Quote from apocatastasis
I got my RN license at about this time last year, right after I started working as a GN at a downtown San Antonio ICU. It's a SICU but we see a wide variety of medical/surgical/cardiothoracic patients. We generally have very high patient acuity. Lots of drug abuse, non-compliance in the face of multiple comorbidities, repeat offenders leaving AMA and coming back a day or two later, etc.
In some ways and on some days, I love working as an ICU nurse. I'm finally able to more or less independently care for the sickest patients that we get. Vented patients, balloon pumps, septic shock pts, CABGs, managing multiple drips, CRRT, RRTs and code blues, I do it all and the rush keeps me going.
But although I do my best when it comes to particular patients, I feel like I generally just don't care anymore. Without even going into the issue of how hospital administration and doctors' attitudes get me WAY down... patient-wise, I see the same things day after day after day. People who don't want to learn, don't care about their health, don't care that our team snatched them from the jaws of death. And then I read about the pertussis outbreak way over there in California. And then I think about my dad, who has years of untreated HTN and refuses to see a doctor and is probably gonna end up as a STEMI on a balloon pump.
And then I think, why do I bother? Why am I busting my ass and breaking my back for you, mister 34 year old, 800 pound, 6 cigarette pack a day CABGx5, when you're gonna go to the nearest McDonald's immediately upon discharge and eat 8 big macs? Or you, the violent, intubated 22 year old heroin overdose with seizures and anoxic brain damage, with a history of being intubated following heroin overdose and hemodialysis since the age of 15, whose insane mom is sneaking in opiates behind my back and screaming that the benzos we're giving him for sedation are killing him.
I feel like I used to care about my patients. Sometimes I still feel like I do. No matter my attitude on any given day, the job always gets done. Some days I go home and I'm proud of my work. I said goodbye to my alert/oriented patients in the morning and wished them well, and I really meant it.
But then there are the bad days where I go home, have a beer, put my head in my hands. And I feel like an empty human being because I don't care about people anymore, entirely dread having to go back to work tomorrow, and wonder what the point of all this crap is.
Sorry, I just had to vent. Thanks for reading.
I've walked your walk, still do. I totally understand. It's a difficult situation to be in, we give so much to our patients, work so hard to help them live to find it all get thrown out the window. We get emotionally involved with their families, see them at their good and worst, try our hardest to impact their lives. ECMO, IABP, dialysis, multiple pressors, working like a dog to keep them alive for one more shift, not even taking time for a bathroom break of our own. Why, what's it all for?
I've found this helps me: it's for that one patient who, when all is said and down, actually makes it through it all and comes back and says to you "thank you for saving my life. my wife (husband, parents, etc) told me all you did for me and how hard you worked to keep me alive." that thrill you get when you see that person walk thru the door, that person the doc said would never live let alone walk again...and see all your hard work pay off. If I wasn't there, that might not have happened....that patient may not have made it. I MADE A DIFFERENCE IN ONE PERSON'S LIFE. And for those patients who won't make it, I make sure to advocate that their last time on this earth will be as comfortable as I can make it, making sure that NO ONE on MY shift will die alone...I'll find the time to stop and hold someone's hand as they pass from this life into the next. The time to tell them it's ok, I'm here for them as they leave this earth. And as they leave, knowing I did all I could for them....that is some small way I hope I've impacted their life in a good way.
I've just learned over the years you have to take the victories where you can and stock them up...keep them in that special place in your heart you take out when it seems like nothing is going right, nothing you do matters.
Let me share an experience that happened a few years ago: I was working in a neuro surg ICU as a travel nurse. Had a patient who was a Jehovah's witness, who ended up infarcting her spinal cord due to blood loss and the resulting low BP's. The doc was angry that the patient wouldn't accept blood and started to berate her. I pulled him off and told him he couldn't do that, she understood the risks and it was against her religious beliefs to take blood and he needed to respect that. He stormed off. I ended up spending a lot of time that night, time I didn't really have, comforting her. She was facing a life of lower extremity paralysis. She was scared, anxious..you name it. I told her to rest, I'd be with her all night and would see that she was taken care of. Well, my shift ended and I was off for a few days after that. She was discharged to a different level of care and I went on to my next patients.
About 4 months later, I was shopping at a local mall one day when I heard someone holler "nurse! Nurse!" I turned around and there was my patient from that night. She was in a wheelchair, barreling across the food court to get to me. She said to me something I've kept in that precious place in my heart: "You made a difference in my life that night. I was scared, lonely and worried for what my life would turn out to be. And that night, you talked with me till I went to sleep. And every time I woke up, you were there...making sure I was ok. I felt truly safe with you caring for me, knowing you'd be there to see that I was fine. You helped me more than you can ever know." At this point, I was crying like a baby and she was too. This precious woman, who had been through hell on earth remembered me. And she stopped enough to share that with me. I gave her a huge hug and wished her well as she continued her recovery and literally floated out of that mall. I will never forget that woman and I came to realize that doing what I did...trying to be the best nurse I could be influenced people in ways I may never be able to measure or initially know about.
On those dark nights, when it seems nothing can go right....I remember that patient. And find the strength to go on. Hang in there, everything you do affects your patients even if it seems like it doesn't. You may be planting the seed that will cause them to make positive changes. Hugs to you.