[00:01] Michelle: Wow. When you hear my interview with Monica Reyes, you'll realize what I've known for a while that she was born to be a pediatric nurse. Her playful nature aligns perfectly with this nursing specialty. She tells us that IV Skills are extremely valuable to pediatric nurses, and she shares her heartbreaking experience of losing a patient. We gained insight into her personal story of the challenges of having a daughter with a chronic disease. In the five-minute snippet, Monica shares what she expects to hear when she gets to the pearly gates of Heaven. Here is Monica Reyes. You're listening to the Conversing Nurse podcast. I'm Michelle, your host. And this is where together, we explore the nursing profession, one conversation at a time. Well, good morning, Monica. Welcome to the show.
[00:59] Monica: Thank you, Michelle. Thank you for inviting me.
[01:02] Michelle: Yes, you were the person that popped up in my mind immediately when I thought of having a pediatric nurse on because you've been a Peds nurse for a long time. We worked together for many years, and I just have so much respect for you. You have so much knowledge, and you're so much fun. Like, the kids, the parents, the doctors, and the nurses. Everybody just loves you.
[01:36] Monica: You're sweet.
[01:38] Michelle: It's all true, you know that? I like to just jump in. So why don't you tell us why you love pediatric nursing?
[01:49] Monica: Well, to begin, I love kids, any age. They just, like, brighten my heart. I have three of my own, but honestly, when I first started working in pediatrics, I didn't have any children, I wasn't a mom. But I took care of my little sister when my mom had her when I was 18 years old, so I helped take care of her. I've always loved kids. Even in high school, I would volunteer here and there. But initially, I didn't start in pediatrics as a nurse, but I always wanted to do pediatrics.
[02:26] Michelle: So where did you start?
[02:29] Monica: So when I began my nursing, I guess, career, you could say I initially started as a CNA, and I worked on Med-Surg. So it was a transitional care unit that was located on 3 West, so as a CNA. And then I became an LVN. But I always wanted to work in pediatrics, and I always look to see if they had any openings because Peds was where I wanted to be. And at that time, there was never any openings. Nurses didn't leave Peds, so that told me. So then I worked, I did have some Med-Surg and then I saw an opening for Peds, and I was so ecstatic. I was like, oh, yes, I want to work on Peds. And I did have a good experience one time when I floated over to the NICU many, many years. I think in like 97, or 98, I can't even remember. And I remember the NICU nurses were so fabulous. And just working with these little babies, that was my first experience, and I was like, yes, I want to work Peds. And then a couple of minutes later, then the opening for pediatrics opened, and I jumped on that. But I work nights, so it was a day shift position. I was like, I don't care. I just want to work in pediatrics. I'll do anything to get in.
[03:46] Michelle: Well, I remember that. So you came to Peds as an LVN, is that right?
[03:52] Monica: Yes, I did.
[03:53] Michelle: Yeah. And so once you graduated as an RN, you stayed in Peds, right?
[04:01] Monica: Yes.
[04:04] Michelle: So doing adult nursing and pediatric nursing tell our audience, because probably people have done one or the other, but not both, and I've never done adult nursing. So what are some of the differences?
[04:23] Monica: Well, I think it just depends on the age population of the patient. I worked on that transitional care unit, so there's a lot of elderly, and they just lighten my heart. They're so sweet and so appreciative, some of them. The majority, they were just very, you go in there, you help turn them, you help the CNA do their activities of daily living. And so when I was working with the elderly, that's why I was like, oh, there's just so the population probably 60 and above at that time, but now we see younger. But as an adult Med-Surg nurse, it was just seen. First of all, I feel like they're appreciative of that you're there taking care of them, and then when, you know you helped, you turn them, get them up to the restroom, and they always say, oh, I don't mean to bother you, but, you know, you're like, no, this is why I'm here. So the difference from adult Med-Surg or adult patients to pediatric patients, when you're in the pediatric population, I feel like it's the parents or the caregiver at the bedside that are there, and they're the ones that, they're your second patient. Not just the pediatric patient, but the caregiver at the bedside. So you're also taking care of them, and I feel like they're the ones that are letting you know, oh, thank you so much. And they're the ones that thank you for everything you've done. That's just the difference that I see from adults to Peds.
[06:03] Michelle: Yeah, well, I love how you describe the parent as, like, the second patient, because it's so true, right? Like, they come as a couple, kids don't come alone. They come with their parents. And so talking about that, how do you gain the trust of the parent and usually just a very short period of time?
