Have you cried? - page 5

He is only 40 years old. He went to the dentist and coded. They did CPR. Sometimes that's not a good thing. He is now in a permanent vegetative state. He has a trach. His secretions are so thick... Read More

  1. by   NotReady4PrimeTime
    I'm going to apologize in advance for the length of this post. If you don't have the time or interest to keep reading, I won't hold it against you! Last year, we admitted a toddler who had fallen head-first into a five gallon bucket of human waste. His home had no indoor plumbing, and the family had been using the bucket as a toilet. Needless to say, he was in very poor shape. He was in Bed 8, the least desirable spot for someone as sick as he was, because of its lack of space. On my first shift with him, I was appalled by how fluid overloaded he was, and how much inotropic support he was needing. His hands and feet were cool and dusky, his eyes swollen shut. The skin on his abdomen was taut and shiny; his pupils were sluggish and he didn't respond to deep pain. His ARDS was severe and he was requiring a very high level of ventilatory support. We were attempting to run CVVHD on him, but because of his size, and the necessary compromise in vas-cath size, we had no end of difficulty. Also because of his age and size, it was necessary to prime the machine with packed cells. As the day wore on, his limbs became cooler and cooler. By the end of my twelve hours with him, we were on epi at .75mcg/kg/min and the dopa was at 12.5. We had run through three units of PRBCs and five filter sets. I went home praying that he would die while I was gone.



    The next morning I arrived at his bedside with my emotions firmly in check, braced for another difficult day. Over night he had continued to worsen, and by then his hands and feet had become dark purple. He was bleeding into his mouth and nose, and his line sites were all oozing. His parents were reluctant to sit at his bedside, and so I only saw them for a few minutes. At noon the hematologist came to the unit to tell us that his clotting factors were incompatible with survival. She was pretty blunt about it. After that I expected our attending intensivist to have The Talk with the family, but for reasons I will never understand, he chose not to. By 1500 we had put up the fourteenth filter set, and used the seventh unit of PRBCs. His blood pressure continued to drift, and his epi was going up by .05mcg every ten minutes. I was told to forget about the titration order and just go up as much as he needed whenever he needed it. About the same time that the fourteenth filter clotted off due to the extremely low flow rate, I put him up to 10mcg/kg/min. His limbs were black by now, the legs to the waist, and pulseless. We decided to stop the CVVHD because if we hadn't succeeded yet, we weren't going to. At 1825 he began to high pressure on the vent and the RT came over to help out. He was just preparing to hand ventilate when the circuit blew off the ventilator and the baby arrested. We got him back before our attending arrived at the bedside. He had finally spoken to the family, and they were all waiting to see the baby. I placed him on a blue pad, wrapped him in a blanket and tossed a towel over the bloodsoaked bed. We took him off the vent. He was so stiff that I had a hard time lifting him off the mattress to put him in his mom's arms. She was weeping softly; about twenty members of the extended family crowded around them, essentially trapping me between the crib, the wall and themselves. He took a few breaths, then stopped. His heart rate and blood pressure dropped slowly. His relatives were transfixed by the tracings on the monitor, so I turned down the gain and angled it so that they could no longer see it clearly. I wanted them to concentrate on him. His heart stopped at 1853.

    All that day, I had been feeling more and more upset by the situation in Bed 8. Twelve years before, my own son had been in intensive care, with MODS following a series of strokes. I was not a nurse at that time, simply the Mom. He had had no urine output for several days and dialysis was looming. The unit he was in did not provide dialysis at that time, and so we would have had to move to another hospital. He was comatose and jaundiced. We had The Talk. I was prepared for what was to come... and then his creatinine peaked just below the threshold set by the nephrologist and he began to pee. I brought him home, a different child, but alive, eleven weeks later. As I cared for my patient, I found myself reliving those days in 1989, and trying to rationalize our intensivist's reluctance to discontinue. I just couldn't understand it. I still can't.

