The Transience of Life

[CrufflerJJ]

In the 19 years that I was active as a volunteer EMS member of my local fire department (2 years NREMT-Basic + 17 years NREMT-Paramedic), I was often amazed at the difference between a "scene" on the day of getting a call, versus the same location a day or two later.

I'd pull up on a horrific motor vehicle crash...car into a tree...partial rollover...pinned screaming pt. You work to stabilize/extricate/transport the victim of the crash. Do the paperwork, and move on. Same with a shooting....stabilize, transport, "wash down" the ground to clean away the blood.....and move on.

A day or two later, I'd be on my way home from work and might drive by the same location. Sun shining, pretty green grass. Maybe a scrape on the bark of the tree, a little shattered glass or a discarded rubber glove on the ground, but nothing else to indicate that this is the location where a human life ended or was forever changed. Just another spot of ground...nothing more.

Now, as an ICU nurse, I sometimes experience the same dichotomy ("here" vs "not-here"). A couple of days ago, I was taking care of an elderly pt with a dissecting/ruptured AAA. While in the OR, the pt received 16 units of packed red blood cells, 18 units of platelets, 8 units of FFP, 6 liters of fluid, and 4 liters of fluid from the intraoperative "cell saver".

Upon arrival to our ICU, the surgeon was very straightforward with the pt's family....the pt was not likely to survive.

Over the next couple days, the pt ended up getting multiple units of PRBC and platelets, along with liters and liters of fluid (plus pressors and hemostatic agents). The pt's family (spouse and children) hoped for the best, while the medical staff could see (from blood work) that multiple organ systems were failing.

The pt's family ended up withdrawing care....finally...after multiple "talks."

The pt's body was still in the room yesterday (awaiting transport to our hospital morgue) when I came into work. The body was eventually removed, leaving an empty room.

And the room remains....a bare, sterile room in our ICU. Ready for the next patient. The only sign of the deceased is the family contact information written on the dry-erase board.

As with scraped tree bark, the family contact information is the only (short-lived) sign of yet another human having passed from this world to the next. Wipe it off with a paper towel....set up the room for the next patient.

Transient...Here vs not here.

[radicalsenseofhope]

What a lovely piece of writing. Well done. Very moving. My grandpa spent his last days on earth in an ICU after a heart attack. I was in my early 20s. Watching the nurses care for him was amazing. They treated him with so much respect and compassion. It was actually one of the first moments where I thought I might want to become a nurse. Thank you for being an ICU nurse and for all that you do. Also thank you for your time in emergency services. My husband is a paramedic. I know all too well how tough a job that is.

[annneubery]

Very poetic and deeply moving. It brought tears to my eyes. Being an ICU nurse really places you on that "edge" between life and death.

I try to not become too connected with my patients. Even after 2 years of being an ICU nurse, it's very hard to separate oneself from another "human being".

[CrufflerJJ, BSN, RN, EMT-P]

Very poetic and deeply moving. It brought tears to my eyes. Being an ICU nurse really places you on that "edge" between life and death.

I try to not become too connected with my patients. Even after 2 years of being an ICU nurse, it's very hard to separate oneself from another "human being".

To all who have posted responses to my article - Thank You! This was the first article I've done on allnurses.com .

As to trying to not "become too connected with my patients", it's a delicate balancing act. In EMS, as with nursing, I find it necessary to maintain a professional distance while still leaving myself open to empathize/feel. It's very possible to prevent personal pain/mental anguish by putting up high "walls", not feeling anything when a pt suffers or passes away. In doing so, however, I think that the caregiver loses an essential part of CARING. Caring (in my infrequently humble opinion) isn't about performing a technical procedure. It's a give & take relationship between the caregiver, the patient, and the pt's family. Caring requires a sometimes painful honesty - being honest with yourself as to your personal limits, as well as being honest with your patient.