[06:29] Monica: Well, all the years that I've worked on Peds, I've learned that a parent or a caregiver, they know their child. It doesn't matter how many years of experience I have, but I always listen to them, and I always let them know, you know your child. You tell me, what is it that you saw that worried you? Do you see your child? Is this how they are at home? So by you having that open question for them, just letting them know that you did the right thing bringing your child to the hospital, or you did the right thing of getting worried about what's going on with your child, it's a baby. It doesn't matter. They're 16 years old. It's still their child. That's how I gain their trust. The caregiver, and the parents at the bedside.
[07:20] Michelle: Yes. So really reinforcing their actions. We see this in the NICU, and you have to because you floated there, which we'll talk about in a minute, but they need a ton of reassurance. Like, they feel so kind of guilty just about everything. You know, they feel like if I brought my child in earlier to the doctor, maybe he wouldn't be so sick and maybe he wouldn't have to be hospitalized. So they're always second guessing themselves. Right?
[07:52] Monica: Exactly. Yes.
[07:54] Michelle: Yeah. So they need a lot of encouragement from us. And I like how you said, like, they know their child. They know their child way better than we do.
[08:03] Monica: Yes.
[08:04] Michelle: And we have to trust that. And it's like we're the eyes and ears. We hear this when we talk about relationships between nurses and doctors. It's like where the eyes and ears of the patient, the doctors are there for a short period of time. Well, it's the same thing with the parents. The parents are the eyes and ears of the child. And like you said, they know them. And we need to really listen when the parent says something is wrong. This is not normal.
[08:41] Monica: Right, exactly. You know, you're working closely with them, and as you said, they're there. We're twelve-hour shifts, we're in and out, and we're taking care of our patients sometimes. And, you know, by the way, how their interaction, how involved they are with their child. So then you, as a nurse, you gain that trust on the parent, like, oh, okay, this parent knows what's going on there. They're holding their baby there. As a pediatric nurse, there's a lot of body language that we look at also, and the support they have.
[09:15] Michelle: That's so critical, that nonverbal, right? It's like you get the feeling about something that is not right. And the other side of that is we have parents of kids that are admitted that maybe they're not on the up and up. We can tell that something's going on that, you know, maybe they don't really know their child that well because they haven't been present or there's, like, substance abuse issues or there's neglect issues and stuff like that. So that's the other side of it, too. So how do you approach a family with those kinds of social problems?
[10:01] Monica: Over the years, all these years in nursing, I'm guilty of being a little judgmental initially in nursing because, you know, you just, oh, no. Oh my gosh, look how they're acting, what they are. But over the years, I tell myself, I don't know what kind of upbringing they've had. I don't know what kind of support they've had at home. For all I know, they could have been a foster child, and they don't have that mother role model, that grandmother role model, or the father figure in their life. I always, over the years, have learned, too, you know what? I don't know where they've come from. I don't know the parent, I don't know their background. But here they are with their baby. So that's showing me that they're here at the bedside.
[10:51] Michelle: Yeah, that is such a great point. You're just kind of meeting them where they are. You're giving them the benefit of the doubt that they care for their child. They may not have the tools, they may not have the knowledge, they may not have the maturity, but they're there and they're showing concern, and we need to respect that.
[11:18] Monica: Right. Sometimes what I see is like, oh, this is some education. There's going to be some education I need to do today.
[11:28] Michelle: Yes, just some knowledge. Knowledge deficits. Right. When we did our care plan, I was always like, that's so easy. I can always pick a knowledge deficit. And sometimes I would question, is it my knowledge deficit or the parents' knowledge deficit. And it was easily mine.
[11:53] Monica: So true. Michelle, right? Yes.
[11:58] Michelle: What are some pros and cons of pediatric nursing? Talk about some of the great things about pediatric nursing.
[12:07] Monica: What I love about Peds is that when you have an unstable, ill child and the parents are so concerned and we're the caregiver, because sometimes now, these days, is not sometimes the parents, it's the grandparents or foster parents. But true for me, my delight is when they get better and they improve, and now they're smiling at you anywhere from an infant to a toddler to a teenager. It makes my heart feel good when they're feeling better and you're like, okay, we did a good job getting them, doing them.
[12:47] Michelle: Yeah. It's so satisfying to see this child come in extremely ill and with the care, they just turn around so quickly. And like I said, they're wanting to get out of bed and go to the playroom, and you're like, whoa, whoa, whoa, let's put the brakes on. You need to rest a little bit. But yeah, that's very satisfying. What are some of the things that you don't like about the pediatric population or pediatric nursing?
[13:21] Monica: Well, to be honest, the age group, it's all about growth and development, right? Over the years, you've learned that, okay, this age group is my biggest obstacle. And saying that I dislike toddlers, man.
[13:45] Michelle: They are a different breed, right?
[13:47] Monica: Oh, yes. So not that I dislike not that it's they're not the ones that make me dislike pediatric nursing.
