It was arguably one of my top three most chaotic and stressful shifts as a charge nurse in our PICU. Within the first two hours of the shift, a patient we thought to be relatively stable had completely decompensated and remained on the verge for hours of being put on ECMO, a heart-lung machine for the sickest of the sick.

My already tight staffing became tighter as a nurse fell ill unexpectedly and had to leave mid-morning. More unstable patients continued to come in as the afternoon wore on, with a second patient decompensating and being also on the verge of ECMO.

I stepped out briefly at 4:30pm to eat the oatmeal and yogurt I had packed for breakfast, and then dove back in.

As I walked throughout the unit trying to assess all that was happening, identify who needed a hand (“Can I hang that medication for your patient while you continue to help with this emergency over here?”), and reconfigure my staffing for all the dynamic patient changes, I found myself very aware of the ways in which I subconsciously looked away from the deeply distraught family members of all the unstable patients that had landed in our unit in just a few short hours.

It wasn’t that I didn’t care. I was triaging, guarding my own energy and stress levels as I needed to continue managing things from the 1000 foot view as charge nurse, while my colleagues directly at bedside cared for the patients and family members.

But I felt the cost.

The physical weariness almost feels like the easiest to bear. But there’s the internal battle to continue self-regulating in a hugely dysregulated environment, to hold steady when feeling devastated for others, to not complain or snap at others when you know too much is being asked of everyone right now. The battle to somehow live one sliver above drowning, and to hold all of this day’s experience when we go home to our “regular” lives and can only say to our loved ones, “It’s been a really hard day.”

We were all running on adrenaline and duty, to our patients, families and each other. That battlefield fire was in everyone’s eyes. We wanted to throw a proper farewell party for a departing colleague but we barely got food ordered for her and otherwise we were in emergency mode, just snatching a bite for a few minutes when we could.

This level of intensity for a singular day wasn’t our everyday normal, and yet we weren’t entirely unfamiliar with it either.

When I left work that day, the status of so many patients remained tenuous. They were so, so sick. We had rallied and done all we could.

I returned to work a couple of days later, and saw I was assigned to be the direct bedside nurse for that first patient who our entire team (and then some) had spent hours working to stabilize.

Her numbers were already moving the right direction, from extreme organ dysfunction to notably improved function. She was still sick, but the doom that had sat in my gut was replaced by relief and hope. Her parents were no longer shellshocked. They asked questions, got nervous at times, but also laughed and expressed deep gratitude over and over again.

I worked very hard for these 12 hours at my patient’s bedside to continue moving her forward towards recovery. There was a cost for me there too, but the reward of seeing her turn around, and knowing that this was the result of our team’s immense efforts, was immeasurable.

These days, it feels as though there is a huge spotlight being put on the personal and professional costs of being a nurse, which I am beyond grateful for. It has become obvious as so many nurses continue to leave the bedside or the profession altogether, that the costs need to be addressed.

And at the same time, it feels important to acknowledge the rewards that still exist. The moments and patient cases that keep us here in this work.

Today, as exhausted as I am, I feel overwhelmingly grateful that I got to witness firsthand the profound payoff for all the costs we paid over a few days.

This life. We saved this precious life, one that belongs to two incredible parents and a couple of young siblings.  We saved their life from being shattered, too.

Today, as exhausted as I am, I am grateful to be entrusted with this work, and grateful for my team.