When Life Gives You Lemons

Lemonade Stand in the ICU

When Life Gives you Lemons 

Susan Fusco-Fazio

“When Life gives you lemons, make lemonade,” is a term originally coined by writer Elbert Hubbard, in a 1915 obituary entitled, The King of Jesters, where he praises disabled actor, Marshall Pinckney Wilder’s optimistic attitude and achievements: “He cashed in on his disabilities. He picked up the lemons that fate gave him and started a lemonade Stand.” 

  When life gives you lemons, make lemonade. That's what we did one day when Laura was living in the Cardiac Intensive Care Unit (ICU). How does a bedridden 13 year old girl wake up one day after several weeks of complications and declare that she wants to sell lemonade from her ICU bed space? Instructions came soon after the idea was born. Laura was explicit about what she needed.

“Mom, Ask Beth if she has any poster board… and some colored markers too. I want to make some posters and signs to put up. We can hang them in the ICU and on 6 East. I think we will need one on the glass wall where I am too.”  

“ Sounds good Laura. We can do that,” I enthusiastically agreed. We were thrilled to see that Laura was feeling a bit better, well enough to have a creative idea.  She was more like the old Laura, who always had a project going.

“Oh, and Mom, It needs to be fresh squeezed Lemonade,” she said definitively. 

Laura always knew exactly what she wanted and exactly how she would go about materializing her ideas.  Laura knew we would do anything for her, even if it meant one of us leaving the hospital, driving to a store, and shopping for the needed items.

“ Are we going to be giving the lemonade away for free?” I asked.

“Oh no, it's not free. They will have to pay. It’s going to be a fundraiser,” Laura explained.
“A fundraiser for the hospital, like you did with the Casey bears?”I asked.

“Sort of.” She paused to think. “Last time me and my friends raised money to give to Beth for the hospital playroom to buy craft supplies for the kids.  This time, I want to use the money to buy toys for kids who are patients here now. You know that baby who was so cute and just had surgery and the boy who is younger than me and in the ICU?”

  “What a great idea Laura,” Paul said proudly, then kissed her forehead. 

“We can go down to the hospital gift shop when you’re out of the ICU.  You can pick them out yourself,” I added.

“When will I be getting out of here and going to a regular room?” Laura asked with a long sigh of frustration.

“Soon, I hope,” I said without making any promises, something we learned to never do. Laura seemed finally to be turning the corner, with new found energy, and the idea of a lemonade stand in the ICU.  

“You said it’s really hot outside, right? —The doctors and nurses and other people might want some cold lemonade.  It's for a good cause too. Mom, you better get going to buy the stuff.” 

Paul, who was sitting by the bed, reached into his pocket to grab the tiny black notebook he always had on him. He looked at Laura giving her the go-ahead.  “We’ll need lots of lemons, Poland Springs water, a citrus juice squeezer, sugar to sweeten the lemonade, a bag of crushed ice, some paper cups, maybe napkins, and 2 large pitchers for the lemonade.” Paul jotted down the items needed to pull this off. 

“OK, I’ll get right on it!” I went over to kiss Laura as Paul handed me the list.

“Wait a minute, don’t we need permission to do this?”  I said out loud as the thought popped into my head. “I hope they’ll allow us to do this.”

 Laura’s face had a sinking expression. Just the thought of not being able to do it, made her sad. Laura lived for her creative ideas. Nothing made her happier than being creative and doing nice things for other people. 

“Don’t worry Laura. It’s such a great idea. They’ll have to say yes. I’ll go ask now. Be right back,”  I said.  

I left her bed space to go get permission, feeling less assured than I indicated to Laura.  Jolted out of our creative fantasy, I headed toward the nurses station to ask for permission to hang posters and sell lemonade from Laura’s bed-space.  In our regular life back home, we never needed permission to institute our creative ideas. We could execute Laura’s project ideas without having to defer to a higher source of authority. At home we were our own authority, and in charge as Laura’s parents. We were sub-parents here in a paternal medical subculture, at the mercy of rules and regulations that exist in a hospital. Realizing this again as if I needed reminding, shook me out of making things happy for Laura reality, and put me back into the hospital’s in charge reality.  I slowly approached the main desk in the middle of the ICU to ask for permission. The nurse said she would speak to an ICU manager and get back to us. I thanked her and went back to Laura’s bed-space to give Paul and Laura an update. We all waited together like children, as if hoping to find out if we could have ice cream an hour before dinner, worried our parents would say no. 

Laura’s nurse popped into the ICU space. “ So Laura, I hear you will be selling lemonade today. Count me in. I will be your first customer.” She smiled at Laura, and then turned to wink at us,  indicating the idea was approved.  Laura’s response was to smile and bring her hands up to a clapping position, which is what she always did when she was excited or felt she had won. 

“I heard that you’re an entrepreneur from one of your nurses. She told me you sold small teddy bears on 6 East one time,” she continued.

Laura nodded yes, but was too impatient for small talk. 

Laura directed  her attention toward me. She was on a mission. “Ok then Mom, you go buy the stuff and Daddy, you go see Beth and get the poster paper and markers. Hurry, I really want to do this!” 

