... some patients die anyway.
I try all I can, what more is there to do?
Why, lets intubate! And get a ventilator too!
One Pressor, Two Pressor, Three Pressor, Four
There's nothing left to pump into you any more
Five fluids, six fluids, seven bags and eight
yet your foley output shows naught all night.
You lie there listless in bed
and here I am at my wits end.
Surrounded by all of modern medicine's marvels
and with nothing to show for all my travails
The only saving grace, if any
Was that you passed from this world surrounded by family
As cruel and abrupt as was your passing
I can only hope the final battle was worth the living.
I'm tired. My feet hurt. My back aches. My mind is fatigued.
And yet, the thought remains - "what if I'd done this or that or something more?!"
A wise colleague imparts sage advice:
"Hindsight never resurrected the dead!"...
... and then after a pause, added:
"Go home! Get some sleep. I'll see you back tonight..."
And so I go home to toss and turn
and snatch fits of sleep
For return I must in the morrow
back to earn my keep.
To dance that dance once again
Against that ancient and final foe
We may win or we may loose
But the dance is one we cannot choose
- Roy Fokker
It has been a rather difficult couple of shifts. I sit here, my feet soaking in a salt water bath, a mug of ice cold beer in my hand... just thinking. Reflecting.
Last edit by Roy Fokker on Jun 2, '09
: Reason: Modified thread content
Jun 1, '09
There is a fate worse than death. death is natural and inevitable, there's nothing you can do even if you go above and beyond. I pray you have the clarity and the strength to do it again.
What's worse is when you have patients who are max code, 97 year old fresh post-op. with end stage liver disease & kidney failure.
Families sometimes just can't let go and the patient suffers.
Jun 1, '09
I am sorry that you are having such a rough time at work. I am glad that their is someone out there that cares enough to go back and do it all over again every day.
Jun 1, '09
Its time for a nurse like me to step in, my friend. To help the family make the transition from "treat" to "comfort." Does you hospital have a hospice liason? (((HUGS)))
Jun 1, '09
I had a patient handed off to me that and it was a well known fact he would not survive my shift. It was no secret I had the patient because the nurses who had more seniority and/or friends on the floor pulled strings to be placed elsewhere. They didnt want to deal with the paperwork of a pt. passing away on their watch.
For the first few moments of my shift, I was myself. Only remembered how upset I was at "getting shafted". Thought to myself more than once "I thought crap with me taking the least desirable assignment would end when I got out of travel nursing" or "aint it a shame, I got out of travel nursing because of things like this and here I am, making less but still getting dumped on".
Then I mechanically went into the pt. room to check how he was doing. What are the respirations? Do I need to up the morphine drip? Will the family stall me too much and make me late with med pass?
Dont know how or why it happened, but as I went in, things just went right. I got along with the family beautifully (there were 7 of them for most of the night) and found myself just wanting to be the best I could be for them. I didnt do anything anyone else could have done, had no pearls of wisdom to pass on and was uncomfortable most of the time. Despite this, I got to know them a little and enjoyed helping them through a difficult time.
First thing that jumped out to me in the poem was how it was about the pt. first. Guess despite the odds, when we are working, thats what we do. We'd be burned out and doing something else if not. The entire begining of the poem is about wishing to do more for the pt.
Thats why I love it.
Jun 1, '09
Because, for me at least, I have this little voice in my head that tells me that not everyone can take care of those kinds of patients as well as I can. I know that I'll give it my all, even if it's hopeless, and there are plenty who wouldn't. I know that sounds self-promoting and conceited, but I couldn't work oncology if I didn't feel that way.
A few months ago, I had a patient who we all knew wasn't going to make it much longer. He surprised me by lasting my shift, but died just before I got back that night. I spent at least four hours in his room, interacting with his family, trying to make him comfortable. There were some screwed up family dynamics going on as well, which meant that I spent an additional hour out in the hallway trying to gently encourage the rational children to do what they could to get along with their irrational sibling. I talked myself dry educating the family about end of life care, what to expect, what I could do to help the patient have a "good death".
I came home that morning physically and emotionally exhausted, and was practically crying as I told my husband "I don't know why I tried so hard and fought so much, the patient was unresponsive and he'll be dead soon anyway." He held me and told me "Because it's your calling to be there. Because you wouldn't be you if you didn't. Because if you help one person, all the sacrifices we've made are worthwhile. Don't ever stop being that person that puts the time and effort in, even if the patient will be dead tomorrow."
Jun 1, '09
No, sometimes it don't matter what you do. They die.
I don't think anything happens to us by accident....and for whatever reason, the Universe conspired to put you with that patient for that time.
Someone once told me, there ain't no such thing as a good death. Expected, not expected, 'easy', 'peaceful', or 'hard-fought'....it is hard to deal with. It sucks. Young, old, whatever. [Having said that, the closer the patient is to our own age, the more we're faced with the reality that it could be 'us.' I know.] It hurts. You grieve in whatever way most works for you.
You were meant to be with that patient in their final moments. Medical interventions may sometimes be futile, but caring never ever is. You cared.
Jun 1, '09
The charge nurse doesn't assign patients to us.
I firmly believe we get the patients we do because God wants us to have them because he knows we can help each other.
Sometimes we help the patients (and families) and sometimes they help us
Jun 1, '09
Thank you....all of your comments remind me of why I am entering into this profession....and I actually have a couple of tears right now...thanks!
Jun 2, '09
Thanks y'all. I'm feeling a little better today (even though I picked up an extra 4 hours and stayed on over for 2 hours more because we were simply swamped - Monday Night Madness!!)
I guess I keep coming back to the thought that when I took report on the patient, one glance at the vitals/labs and one quick assessment was all it took me to come to the conclusion that "Dang! I doubt the patient will live to see day shift"...
... but once the I took over care and the patient became my assignment, that thought hardly entered my mind. I got down to brass tacks - what's the sat? Let's get another ABG and see if the pO2 and pH have gotten better or worse. Suction the ETT (and record the frothy, pink output). Recheck a CXR. Monitor BP. Adjust pressors. Call the doc, see if we can add another pressor. Note I/O. Titrate sedation. How's the perfusion? What about warmed fluid infusion...
So on and so forth.
It's like a part of me knew that the patient was really sick and probably on last legs... but there was this other part of me that didn't bother with those thoughts and instead focused on what needed to be done to keep the pt. alive.
I know I haven't shared information on how the patient presented, age, pre-existing conditions and family dynamics here (and I don't want to to preserve confidentiality) but hospice/withdrawing care wasn't really an idea/option. The pt. was one of those 'on the borderline' - the ones who present with a 'glimmer of hope'... I mean, I've seen/nursed pts. with far worse presenting symptoms to stabilization and witnessed their eventual discharge!
It wasn't as 'dramatic' as a frank code brought in by EMS (98% of whom don't make it... and of the remainder 2%, 1.9% die in ICU anyway and the rare 0.1% are 'saves'). No it wasn't dramatic. But it was certainly hard and it was very frustrating.
It is the slow pace (spread over many hours) of the decompensation that was most vexing of all! Because throughout it all, you're left with this lingering feeling of hope ("the next bolus will turn it around" or "lets add that other pressor, that'll help the BP" etc.) It is the same feeling that keeps trying to block out that part of your brain that said "this pt. will be lucky to last till day shift".
And it's that feeling of 'hope' that is at once both encouraging and deceiving. It encourages you to give it all you have ... all the while deceiving you from recognizing that it will ultimately fail.
Oh what a privileged profession we practice - where the lives of complete, random strangers affect our lives to such extents!!!
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