A mother's story fuels this nurse's passion

By Louise Kinross

Vera Nenadovic connects her work as a nurse practitioner on Holland Bloorview's brain injury unit to her experiences as a 13-year-old girl supporting her mother, who died of breast cancer.

"When families here talk about the terror they feel when they see their child seizing, I can go back to that moment when I first saw my mother seizing and thought she was dying," Vera says. "It was the 1970s. I went with her to her appointments, and I could see how they treated her, and our family, as immigrants. My father was Serbian and my mother was Russian. What struck me was that her doctors were smart but they didn't project caring, whereas the nurses projected caring, which is what she needed. That drew me to nursing."

But it was a circuitous route.

At first Vera wanted to be a vet "so I did a degree in Agricultural Economics with a sideline of Animal Science," Vera says. She didn't get into vet school and took a course in fashion design. "My teacher told me she had a sister who was a nurse practitioner in South America, and who went up and down the Amazon doing cool things. I thought 'This is fascinating, I'd love to do that, but not in the Amazon.'

"So I went into nursing at McGill with the goal of being a nurse practitioner in a remote area. I met my first husband, who was Cree, in nursing school, and he said "Let's go back to my home reserve in Saskatchewan and work there." So she did, working in a medical clinic for five years.

Vera's day on our brain injury unit begins at 7 a.m. "I deal with medical issues in the morning," she says. "Does a child need a change in their medication, or to be sent to SickKids?" I get the report from our night nursing staff to see what's happened over night, and which patients I need to see in the moment or to follow up with. I follow some patients from admission to discharge. Some days are 100 per cent clinical. Other days I may get a bit of time to work on projects."

That includes her research on a brain monitoring system that will predict outcomes in childhood brain injury. "Right now we're flying in the dark in the sense that we wait for outcomes because that's all we can do," Vera says. "For some families it's very painful when we say 'All we can do is wait and see.'"

Vera and Dr. Peter Rumney are testing a system that uses EEGs and computer algorithms to show changes in the brain as a child recovers, and which in future will be predictive of outcomes. "It began with my post-doc in the ICU at SickKids Hospital and we've adapted it to rehab," she says. A partnership with The University of Edinburgh and Royal Hospital for Children and Young People in Edinburgh will see the system trialed in 10 pediatric ICUs in the U.K.

Vera says the greatest joy of her job at Holland Bloorview is working with children and families. "If I'm having a tough or stressful day I reconnect with the patients. That's what's driven me all along, is the relationships with people."

It loops back to her experiences when her mother was ill. "The people that seemed to really connect with us and hear what we were saying were the nursing staff," she recalls. "But they didn't have the power to make the difference back then. It was the physicians who provided the medical care. My mother didn't get compassionate end-of-life care, and that impact has stuck with me. When I meet families who have gone through trauma I can understand it at a personal level, as well as bringing all of the knowledge to try to make it better for children and families."

Vera says the greatest challenges recently have been system ones, whether it's a surge in children's respiratory illnesses, staff shortages due to COVID, medication shortages, or families struggling with rising food costs. 

"Sometimes there's sadness when you wonder how does any one child or family get hit with so many tragedies?" she says. "Sometimes it's anger if you know the trauma is inflicted and the brain injury is not accidental. There's a lot of joy and excitement when you see the changes, especially in children who have been severely impacted. When they start to make gains, when they give a thumbs up or a finger, that's huge. There's the sheer resilience of what they live through.

"My family were immigrants who lived in forced Nazi labour camps and they always talked about how you have to keep moving forward and surviving with what you've got. And we see that in our families who are facing insurmountable odds. That's the rewarding part."

When asked about the qualities that make a good nurse practitioner, she says: "You've got to be smart. You've got to have a lot of patience, a lot of compassion. We have to process a lot of information. We have to be decisive, to assess and quickly determine a path, especially if a child is acute, but you do it with the team."

Vera says her time on the reserve informs how she copes with stress. "I developed a profound respect for people's self-determination," she says. "I learned that I had little control over what happened, and that people will determine their own destiny and make their own choice, and I don't take any of it personally. I can't force you, because forcing you is abusive, even if I think it's in your best interest. The best healing comes when people in community find their own path forward. At the end of the day, we're not going to be there to hold each family's hands when they leave and when their children age out of the pediatric system. If we can help them find their own power, their own strength and their own ability to navigate, we've done the right thing."

Vera's traumatic childhood health-care experiences help her build trust with families. "Professional boundaries are critical, but there is a place for therapeutic use of self. People are vulnerable when they come here and when I can say I've experienced something similar, it does help to break down barriers. I have great connections with families here and trust is the vehicle by which we provide care. It helps that families see us as real people."

In addition to her clinical role, Vera is vice-chair of our Research Ethics Board and sits on the hospital's new Strategy committee to advise on Indigenous health.

Like this story? Sign up for our monthly BLOOM e-letter. You'll get family stories and expert advice on parenting children with disabilities; interviews with activists, clinicians and researchers; and disability news.