference.


What can a nurse, who saw a patient only three times, say in a sympathy card to a grieving mother? In the end, after hours of contemplation, I wrote that it was clear to me that Nina was a wonderful and loving mother and that I'd never forget Katie. I signed the card, "Jodi, RN."


As the years passed, I continued to remember Katie. The road home takes me past her house and I often wondered about the fate of her fractured family.


A few months ago, I stopped at a market on my way home. I was picking up milk when I felt a tap on my arm. "Are you Jodi, the nurse?" I turned to see a woman who looked familiar.


"I'm Nina, Katie's mother," she said. "Do you remember Katie?"


I'd kept my promise: I'd remembered Katie. Nina and I had a brief, polite conversation. Just before we parted, her face brightened. "You might be interested to hear. I'm in nursing school!!"


I told her that I was thrilled, that I remembered how meticulous she was with Katie's care and that I thought she'd make a wonderful nurse. I wished her luck and we exchanged a brief hug. As I turned to leave, I once more felt a tap on my arm.


"You might also be interested to know," she said quietly, "that you made a difference to us." And in the space of a heartbeat, she was gone.


In the brief time that I knew Katie, the difference that I'd wanted to make was to be a part of the team that gave Katie a cure. So I'd imagined, after hearing of her death, that I'd made no difference at all. It never occurred to me that the difference I could make was unintended but very real. Katie didn't survive, but the nurses who cared for her had made a difference for Nina.


The mother who mourned and was in despair is now traveling another path. Someday she too will wonder, "Can I make a difference?"


I'll never forget Katie or Nina. And I have a feeling that Nina will never forget me as she moves on with her life...making a difference to others down the road.