If I may be perfectly honest with you, I love lighter nursing shifts. Maybe because they are so few and far between in our PICU. Maybe because my to-do list with work and extracurricular nursing projects is never-ending, so I welcome any down time I have in my shifts to chip away at those, rather than delegating them to time at home. Maybe because it can be so enjoyable to just sit for a few minutes and chat with my colleagues about life.

In any case, I love lighter nursing shifts when they come. And if we’re really being honest, nurses can to some degree choose how much we want to invest our time and energy into whatever we deem “non-emergent” or “non-vital.” How much do I want to tidy up my patient’s room? How much do I want to shoot the breeze with my patient’s family (this is a big investment for us introverts)? How proactive will I be about helping my colleagues around me?

My recent patient (let’s call her Alma) had a neurological condition with a very poor prognosis that affected her ability to speak clearly, though she was still very much oriented to people and place, and knew what she did and didn’t want. She mumbled her words, and her sentences were breathy and fractured. On top of this, she required a face mask for oxygen that further impeded our ability to hear her or at least try and read her lips.

Alma was very weak, so she depended on others to help her get into comfortable positions. As I got to know her in the first couple hours, I learned quickly that most of her requests were for repositioning. “Sit me up.” “My back hurts.” “Put a pillow on my left.” Even still, both I and even her parents needed to ask her to repeat herself a few times so we could understand her requests. It took time, patience and attention, all of which I could choose to invest or not. If her vitals were stable, she didn’t appear to be in pain, and her ‘hospital pants’ weren’t soiled, I could deem these other vocalizations as not worth my time and effort, not worth my attention. She’d still be alive.

But this was a girl at the late stage of her disease process. She didn’t have much longer to live. She was alert and still had a voice to express what she wanted. I could ignore that voice, or I could pay attention, and shape these precious moments she still had with an honoring of her personhood, her needs, her joys and comfort.

About four hours into my shift, I had finished my assessment of Alma, given her meds, and repositioned her. I was already thinking of the next project I’d chip away at, once I finished a little bit of charting.

I heard Alma say something.

“….[unintelligible]… life!”

“I’m so sorry, Alma, what’s that? Something about life?”

I wondered if she was trying to express something deeply personal, something profoundly existential.

“….[unintelligble]…life!”

“Alma, I’m trying, I promise. You’re saying something about life?”

Then I noticed that her one functional hand, her left hand, was repeatedly opening and then clenching shut.

“You’re moving your hand. You want something in your hand?”

“….squishy.. [unintelligible]…”

“Oh! You want a squishy ball for your hand to squeeze! From the Child Life Specialist?”

Her eyes lit up and she nodded vigorously.

“Oh my gosh!” her mom exclaimed from where she was reclining. “That’s right! She loves those squishy balls. And those Child Life Specialists have been so sweet with her. She loves their visits!”

“Yes! I will call Child Life for you right now and ask them to bring you a squishy ball.”

I’m as human as the rest of us. I’m as tempted as anyone to choose myself over others, in any given situation. This wasn’t an emergent situation. She would’ve lived that day, with or without her squishy ball. But the choice we nurses have to pay attention shapes the way our patients live. Disregarded and devalued, or honored and respected in all their full humanity.