As a rule in the ICU patients do not get out bed so we had to ask specifically for a safe chair. The only one available was one from the MD Call room which they were happy to share. Despite the language barrier, the nurses were open to allowing us to help and were happy to learn suctioning and repositioning techniques necessary for the patients. They were more than willing to learn about the airway patients as they had not ever had airway surgery kids before. Our kids came back with a endotracheal tube in their nose for airway, and in their necks for stenting open a future tracheostomy which is unusual in any setting.

Sarah has a minimal skill for medical Spanish and the plan had been to use wifi for a translation app. The hospital did not have wifi so we were dependent on sign language, smiles and improv …. and the nurses, doctors and families were very patient with our attempts to communicate in variable fashions and somehow communication always happened. The ICU doctors were also accommodating and excited to learn and hear new ideas and thoughts.

Some of the observations we made initially in the ICU from a nursing perspective was that there was only one sink at the entrance to the unit, and none inside. There were only 2 bottle of cal stat for 6 patients.   There were no curtains to divide the patients spaces, (although portable screens were available and used during the death of another patient). There were no chairs for visitors, no continuous tube feeds, no arterial lines for invasive monitoring or precaution gowns or precaution signs for infectious patients. Despite these glaring differences there was an incredible feel of comraderie. The place was spotless, the patients were receiving incredible care and the nurses were warm and welcoming to us both.

Day by day Luisa and Cristopher improved and their post of course went well. With this we encouraged the breaking of a few rules and by Saturday as the unit emptied out there was a little music in the PICU, Cristopher got control of the remote control and the visiting policies were relaxed. We were even trusted enough to cover the unit during a quick break for the nurses.