My Journey to Critical Care Nursing: Gabbie’s Story

I honestly don’t remember the exact moment that I decided to pursue a career in critical care nursing. I almost feel like it’s been forever. When I was younger, I do remember spending time at my older cousin’s house, and looking through all of her human anatomy books. I was fascinated with her nursing text books. My favorite aunt in Mexico is also a registered nurse. She is intelligent, kind and was been a major support through my mother’s illness and after she passed away.

I was a troubled teen and young adult and although I was in college, I couldn’t focus. At the age of 21, I found myself in an abusive relationship and by 23 I was a single mother. I found the courage, with the support of my mother, to leave my unhealthy relationship and start a new life with my daughter. As part of this new chapter, I took a short course towards becoming a medical assistant, which piqued my interest in medicine. Once I started working full-time I went back to community college and started to take more classes with the hope that one day I’d get my nursing degree. My daughter was two years old when I started working towards that goal.

Gabbie with her daughter, who was 2 years old when Gabbie started working towards her goal of becoming a nurse. Today, Gabbie has been a critical care nurse at CHOC for over ten years.

In 1993, my mom had a heart attack and then surgery, and shortly after that we moved to California to be near family. With the support of my mom and family I worked full time and continued taking courses towards my nursing degree. During this time, I worked and saved up money to buy a small condo, while maintaining a full course load and making strides towards my dream of becoming a nurse. I’m not going to lie; this wasn’t an easy time. There were semesters that I only took one class. There were semesters that I couldn’t take any, but I kept trying. I was a mom with a mission. I had my daughter to raise and I wanted to be a good example for. When people ask me what was my driving force was, I tell them that it was Alexis, my daughter. I wanted to be an example of success to her. I wanted to show her that anything was possible. Hard work, dedication and commitment mixed with a lot of faith in God makes anything possible.

Finally graduating from nursing school has been my biggest accomplishment. As a medical assistant I worked in pediatric clinics for many years and it was always my goal to stay in pediatrics. My favorite rotation during nursing school was the pediatric intensive care unit (PICU). I loved the rush of the intensive care setting. After my first rotation in the PICU I knew that was where I wanted to be and I knew that CHOC was the hospital that I wanted to be in.

Taking care of very sick, often medically unstable, pediatric patients has been my passion, especially families who have a language barrier.  There are many moms, dads, grandmas and grandpas whose loved one is critically ill, but they can’t express themselves or their hearts to nurses or doctors due to the language barrier. That was and has been my heart’s mission, to help those families feel safe, supported and care for, just as much as we are caring for their loved one.

I am grateful and honored to be a critical care nurse at CHOC. I have cared for many patients during my time as a CHOC nurse, and I’ve developed many wonderful relationships with many of their families. I have laughed with my patients and I have shed many tears. I’ve held the hands of parents as they have said goodbye to their child when we had done all we could do.

Nursing is what I love. Nursing is what I do best. It’s where I see miracles take place.

Learn more about the pediatric intensive care unit at CHOC

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My Journey from PICU Patient to PICU Nurse

By Jeni Arganbright, registered nurse in the CHOC Children’s pediatric intensive care unit

As a premature baby I experienced a severe lung complication that would go on to affect my early years of childhood. When I was 9 years old, I acquired eosinophilic pneumonia, a disease where a type of white blood cell accumulates in your lungs and makes it difficult to breathe. This led to some serious respiratory problems for me. My parents brought me to the hospital, where I was admitted to the pediatric intensive care unit (PICU). I had to be intubated, which means that my doctors inserted a tube through my mouth and into my airway to help me breathe. I stayed in the PICU for a month before my breathing was stabilized and I was fully recovered from the pneumonia. I later had another serious bout of this same health complication with similar results.

As a child, Jeni was a patient in a pediatric intensive care unit. That experience inspired her to pursue a career as a PICU nurse.

