Why I don't tell my family...

[umcRN]

Ugh! Sometimes it gets to me how wonderfully naive most people are to what goes on in the hospital. Thankfully, I suppose, my family is "medically naive". While my mother suffers from two chronic, progressively debilitating diseases, my family has otherwise no experience with the hospital, and especially ICU world. And while this is a good thing, they get upset when I don't feel like telling them everything that goes on at work, because there is no way they could ever GET it.

This conversation, for instance happened between my dad and I at dinner tonight (I recently transferred from being a NICU RN to a peds CICU rn):

Dad: so whats the biggest difference in taking care of a 6 year old vs a newborn?

Me: (thinking to myself...seriously?? there's A LOT) Well sedation is a bigger issue, they're a lot harder to keep in their beds

Dad: Well, don't they have an IV where you can just give them meds? I mean, you're not going at them with needles or anything, they should already have an IV right?

Me: Yes, they usually already have an IV...or 6, but it takes more people, I have the hold the kid down in the bed while two other nurses go to the pyxis to pull out the meds and draw them up for me

Dad: (very obviously trying to picture this situation) Well, why is the kid trying to get out of their bed...they already have the IV (he things the only reason kids would want out is if i'm trying to stick them)...and he can't be THAT strong (HA!)

Me: Well he's confused, scared, in pain, has more wires/tubes/drains you name it attached to his body, he's on a breathing machine and that's bugging the heck out of him and he's disoriented from the meds I gave him 10 minutes ago which obviously didn't hold

Dad: Well if he's so awake why don't you just let him wake up and take him off the breathing maching?

Me: You would think...

Dad: and why don't the meds sedate him enough? Can't you just keep giving more?

Me: Well, you know how drug addicts and alcoholics build up tolerance to whatever their addicted to?

Dad: Yes

Me: Well, while I just gave this 20kg 6 year old enough drugs to knock YOU out for a day or two, he has built up a tolerance to them and they are essentially having the same effect as a cheap OTC cold medicine.

Dad: Well, then let him wake up

We also managed to tip-toe around the whole overuse of blood products that happens in the hospital (aka pumping blood into a dead body), didn't get too into it because my dad is VERY religious (God will call all time of deaths) and he also mentioned something along the lines of "thats why they pay the docs the big bucks, not the nurses, to call it"

Ugh! I know it's silly to get annoyed over this stuff but sometimes I wish people could shadow me for a day and see what I REALLY do

[RN_PICU]

When I was in service, after a little while I realized how true the line is "you can't handle the truth!!" And that is the same approach I use when people ask me about the work on PICU floor. Give them what they want to hear and what will make them happy. Quick recovery story, happy parents that got their child back etc. No terminology, no brain tumors on 7yo, no suicide attempts by 13yo girls, no abuse and distraction of perfectly healthy kids who would never be able to see/walk/talk again, and certainly no dying babies... I have found that any of the above will make your friends feel very uncomfortable, and in the future they will avoid you all together.

[umcRN, BSN, RN]

Love all the responses, really helps when people know how you feel!

Ironic it is that I would write this post though as I am now facing my own upcoming surgery and ICU stay...those poor nurses (to have to deal with my dad), luckily visiting hours don't start until 12 in this hospital, I don't think you get 24/hr day visiting privileges when your 24 and that's quite all right by me!

[littlebittyPICUrn]

I'm new here, but I've been reading the threads for a long time. My husband doesn't understand, but at least he admits it. I must admit, when I feel like I need to "share", I read on here and I usually find a thread or two that I agree with!

[NewPICURN]

When I was in service, after a little while I realized how true the line is "you can't handle the truth!!" And that is the same approach I use when people ask me about the work on PICU floor. Give them what they want to hear and what will make them happy. Quick recovery story, happy parents that got their child back etc. No terminology, no brain tumors on 7yo, no suicide attempts by 13yo girls, no abuse and distraction of perfectly healthy kids who would never be able to see/walk/talk again, and certainly no dying babies... I have found that any of the above will make your friends feel very uncomfortable, and in the future they will avoid you all together.

As a new PICU RN (still in my sixth month), I have totally experienced this already. I started out feeling overwhelmed like everyone does and venting occasionally to friends and family, but they don't have any point of reference and anytime I mentioned anything sad, they were looking for the happy ending. ("but he got better right?") Like the poster said above, it quickly turned to awkward conversations and now when my friends and family ask me about work I don't tell them it was fine if it wasn't. I just tell them it was "long" or "difficult" and don't go into detail. It's good to hear that others experience the same thing.

