Tips For Surviving Nursing: The Trauma Of Caring

[sandygator]

Today I remembered a 4 yr old... lifeless, so pale, except for the bruises which covered his body. I remember so vividly the parent who angrily confessed that "the boy just refused to walk right"...so he beat him to death. I thought about the terror that child must have felt just before he lost consciousness.

I remembered the tiny little boys we (PICU RN's) referred to as 'the blues brothers' because of the constant cyanotic spells requiring resuscitation, who all ultimately succumbed to their respective disease states. So many infants born of addicted mothers....left...just left...in the PICU to be cared for by us. No family, ever.

A beautiful, fat, porcelain-skinned six months old transferred to us from the NICU...a graduate they called her. She was physically perfect except for a trach which was, apparently, more than her birth mother could cope with. Her life void of any bonding, this child had developed an aversion to human interaction. Months of patient coaxing finally led to eye contact and then to an earth moving smile from her. In my first work-related nightmare I stole this baby...and then frantically tried to figure out how to return her before getting caught. People ask "how can you keep from getting attached?" We couldn't do our jobs without getting attached.

How many mother's faces I looked into as I laid their already lifeless child in their arms after I took them away from the machines which made them seem alive for a while...sometimes very long whiles. How many times I hurt a child in the name of treatment which we all really knew was futile. Oh my God, that one hurt.

I remember feeling guilty about the joy I felt as one family lost a perfectly healthy child to a GSW to the head because another child would live ...perhaps...even though it would mean a life-long regime of medications, physician visits, lab tests, fear of rejection.

The broken hearts of family members over a brain-dead child due to shaken baby....the sorrow I felt because he really didn't know the consequences of his actions....the rage I felt because a mother lied while her baby was dying because she didn't want to get her boyfriend in trouble for his abuse of that child.

I am thinking how there seems to be an invisible wall which surrounds the bedside of a dying child; all the cacophony of PICU noises dulled by broken hearts and pulled curtains.

So many times I was so angry yet so helpless to make a difference.

Burns, abuse, accidents, mistakes, every disease known to afflict adults, head trauma, heart trauma, multi-trauma, multi-system-organ-failure, limbs lost, lives changed, slow deaths, traumatic deaths, anticipated deaths, unexpected deaths, and deaths which didn't happen; all have taken a toll.

There were miracles, yes. There were triumphs, many.

But today I realize, I am traumatized. I will not return to substance abuse...which is how I suppose I lived through it all. But I am asking for your prayers as I learn how to begin to deal with this realization: We as caregivers must recognize the effects of our caring on ourselves! My husband knew, but couldn't tell me. He said he saw me hugging my own children too tight and too long for their ages.

Thank you all.

[gal220RN, BSN, RN]

Dear Friend:

I know....my God, I know. Any PICU nurse who has spent more than a few years will echo your experiences with empathy. I appreciate your candid admission about substance abuse. Let me assure you, we are all abusers of something- food, alcohol, shopping, drugs. They all serve the same purpose, to make us forget for just a little while that our jobs really suck at times. We remember the victories, which are our salvation. But we are haunted by the tragedies. I have flashbacks of the 4 year old meningicoc meningitis who was dead within 2 hours of admission. The indescribable color of his skin, purpuric and bloated from fluid. The permanent indentation of his sternum from endless compressions. The bloody oozing from every stick and every orifice. And worse of all, the wrenching cries from the mother and father who had to see the futility of our work and the violence left behind. That I could forget those moments forever.

I also have the memory of promising an anxious mother who accompained her chronically ill child in respiratory distress that once we assisted her breathing with a vent, that "everything will be just fine- I promise." Little did I know that her daughter would be successfully and uneventfully intubated and 2 minutes later be in full arrest- and die, after 2 hours of desperate interventions. We did everything right, and she still died. I sedated an awake, talking child who was terrified and hypoxic (she had an extensive cardiac hx) telling her I would take care of her and she died under my watch. Walking in with my most respected and competent attending MD to tell this family their child was dead was the pinnacle of horrific anguish, clinging to the mother, sobbing I was so sorry- I had broken a promise. Everything was supposed to be okay and.. it was not. From that day on, I never make promises to my patients. The feeling of responsibility haunts me to this day.

Friend, if those things don't do damage to our hearts and souls, I don't know what will. It is by the grace of God we persevere. Only through sharing our stories will we realize we are not alone. Silence is deadly. I realize I have not shared that story with anyone, the shame still is so near and real for me.

You will have my prayers. Please do the same for me.

[sandygator, BSN, RN]

heelgal,

Thank you so much for sharing. I hope it lightened your burden.

My prayers are with you.

[Nurse_Advocate]

Thank you for your courage to express yourself so honestly. You talked about the horrific things you saw as a PICU nurse. You talked about how you let yourself slip into addiction to cope with it all.

But you've changed that now. You've made a decision to get into recovery. They say that the first step in recovery (from ANY addiction) is to be able to admit that your way of coping doesn't work anymore.

I recently started a blog about how I cope with the stress of nursing. You see, I'm NOT willing to sacrifice my soul for nursing. I LOVE my patients...don't get me wrong. For 12 hours at a time, I am devoted to them like nobody's business. But I'm no longer willing to "keep it all in" and to come home and go into MUTE mode.

I'm not willing to risk addiction, alcoholism, over shopping, overeating, depression, isolation or self-abuse over this career. It's like saying, "Something isn't right here...I'll show you, I'll drink this poison!" Who gets hurt? We do.

Not worth it to be silent any more!

Good for you. Keep doing your steps of recovery. Work with someone who has gone before you. You're doing great!

[deeDawntee, RN]

Wow, what a poignantly written piece! You have a true gift for communication and insight. How could one not be impacted by such autrocities on the most vulnerable of us...our infants. Thank you for the work you do in the face of monumental conditions over which you have no power to change. Your heart and your gifts shine through your writing. I can see the depth of your caring and insight which are profound. Thank you for the person you are. I wish for you peace and realization of your specialness.