Since that time, I have been fine and never acquired such serious respiratory health issues. During my two stays in the hospital as a young child I was left with a tremendous amount of appreciation for the nurses that cared for me. What impressed me the most was the sincerity in which they offered their medical care for me, on both a personal and professional level. I was not just another patient for them to care for, but someone they had a deep concern for, and someone for whom they lovingly offered support. I remember the nurses worrying with my parents about my health, as well as celebrating my good days and eventual release from the hospital. I later thought what a wonderful opportunity to be in a profession where someone could come to work every day and offer sincere and caring support for both a small child as well as their family members. I wish all parents knew how much we care and also share in their emotional worries about their child.

My advice to new nurses is to do your job with the highest level of professionalism combined with openly expressing your sincere care and concern for the child and his/her parents.

Learn more about the pediatric intensive care unit at CHOC

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What I Learned While Becoming a Critical Care Nurse

By Katelyn Meitler, a registered nurse in the pediatric intensive care unit at CHOC Children’s Hospital, and graduate of CHOC’s RN Residency Program

The RN Residency Program at CHOC Children’s is an intensive 17-week program designed for new nursing graduates to help them successfully transition to becoming a professional pediatric nurse. I applied for this program because I knew that I would learn how to deliver safe, independent, timely nursing care; and how to serve as an advocate for my patients and their families. However, I learned so much more than that from my fellow new nursing graduates, from the patients and their families we were lucky enough to care for, and last but not lease from the experienced nurses who patiently and thoughtfully helped us gain hands-on experience. At our graduation ceremony, I shared these unexpected lessons with my fellow graduates.

Katelyn, a critical care nurse at CHOC Children’s

“Learn everything you can, anytime you can, from anyone you can.”

I think most of us would agree we have learned more about what it means to be a nurse in the last four months than in the previous four years of nursing school. Here are just a few lessons I’ve taken to heart during residency.

I’ve learned to care for patients the way I would my children to be cared for.

I’ve learned if you are not ahead in your tasks, you’re behind.

I’ve learned it’s okay to say, “I don’t know.”

I’ve learned to make sure my IV fluids are actually dripping before I walk out of the room.

I’ve learned that the less time I have, the more I get done

I’ve learned it’s okay to ask for help when you feel overwhelmed.

I’ve learned to listen to parent’s concerns and take them to heart. They always know their child the best.

I’ve learned it’s okay to grieve with parents when they receive bad news.

I’ve learned it’s okay to cry and show that you are human.

I’ve learned a hug goes a long way.

I’ve learned that death never gets easier no matter how many times you witness it.

I’ve learned that crying doesn’t show weakness, it shows compassion.

I’ve learned that death is what makes life so beautiful.

I’ve learned that all people cry and smile in the same language.

I’ve learned a smile costs nothing but gives much. It enriches those who receive without making poorer those who give. It takes but a moment, but the memory of it sometimes lasts forever.

I’ve learned that coffee grounds in a bowl make a patient’s room smell significantly better.

I’ve learned the importance of self-care.

I’ve learned to fill up my cup of joy so that it overflows onto the saucer for others to drink.

I’ve finally learned what makes me gag…snot.

I’ve learned the truth about what Gandhi said, “The best way to find yourself is to lose yourself in the service of others.

I’ve learned to listen.

I’ve learned that some days you feel like you conquered the world and other days like the world conquered you.

I’ve learned there is always tomorrow to try it again.

I’ve learned how much I don’t know.

I’ve learned to laugh at myself.

I’ve learned that nursing is extremely hard, but I’ve also learned that that is what makes it so incredibly rewarding.

I’ve learned many lessons through the last four months but one of the most important lessons is…. I’ve learned that I will never stop learning.

Have you been inspired by a nurse at CHOC? Nominate them for the Daisy Award

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One Family’s Story of How CHOC Doctors Became Family

Even after six miscarriages, Gladys Salazar and Paul Gomez kept hoping and believing that they would be blessed with a baby. At long last, the dream came true—twice—with the births of Bethany and then Tiffany. “Two miracle babies,” says Gladys.

