Let's talk about death

ECMOismygame · Feb 22, 2008

Almost from the beginning of our education we have it drilled into us that we can't allow ourselves to become enmeshed with the people we care for. What an oxymoron that is! We're told we must maintain a professional distance and that we cannot allow our emotions to be touched by what we do. We're told it's unprofessional to cry with a patient or their family when things don't go the way we want them to. I say FORGET THAT! If we squash down our humanity and harden our hearts we lose the kernel of why we became nurses in the first place, and we lose the opportunity to truly know ourselves.... These experiences are what makes the other ones bearable.

please make the above a sticky.

AlabamaBelle · Feb 22, 2008

Yes, we are having a run in our unit. One was unexpected, a patient I'd taken care of, had gone out of our unit sitting up & interactive. He came back in a day and a half later in resp distress, "alligator rolling" all over the place. Morphine & versed had no effect. As our team was preparing to intubated, bam! asystole. They worked and worked to no avail. One boy was an oncology patient, MODS. The other was a patient we'd had on ECMO for about a month. We lost count of circuit changes, equipment changes, conventional vent to oscillator and back again. Multiple, multiple chest tubes pouring out atrocious amounts of drainage. The family refused any conversations about ceasing extraordinary means. The child coded regularly several times a shift.

We've also had a bad run of non-fatal but devastating non-accidental traumas. Doesn't that sound so much nicer that what it is? "I shook/beat the crap out of my baby" (all have been 5 months or younger). Just chaps my hide big time.

Just not a happy time for us right now.

Pediatric Critical Care Columnist · Feb 23, 2008

please make the above a sticky.

Done. I added a sentence to take the place of the feel-good stuff that didn't work in a sticky. Woohoo, my very first sticky!

pcicurn7 · Feb 23, 2008

Is anyone else having a bad run of losses at work?

So funny you said that...we havent had one in a little while on our floor, and we had 2 within 24 hours. They were chronics, we knew the day would probably come, but...it was just so weird to see the rooms empty.

Kiwimid · Feb 25, 2008

my heart goes out to you....he looks sooo much like my son who is nearly the same age now....who has had health problems but not as bad as your wee guy. our children enspire us to be more than we could imagine. they birth in us dreams we never knew we had. my guy even has the same pokemon toy.how easly that could be my guy....blessings to you

Indy, LPN, LVN · Mar 4, 2008

We stock our rooms after cleaning them. (icu, adult, small hospital) So friday night I went to get a bite stick and oral airway to put in a room that we had apparently not stocked in over a week. Hmph. Besides the fact that my boss would have a fit, I remembered the last person I attempted to use those items on. It really hit me that over time, I'd be able to associate a death with each room if I stay there for a long time. This last person was dripping sweet, he just acted like I was it on a stick... in that almost pleading, annoying kind of way. He took his education the "wrong" way, and kept telling me he had work to do, he wasn't ready to go. Here I am giving long term advice and he responds with how much he really doesn't want to die. He knew, and it was a week later I had to do his post mortem care and hand him over to the stretcher.

You know, my heart goes out to you who can do this for children because I think I can do it for adults, then there are times it's almost unbearable even for them.

jenj1928 · Mar 9, 2008

I read this thread and I think two things at once, "this is why I want to be a PICU RN" and "this is why I don't want to be a PICU RN".

I did case management for early intervention for 5 years and attended 3 infant funerals. Several families really touched me and drove me to change fields to persue nursing. One was a little boy who seized every 7 second, for his 18 months of life. He tried to die numerous times despite the attempts by his parents to bag him at home and send him back to the PICU, they had the most optomistic outlook for him, and one of the sweetest families I ever had, and at the same time the one that frustrated you the most as well some days, but who were we to say what was right? I developed a great relationship with his primary nurse, who did everything to help them, she had palliative care on board and everything but the parents held on. He finally won his battle to die, I was honestly jealous of the nurse that was able to be there for the family when they needed her most, when mom finally gave in and said couldn't see him go through anymore, I was told her went peacefully in her arms. After that I decided, in the future I needed to be there for my families as well.... I will graduate in May and I'm waiting for my offer from the PICU hopefully next week, the interview went great... but I sometimes wonder what I'm getting myself into, I guess if I wasn't as afraid as I am excited something would be wrong, right?

Pediatric Critical Care Columnist · Mar 10, 2008

Yes, if you weren't at least as afraid as you are excited, there'd be something wrong. For me, the rewards of working with critically ill children and their families far outweigh the negatives. Some kids die, but so many more get better, go home, grow up and live great lives. To know that I've contributed in whatever small way is what gets me out of bed in the morning. For you, I think you have the self-knowledge and the understanding of the job that you'll do well, even if some days bring tears.

gal220RN, BSN, RN · Apr 18, 2008

I am comforted to know so many of my fellow PICU endure the same tragic, gut wrenching experiences all over the world, every single day. After 14 years of pediatric nursing, 7 in peds critical care, I have had to learn to deal with my own demons of sadness, self-deprecation and uncertainty. No one understands the emotional toll this job takes unless they are there. Not your family. Not your friends. Not your priest. Only your fellow nurses can comprehend the stresses we endure. I have found that the nurses that have longevity in the PICU have a couple of consistent characteristics: they talk- a lot- about the past. They remember patients long passed out of this world and recount the experiences surrounding them, as if it were yesterday. I think this is a healthy way of processing grief. The other common characteristic is laughter. It seems simple, but it is true. They find humor in the worst of situations, not out of disrespect, but out of self-preservation.

We are desperately needed to do the work that 95% of the human population are not capable of doing. We are the elite individuals who have the brains and the hearts to care for the littlest, most vulnerable members of our society. Unless we can care for ourselves and talk about our pain, we certainly will not be available to care for anyone else.

Godspeed, dear friends.

Heelgal

:saint:

Okiecruffler · Apr 18, 2008

I love that this thread keeps coming back to life. It shows me that I was not alone in how I felt. It is true that most of your pts live and get better and go about their little lives. But those are harder to remember. It's much easier to remember that BT shunt that threw a stitch and bled out before you could call for help. I remember each and every one of those who didn't make it. I carry a part of each of them with me. Each of them taught me something and I owe them for that. On a board in my shop I have pictures of some of them, obits, a hospital wrist band. I think of them as MY children, and in a way they are. Now I work with CP kids, I'm barely a nurse. It's a different kind of pain, and they teach me as well. Nothing but love for you....John

vamedic4, EMT-P · Apr 19, 2008

My coworkers and I were talking on Sunday about how much we missed our "old timers", our children who've been taken from us in the last year or so. Three of our four oldest cardiac patients have passed on in the last year...three we cared so much about. How can you not get attached when they're hospitalized for 3 months, 8 months at a time?

I, too, keep pictures and obituaries. Funerals are hard for me to go to, but I try. One of the patient's mom's sent me an email the other day thanking me for what I did for her son while he was here. She told me that he enjoyed when I came to take care of him because I always had a way of making him laugh. She told me her other children were still trying to imitate the sounds that I make ( a gap between your teeth does wonderful things for young ones.)

And though I do miss them, I'm glad they're no longer suffering. That they don't have to be here 24/7. That their parents can now move on and focus on the rest of their family.

And John, as long as you've got a caring bone in your body you're never "barely" a nurse. It doesn't matter if you care for one patient for 20 days or 20 patients in one day, you make a difference while they're in your care.

vamedic4