[13:56] Michelle: But, man, sometimes oh, yeah, we've all been there in the treatment room trying to place an IV or do some procedure, and, you know, it's so difficult because they don't like as you said, it's all about development, and they don't understand what you're doing. They sound like they're being tortured. They don't understand the concept of we're trying to do this to make you better.
[14:30] Monica: Right.
[14:31] Michelle: And then they're very distrustful of you. For the usually the rest of the hospitalization, every time you go in the room, they start crying when you hear your voice.
[14:44] Monica: No, loudness.
[14:48] Michelle: Oh my gosh. Yes. I would echo that. That's a challenging age group. I think my favorite age was like four and ups.
[15:00] Monica: Yes.
[15:01] Michelle: You know, when you could reason with them and you could bargain with them and they forgave a little bit easier.
[15:09] Monica: True.
[15:11] Michelle: So talking about treatments and procedures, new things come along all the time. And so how do you stay updated? How do you learn new treatments and new procedures? What's the process for you for that?
[15:27] Monica: Well, the process for me okay, so the pediatric unit where I work in Kaweah Health, it's an eleven-bed or twelve-bed, if we cohort right. With two patients in room one.
[15:38] Michelle: Yes.
[15:41] Monica: Over the years, we've started to get a little more chronic pediatric patients that we probably didn't see before. So for me, I always have, even though I've been here for so many years. But I don't know about this condition or what's the new treatment and my go-to are the doctors, some of these new pediatric hospitalists that are just coming out of residency and learning, and sometimes they have, oh, this is how we did this in Philadelphia Children's Hospital. And you're like, oh, wow, well, that's good.
[16:20] Michelle: A really good point for someone like me that has spent their whole career in one hospital, I guess that can be good and it also can be bad because I've only had the experience of that hospital. I've only had the culture of that hospital. And so when we did start getting all these different physicians like you said, all these younger, like, fresh out of school, and they came from huge teaching universities, it kind of opened up our eyes to different things.
[16:56] Monica: Yes.
[16:57] Michelle: Yeah. So along that line, you mentioned the pediatric hospitalists, but pediatric nurses work with a lot of different disciplines. So you guys work with social workers, and respiratory therapists, and talk a little bit about how those different disciplines affect the care of the child.
[17:20] Monica: Well, I have learned over the years on Peds that we're a team. Teamwork that includes the nurses, the registered nurses, the CNAs, you said the respiratory therapists. When we have a social issue, yes, our patient and family services, social workers. So important to get them involved initially. Right. That way sometimes the social worker also depends on the pediatric patient that has been admitted in the diagnoses. And sometimes the diagnosis isn't one that we want to deal with getting a social worker to come, but sometimes you have to be so cautious if you need to get to know who's at the bedside with the baby or with a pediatric patient. Because let's say it's a motor vehicle accident, right? An MVA. And let's say the driver was driving under the influence or something, right? So now the mom is someone that's at the bedside. It was the father, and you know, you're going to bring up, oh, well, now I'm going to have the social worker come to talk to you. No, you can't approach them in that way. You can't tell the parent because they're going to be oh, why? Just being cautious of how you bring up the social worker when they're admitted. We do that patient Family Service Council and get them involved. Just give them the heads up, hey, we have this patient here for this reason. Mom's a little like we talked about, Michelle. That whole nonverbal, right? And you can tell by the body language. Maybe don't come right now. Maybe you can just give me the heads up. And our social workers are so they're great when they know that us Peds nurses are at the bedside. And so they always will meet before they go into the room to give them an update on what's going on with the plan of care. And sometimes just and sometimes you might not want them to go on the first day of admission, because sometimes you can see that sometimes some parents can be challenging. And they're like, what do you mean a social worker? Why? Just a collaboration. It's a lot of collaboration, a lot of teamwork. We all have to work as a team.
[20:02] Michelle: 100%. I mean, there's so many people behind the scenes that touch patients in Peds, in NICU, and I know other units that the patients are not even aware of. It does take a lot it takes a village. Right?
[20:23] Monica: Yes.
[20:24] Michelle: But like what you were saying about the timing is so important for really any kind of education to take place, because when a child is admitted to the NICU, it's a traumatic event. Usually, if they're sick enough and kids today, they usually have to be pretty sick to be admitted. And so the parents are not really ready to accept speaking to different people. They might not be ready for education. And that's why we have to say things so many different ways and continually repeat ourselves, right?
[21:10] Monica: Yes.
[21:10] Michelle: Just lots and lots of education and patience. Patience, yes. Patience for our patients.
[21:21] Monica: Yes.