Bethany has been battling several rare metabolic and mitochondrial disorders since birth, and Gladys and Paul are grateful for the care she receives at CHOC Children’s. Tiffany was cared for at CHOC as well. Unfortunately, her life was cut short by brain cancer. Still, her parents are grateful for the doctors who extended Tiffany’s life and all of the compassionate people at CHOC who supported them through a painful experience.

Tiffany was affectionately known as “Tiffers.”

Tiffany was initially treated at another hospital, but her tumor didn’t respond to treatment. When it appeared that Tiffany was out of options, Gladys and Paul decided to “focus on making memories with her.” Through the Make-A-Wish Foundation, the family enjoyed outings to Knott’s Berry Farm and Disneyland.

On one of those outings, Tiffany’s color changed, she couldn’t hold anything down and had trouble breathing. An ambulance was called, and when it arrived Gladys went with her instincts and instructed the driver to take them to CHOC. “We made up our minds to let God do what needs to be done,” says Gladys.

At CHOC, Tiffany was examined by pediatric neurosurgeon Dr. Joffre Olaya, who determined that the tumor was growing and causing pressure. He recommended surgery to debulk the tumor. “I was crying,” recalls Gladys, “because I didn’t think it was an option. He said there were risks but that it could be done. The other hospital told us it was out of the picture.”

The difficult operation took five and a half hours. “Dr. Olaya told me he really had to fight to keep my daughter alive,” says Gladys. “He did an amazing job.”

Tiffany spent about a month recuperating in the pediatric intensive care unit (PICU). She spent four days with heightened breathing. “One of the doctors watched her breathe and said she was a real fighter; strongest diaphragm he’d ever seen,” says Gladys.

Sadly, however, complications developed. “Tiffany was in pain, and couldn’t tell us,” Gladys says. “We met with the palliative care team and decided to take her home. We got to celebrate her third birthday with a fiesta. There were Mariachis and the whole thing. We told everyone, ‘Come celebrate the lives of our daughters.’ We also participated in the CHOC Walk in the Park to help CHOC Children’s. We are so thankful that we got to spend six more months with our little Tiffers. It was all thanks to Dr. Olaya, thanks to CHOC, and thanks to God who brought us here.”

Tiffany was admitted to CHOC one last time, where she passed away peacefully. “But it was hard. After six miscarriages, you think, now this, too?” says Gladys. “But Paul said, ‘God gave us our daughters; we can’t be disappointed.’”

“Tiffany was an angel; she brought joy to countless people. I’m so glad we got the opportunity to meet her. She changed me in many ways. Cancer makes you see things differently. Tiffany’s in good hands now; she’s not hurting anymore.”

Gladys thinks of the team at CHOC as family. “We’ve been to a few hospitals before and there’s no comparison to CHOC,” she says. “Just the love and compassion they show towards the

patients. The doctors, the nurses, the social workers, the chaplain…they all care for you so much. Even the people who do the cleaning, and security—everyone is so polite. There was one nurse who was a mom and grandma, and she was so comforting―she felt like a mother to me. For her, it isn’t just a job, she totally loves what she does. Another nurse, near the end, put a little beanie on Tiffany’s head to help keep her warm. I was so touched by her kindness. I am really grateful for coming here.”

The Gomez family continues to rely on CHOC—Bethany has been hospitalized twice since Tiffany passed away. “One doctor said to me, ‘I’m sorry to you have to go through this now,’” said Gladys. “It was so touching. They know us very well; not like a number, like family.”