Care too much, and the pain you feel prevents you from "doing what needs to be done." Care too little, and you don't give your pt the respect they deserve as a human being. As with many things in life and medicine, it's a balancing act.

Sometimes, as when I "triaged out" and turned my back on a pinned driver who was burning to death in order to care for the other driver involved in a two vehicle head-on collision, I have to put up high walls to shield myself from the pain. Lock away your feelings so that you can do your job, then revisit/embrace the feelings at a later time. Share the feelings with someone you trust, or they WILL eat away at you.

As said by the Prophets Geddy Lee, Neil Peart, and Alex Lifeson in "Limelight":

Cast in this unlikely role

Ill-equipped to act

With insufficient tact

One must put up barriers

To keep oneself intact

[Flare, ASN, BSN]

great article. I've been a nurse and firefighter for the past 13 years and i've had the same line of thinking - how a scene that was only days before a view out of a nightmare could look so peaceful and unaffected. I also get to thinking about how somebody's life is probably falling apart right at this instant - house fires, major wrecks, severe illness, you name it. It's humbling really, makes me thankful for every good moment of my life.

[mljallow2003]

A well written piece...i love it..

[whichone'spink, BSN, RN]

It's always a weird feeling to have a coding patient in the resuscitation room at one moment, and the next moment, have for example a child with a dislocated elbow after the previous patient's body was cleared out. Do patients ever wonder who was in the room before them?

[exit96]

Nicely stated....being a nurse and 48 years old, with 3 grown children, and much "life" in my rear view mirror...I have had these perceptions or moments in the past, you summed it up well. It urges me to continue to "live" every moment, an yet elicits melancholy for me personally. I was standing out in my front yard a few days ago, trying to "hear" the distant sound of the several children that used to come to our house for daycare, there were many... trying to invoke my mind's eye to bring up some footage of lives that were lived right at this very location, and coming to terms once more with how time rolls on without apologizing. Thanks for sharing :-)

exit96

[imintrouble, BSN, RN]

Life goes on, but you said it so much better.

[VanLpn]

I enjoyed that very much! Thank You:)

[Aeterna, BSN, RN]

Excellent article! I can strongly relate to it, working in oncology/palliative. There is not a single room on our unit that has not seen a death. I can still pass by some rooms and remember a death that affected me in some way, but then I see someone else in that bed and remember it's all in the past.

What strikes me even more are the odd times when I discharge a patient home while at the same time, have another patient who is dying. One minute, I'm celebrating with the patient and their family that they're better, they can go home, sleep in their own beds, and be with their loved ones. I wave goodbye with a smile, then hurry to another room and quietly provide the best emotional support I can to a grieving family, watching my patient on his/her last hours. And, when all is done, the patient dies and when they leave, in comes another. Lather, rinse, repeat.

[Evan Gross, BSN, EMT-B]

very good

[FranEMTnurse, CNA, LPN, EMT-I]

Very well written. I have had similar experiences, only reverse of yours. My medical career began when I was just 21 working as a nurses aide back in 1964. I experienced many deaths in that LTC facility. I felt the anger I had at those who left their relatives behind to die alone, and became active in helping them enjoy their lives in spite of being left alone. I started a men's club called "The Crackerbarrel Club", plus worked with the men & women on arts & crafts, a co-worker & I put on shows for the residents, and I even helped publish a monthly newspaper called "The Gay Nineties Review."

Fourteen years later, I joined our ambulance corps. Knowing I only wanted to do my very best at whatever it was that I took on, I became the ambulance corp's first EMT and soon after that became a CPR & Basic First Aid instructor.

Having experienced numerous calls of all kinds including witnessing the accidental death of a relative who I didn't recognize, nor did anyone else on that call until his wallet was removed from his pocket, to what we used to call "Taxi" calls. (I believe you know what I mean) I began to wonder if I was getting so used to it I was getting uncaring. I now know I wasn't. I eventually became a nurse. So thank you for sharing a little bit about you.