[21:21] Michelle: Well, when I was researching for our interview, I found several pediatric nursing organizations. And so there's the Society of Pediatric Nurses, the American Pediatric Surgical Nurses Association, the Association of Pediatric Hematology Oncology Nurses, and the Pediatric Endocrine Society. And these were just a few. Are you a member of a professional organization?
[21:53] Monica: Yes, the Society of Pediatric nurses.
[21:57] Michelle: Okay, awesome. I didn't even know about that one. So these were all kind of new to me. What do you think are some of the benefits of being a member of a professional organization?
[22:10] Monica: Wow. Just to begin, technology now is great, right? Technology, because and I'm sure when you first started nursing, we didn't have computers.
[22:21] Michelle: Right.
[22:25] Monica: I remember. And even having to go to the library to search for articles. Right. So just with the technology now, with being a member of a nursing organization, just clicking on the links on the articles, on the evidence-based practice, because that is a big thing now. And just when you're a member of an organization like that, those articles are there for you and easily accessible to get on and to read.
[23:03] Michelle: Yes. And then, like you said, you get the specialized pediatric, all that research. Occasionally you will have a patient in your care who maybe they have a disease or a condition where they're going to pass away. And so I know that you have care nurses that are palliative care nurses. And so tell me about their role in pediatric nursing.
[23:42] Monica: So I honestly have so much respect for palliative, especially pediatrics. Remember Dr. David and Kealani Sine and when they first came to Kaweah Health, and they brought their hospitalist program and they introduced us to a lot of new diagnoses to where we were like, oh, wow. And just I bring up Dave Sine because he's such a patient advocate and he's so involved with pediatric hospice and palliative care. I remember the first patient. So palliative care nurses, that's different, it takes a lot to be able to deal with a pediatric patient that is in hospice or palliative care, right? And that was a challenge for me when I first worked on Peds because I wasn't a mom. And I remember taking care, the doctor sent over a patient that was in hospice, and he was admitting them because the parents thought they wanted their baby to have him at home when he passed away. And I give him big respect, anybody that can deal with having a loved one die at home. So I remember getting that call from Dave, and he was bringing in this baby to die in the hospital. I dealt with death working in adult Med-Surg or the Transitional Care unit and did post-mortem care as a CNA. But here I am now, you know, an RN working beside another RN. And now I honestly was so happy that it wasn't my patient because I was like, oh, my gosh, so much respect, because that day was a long day. Just trying to comfort the parents and see what they need. And you talked about this earlier, about the whole reassuring the parents, and I just got comfortable just letting them know, well, don't look at the alarms, look at him. Don't look at the alarm. Sometimes they don't know what we mean by, like, oh, he's not desatting. Oh, no, he's not bradying. Like, you don't use those words. So just letting them know it's okay, let's do this. Let me help you reposition him. So as the shift got more into the shift, it just got a little easier. It was a very tough day.
[26:38] Michelle: Yes. If you've been a pediatric nurse for any length of time, you have experienced the death of a child. And it's devastating. And we were so lucky, and you are still very lucky to have Linda as the Clinical Nurse Specialist. And she's so good at the debrief procedure. But just talk a little bit about what that procedure is and why it's so important for healthcare providers.
[27:14] Monica: The debrief procedure, when they pass away, you always want to make sure that you don't ask them at the moment what mortuary or what funeral home their child's going to go to, right? That's not something you want to talk about right there in the moment. So that's something that you should already have on hand. And just making sure. This is where collaborative, you know, having our social worker at the bedside, chaplain definitely getting them involved, but then you have to ask them if they even want a chaplain. And I've been lucky that they do sometimes and they'll say, why I never go to church. But yeah, sure, you know, but this is devastating for them. And sometimes they're just reaching out for comfort, for that emotional support. So getting PFS and getting the chaplain involved and just being there and just providing them with comfort and sometimes not even saying a word, just listening and just being your presence sometimes is important also.
[28:34] Michelle: Yes, absolutely. Again, going back to the nonverbal, just somebody sitting with you and not saying anything, maybe holding your hand or just sitting near you. Yes, it's so comforting. And I think as nurses and just people in general, we always want to do something, we want to say something, but sometimes the situation just calls for quiet and just a gentle approach.
[29:08] Monica: Yeah.
[29:09] Michelle: And I think it's so important what Linda does with the debriefing. She's comforting the caregivers in a way. The healthcare providers, a lot of times healthcare providers have a lot of guilt about not being able to resuscitate a child. And so we talk about all of that and it's just really helpful to go through the whole scenario again, what went well, what do we need to improve on? Like those procedures are so important.