Gladys, Bethany and Paul

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5-year-old Rayaan fights through battle with brain, spinal cord inflammation

By Hina, mother of CHOC Children’s patient Rayaan

When Rayaan was 16 months old, he caught a simple cold. He had a typical low-grade fever and slept more than normal. I figured he needed the rest and would feel better the next day. The next morning, he was having a difficult time waking up so I thought I should take him to his pediatrician. She recognized something was very wrong and described him as being “unresponsive.” He was immediately transported to CHOC Children’s via ambulance. CHOC’s emergency department team was waiting for our ambulance and ready to care for Rayaan as soon as we arrived. They quickly assessed him and then placed him on a ventilator as he was brought up to the pediatric intensive care unit (PICU).

His care team ordered an MRI of his brain and diagnosed him with Acute Disseminated Encephalomyelitis, also known as ADEM. This means there was widespread inflammation in his brain and spinal cord that damages the myelin, which is a protective covering for nerve fibers. ADEM had affected over two thirds of his brain. We didn’t know it yet, but we would be at CHOC for the long haul.

Over the course of the next six weeks, Rayaan received multiple types of treatment for ADEM. His care team was vast, and included many different specialties: Dr. Nguyen Pham, a pediatric otolaryngologist (ear, nose and throat specialist or ENT), Dr. Gregory Wong, a pediatric gastroenterologist, Dr. Sharief Taraman, a pediatric neurologist, in addition to infectious disease specialists, in-patient physical and occupational therapists, a respiratory therapist, and the feeding team. He was in a coma and on life support for three weeks. During this time, his doctors kept a very close eye not only on him, but also on our entire family. Dr. Nick Anas, CHOC’s physician-in-chief; Dr. Jason Knight, medical director of emergency transport services; Dr. Paul Lubinsky, associate PICU director; and critical care specialists Dr. Juliette Hunt, Dr. Anthony Cherin and all of our nurses became family to us. I remember when Dr. Anas came to check up on Rayaan and he asked me when was the last time I layed next to Rayaan, I replied it’s been a while, and he ordered the PICU staff to transfer Rayaan from a crib to a full-size bed immediately, so I could lay next to my son. Rayaan was connected to every machine and monitor you can imagine, but his doctor was keeping my feelings in mind.

During this extremely difficult time when we were waiting for him to wake up, we were fortunate to have a wonderful support system. The Ronald McDonald Family Room let us escape for a few minutes, occaisionaly breakfast and lunch was provided by generous donors, and my daughter who was only three years old at the time was taken care of by child life specialists, while a social worker and case manager were assigned to us to provide us with counseling. This period was the hardest thing we had ever dealt with in our lives.

After three weeks of being in a coma, Rayaan began showing signs of waking up. He began by slightly moving his hands and arms. A few days later, we noticed his eye partially open. It would take him almost two weeks to be fully awake.  Although he had woken up from his coma, his journey was just beginning. The inflammation in his brain caused severe brain trauma and he lost his speech, and his ability to walk, eat, swallow and drink. While he was still in the hospital, a feeding tube was placed, as his oral muscles were to weak to swallow and chew. After his discharge, the rehabilitation team came in to ensure he would relearn the basics. Nicole Well, a speech language pathologist at CHOC, taught my son how to talk again. A feeding therapist named Polly provided electrical stimulation feeding therapy to make his muscles strong enough again to be able to eat, drink and swallow on his own.

Four years after his health scare, Rayaan is in Transitional Kindergarten and still undergoes multiple therapies in the effort to make a full recovery from his illness.

Rayaan endured several surgeries and procedures during his hospitalization, and even more after his discharge and as well as multiple visits to the emergency department at CHOC. The CHOC specialists always worked so hard on Rayaan as if he were their own child. I am very grateful to CHOC for saving his life and I know that the comprehensive care we received at CHOC we wouldn’t have been able to get anywhere else.

Today, four years later, Rayaan is in Transitional Kindergarten and still undergoes multiple therapies in the effort to make a full recovery from his illness. He remains under the care of CHOC specialists. I am inspired every day by his strength and his courage to overcome so much at such a young age. Above all, our family is grateful for CHOC, who has provided him with the comprehensive medical care throughout his journey.

Learn more about the pediatric intensive care unit at CHOC

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