Dear Nurses: Please Forgive Me

A letter of reflection, a plea for forgiveness, a note of encouragement for ED, ICU, and Floor Nurses, who work so hard with sometimes so little, understand where the "family members from hell" are coming from. A gentle nudge to remind that the person lying in that bed belongs to the heart of those around them. Ultimately, this is a note of deep, deep gratitude. I could never do what you do and I am so very thankful that you chose your current role. You are unique, powerful, and so important. Kindly remember. At the end of the day--remember. Nurses Announcements Archive Article

Dear floor, ED and ICU nurses,

Please forgive me.

I know he's dying. I get it. I do. We were told five years. Five years on an outlier and he would be gone. We were told transplant was an option but with the dismal survival rates, we opted for rehab. He is now eight years post diagnosis.

We know we are lucky have had him this long. It doesn't make this any easier. Please don't say it like it's a mantra of comfort. For reasons I don't know or even fully understand, it only makes the sting more sharp.

We see it, you know. The mental status changes. The lack of control. The shuffling gate. The use of accessory muscles.

We see it.

And we know exactly what it means.

When he can't remove his bipap to eat, we know. When he can't lower the head of his bed past thirty degrees, we know. When he can't talk, we know.

We know.

Forgive me, please, my many sins. Forgive me the overbearing stare and raised eyebrow. Forgive me for repositioning him and demanding another pillow for under his heels. I'm helpless, you see, to stop the very shadow that will claim him and I have nothing else to cling to. I have nothing else but what now feel as tedious, miniscule scraps of knowledge that amount to nothing. No cure. No hope. I'm lost.

I'm lost.

You must understand that when I nearly demand to read the orders or see the chart, when I loom over your shoulder, it is not that I don't trust you...it is that I don't trust myself. I don't trust myself to be cope, to make all the right choices, to advocate, to deal with the loss and reconcile the feelings of guilt, of doubt, and pain.

I beg you to understand that I'm scared to death and helpless and a control freak and for once I can't make it better. Understand that I glare instead of cry, laugh instead of scream, and go silent when angry. It's dysfunctional, but it's my way.

And I don't want to be up later at night, pacing a hole in my carpeting, consumed by nausea and a feeling of coulda-woulda-shoulda.

So when you see me wandering the halls, wringing my hands, biting my lip and growling under my breath, please don't be afraid to offer a kind word. It is what I need to hear. Even if I do not acknowledge that I heard it at all. Trust me, it got through. And I will remember.

You must understand that this man is precious to me--that I want to guard him the way he guarded me from myself. That when I call every two hours to demand a neuro status check it is because I am not there and I am struggling to convince myself that I really do need to sleep even after being up for nearly thirty six straight hours and you are my eyes and ears and everything else.

Please see what that cranky, demanding creature is to me. He wasn't always this way--a brain sitting in an acid bath is a terrible thing. I can't control what's happening to his body but I can control the flavor of his Jell-O and so, you know what? If that means raising holy hell with Dietary so I can get red Jell-O for him, then I will. Because it's all I have.

Be genuine with us. We can handle it.

Know that he is the first man, since my grandfather, who treated me with kindness, and god help me, love, even though I was a crazed woman-child dwelling in a familial household, riddled with hormones and a gloomy past, laden with baggage, sociopathic tendencies and unable to form any sort of bond and yet he never left. I lived years without that bond. Years without feeling the need for the guidance and protection only a father could give. Some part of me missing that bond and loathing "daddy's girls" everywhere. But he's trying to leave me now...I survived nearly a lifetime without him and suddenly I 'm not ready.

I'm not ready.

I'm not ready.

Know that I never encourage him to use me as some kind of threat...some unholy boogie man that will get you if you don't help him right this very second. Because, "my daughter is a trauma nurse and she will know what you haven't done right." Know that when I come in and acknowledge that, ::sigh:: yes, I am a nurse and then talk a little shop with you, I am not trying to be in your business but show you that I understand what you are trying to accomplish and understand what you are dealing with on a day to day basis.

I am nothing without you and neither is he.

But he is my dad.

Please understand.

I lost mu dad in March of 2009.

I wish those nurses could read this now and try to understand my fear. As I watched him slip through my fingers, I became angry that, after snatching so many strangers from the jaws of death......... why I couldn't do for the most important in the world.....why SOMEONE couldn't do it for me.

I totally get that. Oh boy, do I ever get that.

2008 for me.

And Cheesepotato's post made me choke up, too.

Specializes in LTC, Ortho/Med-Surg.

Thank you for this. Thank you, thank you, thank you.

At the beginning of my shift one night on a med-surg floor, I was told I'd get an admission; a patient from a bigger hospital who was coming to us on a 'virtual hospice bed'.

My hospice patient arrived close to 8:30 that night, and his family came with him - his wife, two grown daughters (who were both nurses), their children, and his two grown sons. They came in irate. Our hospital rooms are tiny, and they had been promised our 'hospice' room - a double occupancy room with one bed removed and a couch in its place. They were not told that the hospice room was occupied, or that they would be getting a 'regular' private room. I got my hospice patient bathed and changed into a new gown, did my assessment, then told the family I would be back as soon as I gave a stat med to one of my other patients. We have a new call system, with a remote control in the rooms to call the nurse, so the call bells on the beds do not work. I explained this, told them how to reach me, and was off. Apparently while I was gathering the med, a new family member came in and hit the call bell on the bed. I was standing outside the hall of my other patient's room when she came storming up the hall, a murderous look on her face. I didn't recognize her, but I asked her what was wrong. She said, "You can find me the worthless nurse for my DYING FATHER and get her down here NOW." She pointed towards the room, and with a sinking heart, I told her I was her father's nurse. I told her I had to pass this med and I would be down to her father's room immediately.