[29:47] Monica: Yes. And sometimes the debriefing might not be right there and then because it just depends on how emotional or how the nurses are taking it, right? We've had a briefing before we'll touch base. Sometimes the nurses or even the doctors have to step away. They step away. And sometimes the debriefing will do it like the next day or later in the shift, whenever everyone has maybe gathered themselves.
[30:26] Michelle: Right. Sometimes it's even a few days later because the CNS needs to kind of get all the information together and then she gets all the healthcare providers there. So, yeah, it definitely can take a few days or more to go through that procedure, but it's critical.
[30:48] Monica: Yes.
[30:50] Michelle: Let's switch gears for a moment, and I want you to talk a little bit about the up-and-down nature of the Peds census and kind of what Peds nurses go through in terms of when the census is really high and when the census is really low.
[31:12] Monica: Sorry, Michelle, I don't mean to laugh, because this is Peds.
[31:15] Michelle: Oh. It's our life as a Peds nurse, right?
[31:19] Monica: Oh, yes.
[31:20] Michelle: And we talk about it and gripe about it pretty much constantly.
[31:24] Monica: Yes. Oh, yeah. You know, the girls probably hate when I say we've always floated in Peds. It's not something new. But when the census is high on pediatrics, adult nurses are scared to come and help Peds. They're afraid of Peds patients.
[31:44] Michelle: Yes. As we are of adults.
[31:47] Monica: Right. Yeah. And sometimes yeah, because I remember when we had to float up to the house, those nurses that had worked meds and were like, oh, all right. But then the nurses that have never been taking care of adult patients. But I totally get it. But yeah, when the census is high, man, we're just sometimes just reaching out. Can anyone just come and help us sit at the desk?
[32:15] Michelle: Sit at the desk.
[32:17] Monica: Yes.
[32:17] Michelle: We just had someone stationed at the desk, we would be happy, right?
[32:23] Monica: Exactly. Yes.
[32:25] Michelle: Answer the phone. Answer the doorbell.
[32:28] Monica: Just get them some water.
[32:31] Michelle: Yeah. And then so when the census was low, you wonderful folks would float over to us in the NICU.
[32:39] Monica: Oh, yeah.
[32:40] Michelle: And we absolutely loved having you there.
[32:45] Monica: Thank you so much. I love the NICU. That would be my second home.
[32:52] Michelle: And, you know, certain nurses feel more comfortable there. Some of them don't feel super comfortable there, and I think that goes wherever you are. But definitely, being a Peds nurse for 18 years, we did a lot of floating when the census was down, and then when the census was up, it's exactly like you said. Not a lot of people could float to us because we're such a specialized unit.
[33:21] Monica: Right.
[33:23] Michelle: Yeah.
[33:24] Monica: And I always try to be looking in a positive way. We're keeping up our skills because in pediatrics, we take care of two-day-olds and three-day-olds. Sure. Preemies that now are three months, four months old, or even a year. And I always looked at it like, this is keeping up our skills, this keeping up our knowledge. What's the new thing going on in the NICU? Or even on the postpartum floor? Taking care of the bili babies and doing the hepatitis B injections and the TCB bili tool and the CHDs. So a lot of times, it's like, PKUs.
[34:10] Michelle: Yeah. Well, talking about skills and keeping skills up. So if I'm a nurse and I want to go into pediatrics, what kind of education do I need? I mean, I know I can go in right from school, what kind of orientation do I get?
[34:29] Monica: So I've precepted and mentored new hires, and I can always, if even to have a little bit of background babysitting as teenagers or being a nanny, I can tell when they come on Peds and I'm orienting because sometimes I can see how they don't have you don't have to explain to them how to hold a baby. Sometimes I can tell the ones that have been around children because they comfort them in a certain way and just, you know, the skills definitely the IV, inserting an IV and where from an infant because we take care of all these different age groups anywhere from two day old to 17 years old. And just the skills of inserting an IV into these tiny little veins, and their eyes are just like, how am I going to do that? Right. Yeah. And so the IVs are always a challenge because I remember always looking up to you, Michelle, and to Linda, like, oh my gosh, we need an IV on this little three-day-old. And here you guys come like, okay, you guys would get it. And I'm like, wow.
[35:48] Michelle: Just experience, right?
[35:50] Monica: Exactly.
[35:51] Michelle: Yeah. And now you're the one that they go to. Monica, we need an IV and you make it look easy.
[36:00] Monica: I never thought I would get to that point when I first started.
[36:03] Michelle: Right. I don't you're just like, oh, well.
[36:07] Monica: What drives me is like, we need to get this IV because we need to get this baby better, this baby is sick. And we need to do what we need to do to make them feel better.
[36:20] Michelle: Absolutely. What's your take on being a certified nurse? First of all, are you certified in pediatrics?
[36:28] Monica: Yes, I am.
