Have you cried?

  1. 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 they bubble back out. He needs suctioned hourly, if not more. But that's not why he is in the hospital. It's decubiti. He coded in July. He now has a massive stage 5 on his coccyx. Monday they will debride it. It is infected. It doesn't help that he is diabetic. His left leg now has a stage 3 on the top of the shin, and his back his covered with stage 1's. His heels are breaking down.
    He has pink eye in both eyes.
    His right arm is contracted.
    He has a feeding tube and a foley.
    He will never get better.
    He will only get worse.

    As I bathed him tonight I looked into his big red eyes and I saw him inside of there. He can't talk, but he was there. And the way his eyes locked on to mine was a form of communication, he was telling me he was helpless. No more than that. And he tried to move his mouth and talk but no words came out.
    And I sort of hugged him, and I started to cry.
    I know that I must sound crazy but I just know what he was telling me with his eyes.
    And I have never felt so damn helpless myself, in all of my life.
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  2. 65 Comments

  3. by   nightingale
    Yes.. I know what you mean....

    When I was a relatively new nurse, I had a young man (maybe late 30s) same situation.. He was in in Rodeo accident. He was a quad, multiple decubes, unable to verbalize, drooled, and his eyes spoke to.... I do not think I was with it enough to know that he was aware of his surroundings, but his family made sure we understood....

    I am sure at some point I cried (I cry for my patients usually when I am on my way home.. if I do cry)... I remember him like it was yesterday though.. and it was over three years ago...

    Hugs to you thisnurse... it is good that you care so much but hard on ya...

    B.
  4. by   LadyNASDAQ
    We have to set ourselves apart from these situations. We can not be enablers. We are there for a purpose and that is to care and treat the patients.

    You know that this will happen. Our Nurse Teachers told us about this. Our instinct as good people tell us to care, to grieve and to feel sympathy.

    I can't tell you how this hurts to write this but I know that we become ineffective when we get incorporated into this too much.

    I can only stress that the best thing to do is rotate this patient Nurse to Nurse so that no single Nurse becomes so involved that this turns to be too much.

    I know from being a Charge Nurse and an Assistant Manager thst this is where this patient needs to be taken care of by a rotating assignment.

    I would cry, too.
  5. by   nurs4kids
    I completely disagree ladynsadaq! When I loose the God given gift of compasson and caring, I hope God will be good enough to my patients to remove me from nursing all together. There is absolutely NOTHING wrong with crying over a patient; most of us have done it several times. I've done it the first day of having a patient, do you suggest I just remove myself from nursing since your rotation philosophy won't work there? What is wrong is when a nurse becomes so damn cold hearted that they are robotic in their care, rather than humanistic. I've seen this before too, and I hate to work with these nurses.

    This,
    Hugs to you, I know exactly what you're saying; what you felt. When I first started nursing, I had this anger about all these CP kids. I felt like we shouldn't have coded them; like it would have been more just to allow them to die. I felt sorry for their parents because their lives were "monopolized" to care for this poor vegetative child. The more I was around these kids, the more I watched their eyes, the more I watched the love parents have for these kids; I came to understand true love. Now I sometimes look in these; these DEEP eyes. I see a child in there who has much to say, just no means to express thoughts. Sometimes I wonder if these kids aren't beyond us "normal" people, perhaps their thoughts are more intellect than we'll ever imagine. I think perhaps they are happier than we could even dream of being. Watch one give a semi-smile, show a fraction of the way we show "happiness", it's different...deeper, more sincere. Watch a parent care for this child, THAT is unconditional love. Watch a parent cry when this child dies; it's no different than a parent of a "normal" child dying. So, who are we to say? I say love 'em and care for 'em, they are precious!

    God bless you thisnurse..and if ever me or mine are in this same situation, I only hope to be fortunate enough to have you as a nurse.
  6. by   hoolahan
    I totally and respectfuly disagree with you Lady NASDAQ.

    I once felt the way you did, and I thank God that it took one little girl to help me see the difference. The difference between what I'm not sure I can put into words exactly.

    If thisnurse feels she cannot take care of this man anymore, then it should be her decision for her own mental health, not anyone elses. I applaud her for sharing her most personal feelings with us so that we all may see what nursing is really about.

    Nursing is not easy. Many times nursing hurts. I know when I became attached in my situation, I was doing OT on the condition I could have this little angel as my assignment. There were many nights that I did not see my own toddlers b/c I chose to be with this little girl when she needed someone the most, then I went home and hugged my own two healthy children as tightly as I could and said a prayer of thanks for it.