Paul handed me the car keys, and a credit card. I grabbed my purse, and took off to the Children’s Hospital Parking Garage where our car had been sitting unused since we were admitted a month ago, racking up a pricey bill. I would need to pay the whole fee before I could leave to drive down Longwood Avenue and onto Harvard Street to shop at the Coolidge corner Trader Joe’s for the supplies. 

Returning with “the goods," I took the bags into the kitchen area inside the designated Parent ICU sleeping quarters.  As I set up the apparatus on the table and proceeded to wash the squeezer and the lemons, I imagined Laura to be busy making the posters with her Dad, hoping things were still going well. I never knew what to expect. As I squeezed the sour lemons, I thought back to our other times in the hospital, how fast things could go sour for us.

I arrived at the bed-space with two pitchers of ice cold lemonade, cups and napkins. Laura looked up and beamed with excitement. She immediately pointed to the cups making a silent request. I became good at interpreting Laura’s every gesture especially when we were in the hospital. Understanding, I poured a small amount of lemonade into a cup and handed it to Laura, waiting for her seal of approval.
“ A bit more sugar,” she directed.  “It’s too sour.” I added more sugar and handed it back to Laura.  “Yum, this is good. When can we begin selling it?”

“As soon as we get these posters up. They look so colorful. I like the drawings of the lemons and the wording too,” I said to keep up the momentum.

“This was all Laura’s idea,” Paul exclaimed. “As you know, she’s the director!”

We all chuckled about this together as we prepared for the day’s event. 

“I’ll go see if I can get some masking tape and push pins from the nurses desk, then go hang the signs.” Laura’s Dad informed, then departed.  I stayed with Laura, lining up the cups and napkins, and setting out the pitchers on a moveable hospital tray table, creating a selling station.  We took an empty tissue box and turned it into a bank to collect the money.

It didn’t take long for Paul to return and hang one poster near Laura’s bed, and another on the outside of the glass partition that gave Laura a view of the ICU’s  main space. Laura had recently been moved to a more private bed space. It was more like a room; with three solid walls, one glass wall, and a doorway. If she needed privacy, we could pull the curtain around the bed. There were only a few spaces like this in the Cardiac ICU, primarily used for children who spent a long time in the unit. We had spent a long time in the unit during this particular hospitalization, in “limbo”; waiting forever it seemed for Laura’s condition to improve. Laura was frustrated at how long it was taking for her to get to the floor, the cardiac inpatient unit where patients in the ICU went after transfer orders.  

Laura was still not well enough to go to the floor, which meant to 6 East and into a regular in-patient room.  She had spent the last four weeks in the intensive care unit fighting for her life since the staph infection set up in her chest wound incision after the Fenestrated Fontan surgery on May30, 2000.  Laura had been discharged home only 7 days after her open heart surgery, became direly ill within a few days, and was rushed back to the hospital by ambulance in the middle of the night.  After a very long wait in the emergency room, then an even longer wait for an in-patient room it was finally discovered 12 hours later that a staph infection had developed in Laura’s heart surgery incision site. She also had massive amounts of fluid behind her lungs, squeezing them to a small and ineffective breathing space. Short of breath and in pain, Laura was sent to the Cardiac Intensive Care unit for treatment, where she would remain for as many days as it took to end the infection that was triggering her declining post operative state.  

Today marked four long weeks. Laura was still in the Cardiac ICU, hooked up to intravenous antibiotics (Vancomycin, Oxacillin) after many rounds of tried medicines that were D’C’d (discontinued) because they were ineffective or resistant to this strain of staph infection. The chest tubes that were painfully inserted into the spaces behind her lungs when she arrived at the ICU were still there, draining large amounts of fluid called pleural effusions into the pleura-vacs containers. Laura had also undergone endless dressing changes of her heart incision wound, frequent IV insertions, and twice daily blood draws. She was hooked up to a heart monitor and getting oxygen through the nasal cannula. After enduring weeks of high fevers, pain, nausea and lethargy, Laura had been too sick to do anything but lie there mostly asleep and intermittently awake, until this day, the day she woke up with the bubbling idea of a lemonade stand in the Intensive Care Unit.

                                                  ~~~

Finally by around noon, Laura’s ICU Lemonade Stand was up and running. Word traveled fast. Laura’s doctors who were working on that hot July day came into Laura’s bed space to buy a cup of lemonade. News travelled to other areas of the hospital, and more doctors and nurses who knew Laura came to see her and purchase the lemonade. Dr. W, who put in Laura’s pacemaker, Dr. L, who performed her catheterizations, and Dr. Mary, her cardiologist, came to participate and donate money to Laura’s fundraiser.  Beth, the Child Life therapist and many of Laura’s nurses who worked at the ICU and on 6 East that day came to buy the lemonade and to see the patient entrepreneur, and to marvel at the invincible Laura Fazio. Laura was overjoyed at the response. It was said by the ICU staff that this was the first time a patient ever had a Lemonade stand in the Cardiac Intensive Care at Boston Children’s Hospital.