[36:30] Michelle: How do you feel about that certification? Do you feel like there are benefits?
[36:36] Monica: And I'm proud because that was a big accomplishment.
[36:40] Michelle: It is.
[36:41] Monica: Yeah. That test was almost like the NCLEX, right? Yeah. Just the preparation. And that's where you know how you were asking me about what society, the Society of Pediatric Nurses, they being a member, they really encourage getting certified and they have not incentives, but like, you know, they have where they will help. They'll send you educational materials to prep you, to get you on board to get certified. And I think it was a couple of us who were the first ones to get certified on PEDs in pediatrics. Certified pediatric nurse. And Keri really encouraged, really drove us to. We really want to have the nurses become certified because it's a big accomplishment and it makes you feel like, OK., I guess I do know my stuff.
[37:37] Michelle: It says a lot. It says that you're at the top of your game. I think when parents see that, they feel more confident. I guess some of them might not know what it is. I remember some parents asking me, what is the RNC-NIC, what are all those letters? And, I just would say that just means that I'm certified to be the best in neonatal care. And I think they really appreciated that and liked that.
[38:12] Monica: Yes.
[38:13] Michelle: But there's tons of benefits to that.
[38:15] Monica: Oh, yeah. And I feel like it makes them feel more like, oh, they do know how to take care of my baby.
[38:24] Michelle: Right.
[38:24] Monica: Yeah. Especially because it's a small hospital, a small pediatric floor.
[38:29] Michelle: Exactly. Yeah. It just gives them more confidence, I think.
[38:33] Monica: Right.
[38:35] Michelle: Well, I wanted to talk for a moment about your daughter Vanna, and she is a sweetheart.
[38:44] Monica: AW.
[38:46] Michelle: Yeah. I've gotten to know her through seeing you guys on Facebook and everything, and I know that she's a newly diagnosed diabetic, and I just wanted you to talk for a moment about that in terms of being a mom first right? Of a child with a chronic illness and then being a nurse. What are your feelings on that?
[39:12] Monica: Well, you know, when she got diagnosed, in December 2021, it changed, of course, our family, right? And not just that, but the way I've always listened to the parents, and I've always like, okay, they know they're a child. But for me, it opened my eyes to be these parents have been sitting in the ER for how long? For us, it's like, oh, it's only been 6 hours. I was on the other end sitting in the ER and she got diagnosed. What is it, like an incidental finding? Because I thought it was cellulitis that she had on her left elbow, swelling up to her shoulder throughout the days. And being a pediatric nurse and a mom, sometimes you're like, oh, you'll be fine. Oh, that's just a fever. I'll just give you, we can downplay. Right?
[40:11] Michelle: Yes, absolutely. That's one of the downfalls of being a nurse.
[40:17] Monica: Right?
[40:18] Michelle: Yeah.
[40:21] Monica: But when she got diagnosed, I just listened. Of course, it's around this time of year when it's so busy, and I had been working, and I remember her sending me a picture of, look, mom, look at this pimple on my elbow. And I'm like, okay, you are ten years old. You don't get pimples on your elbow, but don't pop it. And I ended up taking her to Urgent Care, like two days later. Just listening to your mother instinct, just listening to the 6th sense. I don't know. I took her to Quick care, and the PA saw her and said, oh, it just looked like a little cellulitis. Started her on some PO antibiotics. I'm like, okay, good. All right, good. Get the antibiotics. But it was already, like, I would say 5:30 by the time we got out, so I had to work the next day. So my husband picked it up, and he started giving it to her. And I even looked at it, and I was like, oh, I'm going to draw a line because it looks like it's getting a little red, but just to be cautious. So then mark it. We do marking, this is where my nursing came in. I was like, oh, I'm going to mark it. Maybe I'll take a picture of it too, right? And I came home. It was on a Sunday after working 12, 13 hours, and I noticed that she was flushed, her cheeks. And I was like, oh, man. I go, do you feel hot? And I remember I had taken pictures of it, like every day, starting like it was Thursday and this happened after Thanksgiving. And I was like, well, I mean, you need to give it time. And I checked her temperature and she was like a like, oh, wow. Now the red flags, right? I remember Dr. Valladares, the pediatric hospitalist was on and then I get a phone call, maybe it was around 08:00 at night, and it was Dr. Valladaras calling me on my cell phone. And so we talked, and he goes, you know what, Monica? How's her arm? And he goes, I saw the pictures. You want to make sure that it's not a septic joint. And I was like, oh, I wasn't even thinking that. I was thinking just maybe like cellulitis. He goes, how's she looking? I'm like, well, you know, she's ten. She's walking around, that wound. I mean, is it draining? I go, yeah. He goes, oh, well, that's a good thing that it's draining. I'm like, okay, so you're just talking with him. And then Savannah heard me. She was listening, you know, little ears hear everything, right? And I was like, well, she was mummy, do I have to go to the hospital? And then she starts crying. I'm like, oh, my gosh. I don't want no pokes! Because they hear me talk about right?