    This man, and my little girl and the others who followed her, will only be here for a short time. They are suffering and need a human touch. There is and never will be anything wrong with showing your feelings and compassion while caring for human beings (or animals for that matter.)

    Thank you thisnurse for sharing that. Don't ever change the way you care. If you do feel yourself coming apart, please tell us, tell your co-workers, and then ask to change your assignment if you have to. I was suprised to learn that my co-workers were barely able to keep it together when this little girl was in our unit too. But we were all such tough ICU sharks, we thought it would be weak to show it. I thank God our manager had the smarts to call in debriefing team in and we all opened up and had some good cries together. We all worked as a much better team after that too, and made sure we shared our feelings with each other more often too.

    {{{{{{{thisnurse}}}}}}}
  7. by   Q.
    I disagree and agree with LadyNasdaq.

    I had a patient come into Labor and Delivery at 21 weeks, bleeding and cramping. It became apparent that she was aborting, but we were waiting for the MD to come and evaluate her. Her husband that was at her side, was....compromised intellectually in some way...not sure how, but he was "slow" in some sort of the word. He was a very big, tall, gentle man. His eyes started to well with tears and he asked me in a very shaky voice if his baby was going to be ok, and the baby would be ok right? He was asking me over and over again and beginning to cry. At that moment, I felt myself lose it. Before I spoke, I gathered everything I had to speak calmly and steadily, and told him that we will do everything that we can do to find out what is wrong. I couldn't look at him and busied myself with adjusting her contraction monitor. At that moment, another nurse came in and as soon as I saw she was there, I left and sobbed in the hallway. She took over the assignment for me.

    I felt at this time, this couple needed a nurse who could be strong and supportive. This is where I agree with LadyNasdaq. However, in Labor and Delivery, we have often cried and showed emotion towards our patients and this is good, but I think the decision to remove a nurse should be based on individual situations and the nurse's preference.

    Another case was a 30 year veteran nurse who was in attendence at a delivery of unknown Trisomy 18. This nurse also lost it and could not provide strong, supportive care to this family. She requested assignment change. I just think it all depends.
  8. by   LauraRN0501
    In nursing school we were told that it can be good to let our patients know we feel with them. I worked all weekend with an 82 year old man who had had his second big stroke and was totally unresponsive. He had secretions in his trachea Friday morning when I first came on, I could hear him in the hall. No amount of suctioning seemed to help, it actually seemed to make it worse. I finally got an order for 2-4 mg MS q 30 minutes as needed. I didn't need to use that much, had him comfortable and quiet with 4 mg q hour by the time his wife came in. His wife and talked for a long time, really bonded, you know how that goes. She was totally ready for him to go, she knew this wasn't her husband and she didn't feel a need to hang around and watch him die. This woman was totally in control of herself and was making arrangements before he died so that she knew everything was done in case she fell apart. But, while she was talking about their life together, she teared up and at that point, I did too. She saw it and was very touched. Sharing my feelings with her let her know that her husband was in good hands and that he would be comfortable.

    Overnight there was a code pink and the night nurse was unable (and unwilling, I think) to give him the MS q hour. She felt he was comfortable with it every 2-3 hours, but by the time I came back on he was full again, and I could hear him in the hall AGAIN. I started with 4 mg q half hour at that point and kept him on that schedule. It took a LOT longer to get him comfortable again and I sure didn't want his wife to come in and hear that. By the time she got there he was quiet and she was glad that I was there! It made me feel really good, like I was being a good nurse. The pharmacy decided they didn't have enough 4 mg MS syringes to last and called the doc and got a MS gtt!!!! Thank God. Then I knew he would be getting what he need to keep him comfortable.

    I have to say that I tried my best to help him pass quickly, but he was an athletic man and was STRONG. I knew it wouldn't be long as his temp was 104.3 ax when I left and his sat was 69-70. I called today and he died last evening, peacefully and quietly, not pulling for every breath he took.

    I put more in here than was necessary, but I guess I needed to vent. I am trying to make the point that my patients wife knew I cared about her husband and that I would do whatever I could to keep him comfortable. She didn't have to agonize over his suffering and I helped make his passing easier for them both. I can't see anything wrong with that.

    It also reinforced my desire to do Hospice work when I have enough time in!

    Thanks for listening.

    Laura
  9. by   LauraRN0501
    Sorry, thisnurse, I didn't tell you what I wanted to in the process of purging myself.