I passed the med and went down to his room. The woman was standing outside his door, arms crossed. I opened my mouth to say something, but didn't get a word out before she exploded. "I have been hitting this call bell for fifteen minutes and NO ONE answered. I think my father's in pain, and this room is too small, and we don't have enough room for our family to be here, and this is ridiculous and cruel. I want to speak to your house supervisor, NOW." I told her I would go call the house supervisor, and as I was walking up the hall, several of my fellow nurses who had heard her commented - all along the lines of "Wow, what an awful family." I called the house supervisor and returned to her father's room with pain medicine. On the way down there, I thought about what his family was facing. This man had only received his diagnosis six weeks prior - they hadn't even had time to process that this man was sick, let alone dying. And now here he lay, in a tiny, cramped room, nonverbal and unable to turn himself, unable to control his bladder or bowels, and he had just endured an hour-long ambulance ride with his family following behind.

I gave her father the pain medicine, then approached the woman and told her, "Listen, I think we got off on the wrong foot. I have called the house supervisor and she is coming, but while we're waiting, please allow me the chance to talk to you." I asked her if she had used the call bell on the remote and she said no. I explained that was why I didn't get her calls. I went over the new call system and demonstrated it for her. Then I told her how sorry I was that this was happening to her father and her family, and that I understood their frustration with the small room, especially when they were told they would have the hospice room. I told her I didn't know if we could switch his room, but I got extra chairs, pillows, and blankets from the supply closet. I told her that it was my desire to do everything I possibly could to make sure her father and her family was as comfortable as I could make them. Then I went to the pantry and fixed a pot of coffee, and brought coffee down for everyone.

We were unable to switch rooms that night, but the woman and her family warmed up to me as the hours wore on. Before I left that morning, she pulled me aside and said she was sorry, that she had misunderstood the night before and was afraid that I would be negligent towards her father. I told her she had no reason to be sorry - she didn't know me from Adam and wanted to make sure her father was properly cared for -- any daughter would want that.

What I have written a book to say is that, as nurses, it is so easy to forget what it's like to be the family member. It's easy to see the families as difficult and demanding, and pass judgement without ever really considering the enormity of the changes they are facing in their lives. We forget sometimes to read between the lines, and to realize that we are just an outlet for these families' anger, hurt, and confusion. That doesn't mean that we should allow ourselves to be mistreated, but it does mean that they need the very best of our nursing skills - our compassion, our understanding, and our ability to bear witness and stand beside them. As CheesePotato says, they know that their loved one is dying, even if they don't understand the medical jargon for it, they don't need any more demonstrations from us on how we know the person is dying. They need us to say, "I am so sorry. I am here, and I am honored to care for your loved one and your family, and I will be here with you through this. I AM HERE, AND I CARE."

Sorry this is so long, but CheesePotato, your article really, really touched me.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I totally get that. Oh boy, do I ever get that.

2008 for me.

And Cheesepotato's post made me choke up, too.

:hug:.....I'm sorry. sniffle....

So true.

Excellent reminder. Thank you.

Specializes in PICU, NICU, L&D, Public Health, Hospice.

Your essay is my professional life...from the other perspective. All of my patients die and all of the family members are somewhere in their grief. Many of the families have a nurse or other health professional in the midst because of the employment mix of the region.

Go gently, live each day with the goal of no regrets...not today, not tomorrow, not 6 months from now. Be "in the moment" with your loved one. Breathe.

I wasn't planning to be moved to tears when I logged on this afternoon. Daggnabbit.

Love to you.

Much love and God's peace to you. As a critical care nurse, this seen is relived before me many days. As yourself, I also understand because I have been there not to longer with a family member myself. As hard as it is, please allow yourself to remember the good memories. Also, though it will take time, I thank God for my loved one not suffering any more. Again much love and comfort to you during this time. God bless you : )

Specializes in Corrections.

I am going to print this out, and post it at the nurses station.

Everytime we have one of those days where we may feel "this job" is ridiculous we should read this and remember this is more then a job....these are peoples lives and why we got into this field in the first place.

May God watch over you and your family and guide you through this troubling time.

God Bless

Your plight is beautifully written. It makes me raw. I just lost the man who gave me my husband in May. I did the same things. I fussed. I meddled. God, I couldn't bear to lose him. He may have been an in law, but the emphasis was on FATHER. He accepted me as his own. He was actually closer to me than my own father.My heart goes out to you. I feel your pain. I lived every word of your post. You are strong. But this is tough. I have no magic words, but know you are in my thoughts.

Specializes in LTC,Hospice/palliative care,acute care.

Peace to you....

Specializes in Sleep medicine,Floor nursing, OR, Trauma.

To those who have responded and have suffered a loss of their own:

My deepest condolences. Of all the things I wish would build camaraderie, how I wish it didn't have to be something like this.

Keila:

Do not apologize for the length of your post. Your words were perfect and your story a sharing of your courageous heart. When others would withdraw, you returned and that, my friend, is the very hallmark of integrity. Believe me when I say they remember you, even if your name has faded from their minds.

~~~~~~

And no, there is no clean cut way for this to progress. He, himself, is no longer sure how he wishes his care to continue and in what manner. Advocacy when the answers are cut and dry is easy. Advocacy when the wishes vacillate from day to day is a nightmare. And I will do nothing if not carry out his desires, be it intubation and suspension of life or a place in Hospice.

If I fail to uphold his desires, what good am I?

After all, it is not our place as nurses to pass judgment on the progression of care; rather, it is our place to uphold those choices, protect, guard, and keep them when everyone else shies away--regardless of our personal hang-ups and beliefs. I speak for those whose voice is silenced.

I am the Lorax, I speak for the trees.

::snicker::

Inappropriate humor is inappropriate.

I....I am so sorry.