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by Tele_Nurse4u

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Posted: May 20, 2008 03:30 AM

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The Fixer

Working in a critical care field, Cardiac IMCU, has evoked many emotions from within me: fear, excitement, determination, and frustration. Looking back only a few years ago it’s amazing to me the basic things I had no clue about. I could never imagine I would understand what seems like a thousand different medications or comprehend the inner workings of the heart. School taught me everything I know. School taught me the delicate balance of life, how to be A FIXER. Fix problems and help patients achieve a better way of life. A patient, Lucy* would teach me an entire new way of thinking…and fixing.

I received Lucy one extremely busy night as usual. Scheduled a midnight shift , I settled myself. Lucy was only 56, and an end stage liver CA patient. Full DNR scheduled to go home with hospice in the morning. She was ‘on her way out’ the departing nurse told me. I had never had a patient “on their way,” so to speak. Only a nurse a year, I was lucky. I hadn’t lost a patient yet. Not even a code. Came close. Luckily I got them to the threshold of safety…ICU. I realized that yes, every living thing is dying, but nurses are FIXERS…assisting medical staff to provide the best quality of life possible. Numerous IV sticks, drips, late night phone calls, and Code Blues had taught me that. After all, I became a nurse to help people get well, not to watch them die.

Unfortunately, as I assessed Lucy I realized she wouldn’t make it through the night. She couldn’t speak. She just stared at me. Did not answer questions, did not move. Even my stethoscope placed against her chest seemed to evoke pain. Lucy’s O2 saturation was only 88% on 6L NC. Vital signs were still stable otherwise. Lucy’s skin was cold, her face expressionless. She broke my heart in ways I am unable to describe. Yes, indeed this woman was on her way. AND I COULDN’T fix it. No matter what, there was no fixing this situation. I reassured Lucy I would be right back . Her huge, sad brown eyes looked up at me.(I’m pretty sure she understood) I rushed to quickly assess my other patients and call her family.

A 1:30 AM phone call from a hospital is never well received. “She’s dead isn’t she? You can tell me, it’s okay.” Her best friend’s voice quivered on the other end. I didn’t know what to say…I felt lost. I felt scared. I calmly and simply told her the facts. And told her to get to her as soon as possible. I went back into Lucy’s room almost in a fog…a daze. Poor Lucy. What am I supposed to do? “Lucy, your family is going to come sit with you tonight, won’t that be nice?” I tried so hard to be calm and reassuring. I sat and held her hand until family arrived. Her cold, tiny hand. I hoped she could feel it, I hoped it brought her some sort of peace. Her breathing was becoming more erratic and shallow.I hoped she would make it until they arrived.

Lucy was still not responding when her family arrived. Her o2 sat had decreased to 76%. She was refusing to wear any sort of O2 mask, ripping it off. With the family’s permission, I left the nasal cannula in. She appeared to be comfortable. I sat with the family and waited. Answered questions, filled requests, gave them their space, and called pastoral care.

Lucy’s monitor alarmed a short time later. Her family at her side, Lucy took her last breath. My chest tightened, and I wanted to cry for a woman I never knew. She was a friend, a sister, a mother. She was SOMEONE. She was loved. My heart broke for a woman and family I truly never knew. I turned off the monitors and allowed the family time to grieve.

Lucy allowed me to realize a very important, and simple, thing. Not everyone can be fixed. For Lucy her ‘fixing’ came not with a ventilator, drips, or medication-but with her dying. All I can hope for is that her family brought her some sort of peace and her exit from this earth was as beautiful as her entrance. This was all I could do, no fixing required. School spends years teaching you how to fix, but very little time on how to let go. Sometimes fixing isn’t an option.

I thought about Lucy for the nexy few days. Wondered about her life, what type of person she was. Eventually, my thoughts wandered and I moved on. But she taught me such an important lesson, I will never forget her. I'm sure each 'Lucy' will affect me, but hopefully never less than the first.






*Name has been changed

May 20, 2008 07:22 PM - You did "fix it" for Lucy. She didn't die alone, feeling uncared for. You were her voice, when she was unable to speak. You were her heart, when she was unable to express herself to those she cared for most - connecting them again in her final hours. You did "fix it". You gave her a wonderful gift - the gift of yourself. You watched over her and helped her pass from this life with dignity, surrounded by those who loved her and whom she loved. I disagree with you. You did "fix it" for Lucy, and you did it with all the grace, dignity, caring, and heart, and so much more, that can only be summed up in one word, 'Nurse'.

May 20, 2008 08:07 PM - Dear Friend:
I know there are heads nodding in understanding all over the cyberworld as we read your unique, yet familiar story. It is right you should grieve over this woman who you barely knew, yet knew intimately because she was your patient. You were there when a life passed from this world into the next, and that makes you very special. Sometimes "fixing" is not curing. It is an honor to help a patient die with dignity, lack of fear, and even more important, not being alone. I think this is what terminal patients fear- that at the end, when all the treatments and unsuccessful protocols have passed, that they will die alone and in pain. This is the pinnacle of who we are as nurses- to be present. It is our privilege to help patients die a "good death."

We love the stories of heroism and miracles, of new life and of lives pulled back from the brink. Might I suggest the real heroes are the ones who do not succumb to their fear of the unknown while caring for dying patients. They boldly plunge into the realm of the supernatural, embracing for a time not the role of a 'fixer', but of a nurse in her truest form. They face their own dilemmas about end of life issues and confront their own demons of fear. They press on, caring until the end. They grieve. And then they go on, carrying each patient who slipped from this life in their hearts and minds forever.

Godspeed, dear friend and press on

If you are looking for a great resource as a reference, try any of Patricia Benner's books on dying. She is amazing and her perspective on end of life issues is thought provoking and rivoting. A must read for any nurse!!

Jul 13, 2008 11:45 PM - My brother had a similar experience, and it really broke his heart to the point that he didn't want to continue his profession. In the end he was able to let go... but never did he forget.

Jul 15, 2008 11:21 AM - Its funny to read this this am because I was just talking to my co-workers about this. As a nurse you are suppose to be a "fixer" sometimes you feel like a failure if the person dies, or the outcome as not the way you had planned it. But its really about how you touched the life of others, that is how we are sucsessful in our work. You are a good person and a great nurse don't ever forget that. Your story is beautiful.