[43:14] Michelle: They don't and they don't want to be part of it, right?
[43:18] Monica: Yeah. But she's like, because I hear what you say sometimes. So I'm like, okay, I'm a little calm down. I was so exhausted. And when she went to bed, I just listened to my instinct. Michelle was like, you know what, I got up early that morning and I packed a bag because I go, oh, maybe on Peds, they'll admit her. Maybe she can get like two days of antibiotics or nursing comes in, sure.
[43:42] Michelle: Yeah, get in and out and just get it over with.
[43:48] Monica: In the morning. I was like, no. I got up and I got her ready. It was maybe like six in the morning. And I said we're going to go to the ER and she wasn't as emotional, and she's like, Why, Mom? I said, well, because I need to look at your arm. Your arm isn't getting any better. So here I am having to talk with her how kind of like how I talk to my Peds patients, just to go to the ER. Because I was like, you know what, I'm not going to wait over here. And I remember Samantha looking at the vending machine, going, mommy, can I have a Pepsi? And I'm like what? I'm like, Savannah, it's six in the morning, babe. I just really want one of them. Like listening to myself, I'm like, no, water, you know? And then as soon as they took us in and yeah, and I remember the PA taking a look at her arm, and she's like, this is infected. And then I went into mommy mode. I'm like, you know what? You do what you need to do. I'm here, I'm going to support my daughter, be a mom, and just distract her. What we do on PEDs. And I remember that they drew blood and then they had us go to the intake area, to another area because they wanted to transfer her because she said, you know, no, orthopedic we don't have a pet orthopedic here, they're not going to touch her elbow. And so she's like, you know, we're going to have to transfer her. And I was like, oh. I was like, oh, gosh, because I know it's a process. And then I remember waiting and she came and she said, you know, the lab results are back. And her CRP was like 300 and something. And I was like, oh. And she's like, yeah, her WBCs were like, 30. We really need to get her transferred. I'm like, okay, that's fine. Whatever needs to be done to take care of my daughter. Whatever you need to do. And she's like, okay, there's another blood result that is worrying. And then she goes, well, it's her glucose. She goes, and her glucose is 680. My heart dropped and I was like, 680? And then I just hear Savannah. She goes, yeah, her sugar is really high. And then poor Vannsa starts crying. She goes, Mommy, does this mean I have diabetes?
[46:02] Michelle: Oh, wow.
[46:03] Monica: Yeah. Michelle, where does she know this? Yeah. And I was like, okay, Van. I hear I'm dealing with my emotions, went to the side, right? And I'm like, really? She goes, she does not look like the numbers. These results, looking at, reading the lab results is like, you would need this kid. Look, septic. Looks like they're going into DKA. It looks really bad. Anyway, to make a long story short, that was the beginning of the journey. That me and Vanna, that we're in now.
[46:36] Michelle: So it's almost been a year then.
[46:38] Monica: Yeah.
[46:40] Michelle: How is she doing now?
[46:41] Monica: She's doing good. We go to the endocrinologist at Valley Children's and she goes in her phases, she's eleven years old, preteen, and, you know, it's all about how her peers see her and wanting to fit in. So on that part, just talking to her, just listening to her sometimes.
[47:05] Michelle: Exactly. As Peds nurses, we've taken care of a lot of diabetic kids, and some of them her age, some of them teenagers, and they want to be part of the crowd. They want to do what their friends are doing. They want to drink Pepsi, they want to eat pizza. They don't want to take their medication.
[47:27] Monica: Yes.
[47:28] Michelle: So it's challenging. And, you know, you're there as her mom number one, and then you're also a nurse, so you have all the medical background behind you in terms of education and knowing what she needs, but also being her mom and being emotionally attached to her and all that. I just could imagine the feelings.
[47:54] Monica: Oh, yeah.
[47:55] Michelle: We're just all over the place. Wow. Well, I'm really glad to hear that she's doing better. I have really enjoyed talking to you, Monica. I feel like you've given our audience such a glimpse into the life of a pediatric nurse, and I sure appreciate that.
[48:17] Monica: Thank you, Michelle. You know, it's all about being a Peds nurse. You're also a teacher, educating all the time.
[48:24] Michelle: Yes, exactly. Lots and lots of education.
[48:28] Monica: Oh, yeah.
[48:29] Michelle: Well, you know, at the end we do this thing called the five-minute snippet. So are you ready for that?