    As this was proceeding in Bed 8, the decision had been made to discontinue for the teenaged boy with CP in Bed 7 who had suffered a severe and prolonged seizure which had left him in a vegetative state. He had been extubated several hours earlier. To that point, I hadn't really paid much attention to him, and hadn't even taken a good look at him. Someone at his bedside dropped something and I glanced over my shoulder to see what it was. In that split second, the glimpse I had of him shocked me to the core... he looked exactly like my son does now, right down to the high cheekbones and five o'clock shadow. It was all I could do not to burst into tears. When I looked again, the resemblance was gone.

    I cried in my car. I sat in the parkade and cried. Then I drove home and sat in the driveway and cried. Once I had pulled myself together, I went into the house and crawled into bed with my son. He was a little nervous, but didn't say anything. After several minutes, he kissed my cheek and whispered, "I love you, Mom."

    That day will go to my grave with me. If I ever find myself feeling a little too detached, I think of the three boys who, each in their own way, touched my heart that day.
    Last edit by NotReady4PrimeTime on Feb 21, '02
  2. by   nightingale
    (((((((((((janfrn))))))))))))):kiss
  3. by   rncountry
    janfrn, talk about crying in your tea! You just made me remember acutely why I left ICU. Most of my patients were trauma's somehow, at the end of my time there I began to regularly have nightmares about my children on vents, and I knew it was definately time to go.
    Thank you for sharing:kiss
  4. by   kaycee
    I'm crying now
  5. by   betts
    Being a Nurse Means . . .

    You will never be bored.
    You will always be frustrated.
    You will be surrounded by challenges.
    So much to do and so little time.

    You will carry immense responsibility
    and very little authority.
    You will step into people's lives
    and you will make a diference.
    Some will bless you.
    Some will curse you.

    You will see people at their worst -
    and at their best.
    You will never cease to be amazed
    at people's capacity for love, courage, endurance.

    You will see life begin - and end.
    You will experience resounding triumphs
    and devastating failures.

    You will cry a lot.
    You will laught a lot.
    You will know what it is to be human
    and to be humane.

    - Melodie Chenevert, RN
  6. by   semstr
    now I know why I have this burned-out feeling!
    But boy, it is good to cry!!
    ((((((((((( for all of you)))))))))))
  7. by   hoolahan
    janfrn, I did a few years in peds icu and it was not easy!! Right after my little girl (Not my own child, just came to feel like that) died in the unit, we had another child, a 14 year old with Downs who had an AV Canal repair, and he was doing very poorly as well. Both of these families were from South America, my girl's grandmom had come here with her and Michael had his parents. Michael's parents spoke English very well, and I will never forget the day Yadska, my girl died, we went up to see grandma on peds during the final hours-long code. Michael's dad was there and interpreted. Michael's dad could not handle hearing she was dying at all. A few days later Michael coded and died. I will never to this day forget the sounds of his father sobbing. His mother was catatonic, but his father, it was chilling to hear his sobs.

    I cried both of those days, but the day I cried the hardest was the eve before Yadska's surgery, because I knew she wouldn't survive the surgery. I and another nurse were not allowed to participate in her care or the code. I am glad my coworkers cared enough to realize we couldn't have done it.

    (((((all nurses who care and share))))))
  8. by   thisnurse
    i cared for michael for the night before he was being discharged back to the nursing home.
    he was very restless for some reason and he sounded "different". his breathing always had a certain rythm to it and that was off. his vitals were normal, his sat was good, and yet something was wrong. he was grabbing on to me and desperately trying to talk. he was pointing down at his leg. there was nothing wrong. when i suctioned him it made no difference. i could hear fluids in there but couldnt get anything out.
    i tried again and i got "chunks" of blood. solid secretions. after i got that crap out, it was just blood tinged mucous followed by his normal foamy guck. his breathing sounded better buthe was still restless. he was sitting up and grabbing on to my arm.i could see the anger and frustration in his eyes. he tried so damn hard to tell me something. it was the first time i ever saw him move on his own accord.
    i called the doc and reported what had happened. she came to see him while i was in report and wrote nothing. i was absolutely furious. no xrays, on RT consult, no labs... nothing.
    then one of my coworkers made the mistake of telling me there was nothing that doc COULD do. and asked what i thought she should have done.
    i went off.