    IMHO, you did the right thing by sharing your feelings with your patient. How great it is that he knows he is being cared for by loving, feeling human beings.

    You gave him a wonderful gift and I hope you feel good about that.

    Kudos,

    Laura
  10. by   babynurselsa
    LadyNASDAQ, I have to disagree with you also. We are, or should be human. It is unfair to that patient to plan care as you described. This is where primary nursing can be so important. Not just to him but to his family. Continuity of care can make such a difference. It is Ok to feel empathy, sympathy and compassion. If it gets to the point that it is interfereing with the care that is being given, then that nurse may need to take a step back and let someone else take over.
    My own story was a child with a diaphramatic hernia. I cared for her for 7 months, not just her but her mom and other extended family. This child knew me, responded to me and trusted me. Would it have been fair to her or remotely compassionate for her to have a new caregiver each night?!?!?. Hell No.
    maybe I got too close and yes my heart was broken when my dear little Jayla passed. But that little girl had those who knew her and that she knew right up until the end. Would I hope that someone could care enough to do the same for me or someone I loved in the same situations? You bet.
    That is waht nursing is to me. It is not just a paycheck, or a job. It is about having someone who really cares ministering to those who need it. That goes beyond physical needs.
  11. by   thisnurse
    thanks for sharing your stories.
    i think what made me cry was realizing that the pt knew he was helpless. its one thing to be in that condition if you have no mentality but it must be horrible to know whats going on.
    and when my eyes met his, i knew thats what was happening. and i knew that there was nothing i could do to help him. in a much lesser way it was a reflection of his feelings i guess.

    and how absolutely awful it would be to be trapped in that state and have everyone talk around you as tho you dont exist. to have people come in your room and do things to you without telling you what they are going to do, or even who they are.

    lady we are taught in school to seperate ourselves from our patients. sometimes i think thats a good thing. i am confident that when there comes a time i am too emotionally involved to care for a patient, i will step out of the case.
    thats not whats going on here tho. i want to care for this patient. i am better able to care for him than most of our staff who see him as extra work, or a pain in the ass.
    sometimes i think we have a tendency to look at patients like this as "things" rather than humans. it protects us emotionally.
    i feel very good about the care i gave him. i also feel very fortunate to have been given the gift of
    understanding.
    it is a gift i do not take lightly.

    lady, while i totally understand your philosophy (which does not make you a bad nurse, clinical but not bad) i just hope you and everyone else keep in mind that we dont really know if these people can hear and understand or not. its far better to assume that they can. its a better mistake to have made.
  12. by   MickeymomRN
    Showing that we care by hugging and crying is also a form of nursing.
    We may think that the pt or their family needs someone to be strong but they also need someone to show them that it's ok to cry and hold onto each other.
    I didn't take care of another nurse's pt who had a miscarraige. I don't know if it was spontaneous or induced. I happened to need something in that pt's room. I had heard that she had just delivered. When I entered the darkened room, I excused my intrusion. As I was leaving, I noticed that she was alone and crying. I left and returned with a box of tissues. I gave them to her with only a few words then hurried to my own pt. Several weeks later, I attended a support group for persons who had lost babies, preterm and neonatal. As we went around introducing ourselves and telling our stories, I recognized no one. I was there for my own pain. This woman shared her story of how "cold" her nurse and doctor was. How everyone "ran" out of the room and left her alone. How she felt abandoned. And this is where she got up and walked across the room to me and said "but she came into my room and gave me a hug. And in her actions, told me it was ok to cry." I will never hold back my compassion. I will never be strong when I'm unable to be. I will take on my nursing assignments knowing that I will do my best and give my best no matter what or who.
  13. by   Teshiee
    I disagree with nasdaq. That is the problem with nursing school unrealistic expectations. I took care of a 24 weeker that was maxed out on dopamine only to start dobutamine. When I checked his poor body he looked so helpless I cried and at the same time I gave a silent prayer and knew I can only do so much and know that he will be going to a much better place. With my spiritual beliefs I can cope with my patients even if their outcome is grim. I will never set myself apart like that that is what makes nurses of all walks of life special. My heart goes out to you! I have seen some sad things in my life we may not be able to change their outcome but just showing the care and compassion before they go means a lot to them.

    When a nurse becomes that callous he/or she should be a pencil pusher with no patient contact. It is obvious their heart is not in it. Just think when you get old and helpless would you want a nurse like yourself taking care of you? Uncaring and feeling?
  14. by   Cubby
    BRAVO Teshiee.

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