[48:36] Monica: I am ready. I've heard this in the past and I think it's hilarious.
[48:41] Michelle: It's a lot of fun. It's a great way for the audience to get to know the off-duty side of Monica. So I'm going to start my timer and then we'll just start asking you some questions.
[48:54] Monica: OK. All right. Sounds good.
[49:01] Michelle: Okay. Do you have a favorite childhood memory?
[49:04] Monica: Yes, my grandparents.
[49:07] Michelle: So nice. Yeah, their grandparents are the best.
[49:10] Monica: Yes, they are.
[49:12] Michelle: Just wait till you get to be a grandparent. Oh, it's such a different relationship. You're like, I'll wait a while. Right, right. Let's see. What profession, other than your own, would you like to attempt?
[49:30] Monica: I'm a clinical instructor for Peds nurses, but, you know, I don't know. I would love to do school nursing.
[49:38] Michelle: Really? Okay.
[49:39] Monica: Yeah, school nursing. I mean, I just love those kids. You know what, too? A PE Teacher.
[49:45] Michelle: Oh my gosh, you certainly have the energy for that. I could see you out there, like, doing the jumping jacks and running. How fun. Well, you'll have to look into the school nursing thing.
[50:02] Monica: Yeah, but that's a lot of paperwork. Sometimes I'm like, okay, I'm passed that.
[50:09] Michelle: Okay, let's see. Room, desk or car? What do you clean first?
[50:21] Monica: Well my car, because we live in our cars, right? Yeah. You need a car to get to work.
[50:24] Michelle: Right. Who cares about the desk or the room, right?
[50:30] Monica: You know, I have three dogs, and three kids in my room. This is where they come and I'm.
[50:35] Michelle: Like, oh, gosh, like, my room is not my own.
[50:39] Monica: Right.
[50:41] Michelle: Let's see. What do people ask for your help with?
[50:44] Monica: With when they have questions about their children when they are sick?
[50:51] Michelle: That is a good question. So do people in the community, like your friends and family, and people who may know you're a Peds nurse? Do they ask you, like, medical questions?
[51:03] Monica: You know, I think, I don't tell everyone I'm a nurse, I don't tell them immediately because I know what comes along with it.
[51:11] Michelle: Right. You're smart. Yeah.
[51:15] Monica: I'm like, I tell my husband I'm never going to put RN on my license plate.
[51:20] Michelle: That's right. That's funny. Do you have a favorite word?
[51:29] Monica: Practice makes perfect.
[51:32] Michelle: That's a good one. And that's a good three words.
[51:39] Monica: It's a three-word.
[51:41] Michelle: My favorite word. So when I was a Peds nurse, the children in pediatrics that would come in that were Hispanic and they were Spanish speaking, I knew a little bit of Spanish, and I would ask them how to say certain things, like como see dice balloon, and they tell me bomba. And so one day, this child was eating lettuce, and I said, como see dice, lettuce? And he said, Lechuga. And that became my favorite Spanish word. I love that word. I just love the way it sounds. Well, I know you love the central coast oh, yeah. A lot. And tell me what it does for your soul.
[52:28] Monica: Well, just the open space, the water, the calm, depending where you're at. Right. It just makes the fresh breeze, the fresh air. Oh, I just love it. And the sun, the sunshine.
[52:46] Michelle: Cool air when it's 108 over here in the valley, right?
[52:50] Monica: Yes, that too.
[52:53] Michelle: Yes. Well, so our last question, we have about 40 seconds. This one I thought was really interesting. And I know that you're a woman of faith, so it says if heaven exists, what would you love to hear God say when you arrive?
[53:14] Monica: Your home.
[53:17] Michelle: I love that you're home. Welcome home.
[53:22] Monica: Yes. Because I feel when you're home, you see all your loved ones.
[53:27] Michelle: Yes. Well, I'll tell you what, this has just been such a joy for me to talk to you, and I know our listeners have just been as enamored with you as I am. So thank you so much, Monica, for coming on and talking with us today about what it is to be a Peds nurse.
[53:48] Monica: Well, thank you, Michelle. I felt so honored when you asked me to be part of your podcast. You're an amazing woman. During all the time that you were on Peds, you taught me so much, and when I would see you, I would say, I want to be like her when I grew up.
[54:07] Michelle: Oh, my gosh. That's like the hugest compliment that somebody could give me. So. Thank you, Monica.
[54:14] Monica: Well, thank you. Thank you so much for having me on.
[54:18] Michelle: You have a good rest of your day.
[54:19] Monica: Thank you, Michelle. You too. Same. Okay.

Monica Reyes, RN, CPN

Clinical Nurse Expert

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Pediatric Nurse, Monica Reyes