    it was then i realized that i could not care for michael after that point. i was letting the case get to me personally and i realized that my feelings were going to cloud my professional judgement and hinder care.
    if he hadnt been discharged the next day i would have asked to not be assigned to him any more.
    of course i would have kept tabs on him and gone in to see him, i just wouldnt have been able to provide care. its our job to see things from an unbiased perspective. i knew i was no longer capable of that.
    the up side to it was that its evident he CAN hear, see and understand. maybe in time he will be expressive again.
    i learned so much from him, and from all of you. thanks all for your stories and understanding. our unit is made up mostly of clinicians. its so nice to know there are so many NURSES still out there.
  9. by   judy ann
    I just found this site. I am crying so hard it is hard to respond. I had a patient similar to "thisnurse". He was completly paralyzed, aphasic, and as stiff as could be. Had a G-tube, trach, and a foley. The worst part, he had a wife who didn't want the nursing staff to talk to him or relate to him in any way-- "He is mine!" I was a new employee, and was unaware of this. At night, when I was giving him care, especially tube feeds "we" would talk about things--his grandson's picture on the wall the weather and most of all the local football team. I always felt that he gave me looks of understanding and of gratitude. I also felt compassion for a man who was trapped in a body that did not work. He had a nice beard, and I like beards, so I asked him if I could pat it. He gave me what I can discribe only as smiling eyes. This became an every night event. This got back to his wife. This did not make her happy, and she forbid me to be assigned to his care and to even enter his room. I asked a sympathetic aid to at least tell him where I had gone.
    I had another elderly gentleman at about the same time, who was terminal with bladder cancer. He had not had any visitors and rarely said a word. One night, I was changing his TPN, when he awakened. He said "I love it when you come in here". I asked why I was different than the other nurses. Come to find out , I reminded him of a long since past relative that he had loved. I, wanting to keep him talking, asked what he missed most about her. He thought a few seconds, then a big smile spread across his face. "Her HUGS" I asked if he wanted a hug from me, and he said yes. Of course he got one. Two days later, I was called to the nurse managers office and fired for hugging an 84 year old man and accused of sexual harrasment involving the first mentioned gentleman. The manager reported both of these incidents to the Board of Nursing and I was forced to relenquish my nursing license. I have been a nurse for 42 years, and have never felt that a hug , or a tear is not a big part of my care. I support you entirely and completely and I send you many hugs, and I've used a box of kleenex reading these letters.
  10. by   micro
    Originally posted by moonchild20002000
    thisnurse,
    I sure understand how you feel. I have been a nurse for 28 years,there have been many times I have cried. I don't really have a story to relay,there are so many I could tell you about. I have always felt that when I lost my ability to cry I would need to leave nursing.

    :stone :stone :stone we are not stones or robots.......

    we are human beings that are also nurses...............

    how many times I have done postmortem care with tears streamin down my face..........cause just two to ten minutes ago I was just talking to this patient.........

    when I comfort families.....do i try to stay stoic.......no i try to stay professional, compassionate.........and offer support........

    when I care for someone.......i care.............
    there is a fine line between professionalism and caring too much.............but SICU nurse you said it very well................

    it is a question of caring..........if i ever lost my ability to care, then i would need to leave nursing.........

    :kissblush micro
  11. by   micro
    sorry.........moonchild.....I quoted you.......and the cmplt directed your way.............

    you and sicu nurse share the same avatar......and sicu nurse also has had some very insightful opinions.........

    sorry, micro will take relearning reading 101
  12. by   MarnnaRN
    fired for hugging a patient? geez, that's a bit extreme. I am so very sorry you had to go throught that, and lose your license. I hug patients, and family members. Sometimes, it is just needed. Judy Ann, you sound like an absolutely loving and compassionate person, and if I were a patient or family, I would let you take care of, and hug, me and my family.
  13. by   micro
    since when weren't nurse allowed to hug patients............:-O


    judy ann, second the above sentiment.........

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