Having trouble with a difficult situation

[canesdukegirl]

Hey y'all,

I am a very compassionate person...sometimes too much so. I work in the OR of a very busy level 1 trauma center. We do transplants and harvests routinely.

We have recently had quite a few donors. The "brain death" donors, although still difficult, don't rip my heart out as much as the "cardiac death" donors. I know that death in general is so difficult for families to deal with, and I tend to relate to these folks because of my own experiences with deaths in my family.

In the past, I have posted my experiences regarding organ harvests and the emotions that I felt in the aftermath. I take comfort in the fact that several patients get a new lease on life from these donors, but still struggle with the horrible tragedies surrounding these donors and the emotional fallout that their families experience.

I would like some advice from those of you who have dealt specifically with cardiac death donors. These donors rip my heart completely out. It is UNBELIEVABLY difficult to deal with emotionally. As a nurse, my first instinct is always to comfort, provide care and ease the pain of my patients...hell, isn't that what we ALL do?!? I can't even put into words how hard it is for me to watch the anesthesia care provider extubate, discontinue care and just WAIT for the pt to die. It is even harder when the donor is a pediatric patient.

So how do you deal with this, y'all? I know rationally that the organs will help to save many others who desperately need them. But emotionally, it is a roller coaster ride.

Thoughts?

[bjaeram]

I think brain death is easier because the "person" is dead. With cardiac death the person is still there but the body is dead.

My SIL died a year ago due to sepsis. It was the hardest time of my life. She was on a vent, dialysis, ect for 45 days. They finally said her lungs, liver, ect will not ever recover. Her brain however was perfect. How in the hell do you okay stopping treatment when the person is still there. We didn't have a choice though. Her body could not survive outside of the ICU. Sooo hard!

[Nurse SMS, MSN, RN]

I think brain death is easier because the "person" is dead. With cardiac death the person is still there but the body is dead.

My SIL died a year ago due to sepsis. It was the hardest time of my life. She was on a vent, dialysis, ect for 45 days. They finally said her lungs, liver, ect will not ever recover. Her brain however was perfect. How in the hell do you okay stopping treatment when the person is still there. We didn't have a choice though. Her body could not survive outside of the ICU. Sooo hard!

Similar situation when my son died. He was 13, beautiful, perfect, but his lungs were so damaged by ARDS after four weeks on vent/oscillator, there was nothing to be done. And yeah...the nurse that was there that day? In my heart forever.

OP, I am both sorry for and yet thank you for your pain. That probably sounds weird.

[HouTx, BSN, MSN, EdD]

Kudos to all my colleagues who deal with these situations and provide so much care and empathy to the patient's loved ones.

I hope you have also established 'caring mechanisms' for the nurses who must cope with these events. We have evidence that the cumulative effects of involvement in tragedy & sadness can give rise to PTSD among caregivers. If your organization does not already provide it, I would encourage everyone to establish a protocol for critical debriefing sessions led by qualified facilitators.

Without a "sanctioned" and acceptable process for dealing with the emotional burden of caring, nurses can fall into maladaptive defense mechanisms just to numb the pain - such as self-medication, substance abuse or emotional withdrawal and isolation. We need to care for and support each other.