[tangerinetea]

I see your perspective, but my family don't ask because it makes them TOO sad when I tell them about a child, even one that is going to be just fine. People will NEVER understand what we do, how we have to think about every little detail and the repercussions that occur if we miss something. They don't understand the emotional attachments we make, and how we have to put them aside to do our job properly - none of it! And you know, they aren't expected to. I can totally understand your frustration, but I think it's also really nice that your dad shows an interest in what you do rather than being afraid of the sad, scary stories that happen at our workplace. Try to see it like that, or be diplomatic in your answers and try to round up the conversation rather than egging it on.

One question, what do you mean by pumping blood into a dead body? We would never do that....

[umcRN, BSN, RN]

One question, what do you mean by pumping blood into a dead body? We would never do that....

Surgery on a child with a disorder that is incompatible with life (anencephaly), "fixing" the heart of an infant who has no kidneys...therefore little lung tissue, putting a child on ECMO who does not even meet criteria and spends days on ECMO and every life sustaining drug available until they pass anyways (pumping blood into a dead body if you ask me). Situations like that where every resource is used in a situation that we know for a fact will not have a good outcome. Drives me crazy.

[NotReady4PrimeTime, RN]

Surgery on a child with a disorder that is incompatible with life (anencephaly), "fixing" the heart of an infant who has no kidneys...therefore little lung tissue, putting a child on ECMO who does not even meet criteria and spends days on ECMO and every life sustaining drug available until they pass anyways (pumping blood into a dead body if you ask me). Situations like that where every resource is used in a situation that we know for a fact will not have a good outcome. Drives me crazy.

Therein lie the seeds of moral distress for many PICU nurses. I could add transplanting an organ for the third or fourth time in a child whose list of comorbidities grow with each admission (admissions that grow longer and more complex) until they're beyond saving. I could also add almost monthly air ambulance flights for children from outside the region whose complexity of care necessitates admission to our PICU, who with each admission comes closer and closer to the point where no one will be able to do anything for the child. The routine of admit, resuscitate, operate, stabilize, repatriate, readmit is expensive and almost guaranteed to fail. But it will continue until someone with the authority of last word will say, "We're done. We aren't going to be able to do anything next time, so let's not HAVE a next time."

[tangerinetea]

I understand where you come from and can totally relate. Where I work it is usually in the case of our long-term patients where we do everything and anything in a sort of Concorde fallacy way because we're all so attached and have done this much, so why not a little more....

However, I was caught out the other day and it gave me a little boost of positivity that sometimes things don't work out the way we thought they would. A small patient who aspirated a toxic fluid, MASSIVE shock, worst CXR I have EVER seen, couldn't be oscillated (SO2 ~25ish on HFOV), major DIC... they did ECMO about 2 hours post admission (we were all wondering why bother) a few weeks later = neurologically appropriate child requiring no O2.. amazing, wish they all turned out that great!

[NotReady4PrimeTime, RN]

but that's the thing about ecmo. it is supposed to be used for reversible conditions. things like ards from influenza or severe asthma exacerbation, toxic aspirations, cardiac stun, bridge to transplant... those are all reversible processes. but when you put someone small on ecmo as a bridge to transplant who has already failed vad treatment and has had more than one previous transplant already, with severely damaged kidneys and lungs and a panel-reactive antibody count of 35%, you're doing it knowing that the odds of finding a suitable organ are - well, extremely poor. once you've started, when do you stop? how do you stop?

[tangerinetea]

We were more worried about the neurological outcome in this case after a 15 minute down time of CPR during transportation to our hospital, the awful DIC, the terribly low sats for 3 hours, they had given her 10% chance of survival..... However, we were totally wrong as she was a toughie :) But yes I can see how those are all very difficult situations - I honestly haven't witnessed much of that where I work thankfully, for example, the last child I looked after that went into rejection became immediately not for re-transplantation, or dialysis for increasing renal failure from useless heart & sky-high tac levels, based on the odds that a new heart would fail too (due to age/sex/previously early rejection) and it wasn't in the best interest of the child..... and it really wasn't. I like to think we do all and not excess beyond good reason, but it doesn't always work like that...

[breaktime]

I agree with all of you, family members, friends, and whoever else we talk to who doesn't work in a similar field just don't get it. Luckily for me my family doesn't ask too many questions, and can handle a short, unspecific description of a bad day. However the above mentioned scenarios, those are the ones I don't mention. The patient we "saved" that we all know/wish we wouldn't have, but unfortunately had no choice. I was asked recently by a student how I dealt with losing patients. My response was: it is not the dying patients that I struggle with, it is the patients we save but shouldn't because we did things to them instead of for them. I don't think there is any way to effectively explain the emotional anguish those types of situations cause, to someone who hasn't experienced it first hand. If there is a way, I certainly haven't figured it out, and don't really plan on trying. For my family's sake, I think some thing are better left unsaid.