A nurse looks at what nursing means. Some of the things we see are heartbreaking, and some is beautiful. Much of it affects us, and some of it we carry forever. I've carried a lot with me over thirteen years of nursing. Here's a glimpse...
Every so often, a thread pops up around here: "What's in your pockets?" In other words, what do you carry that you know you'll need before your shift is up? Most of us carry alcohol swabs (never enough of those), penlights, probably a syringe or two, some 2x2s, tape, and it's a running joke on my unit that real nurses carry hemostats.
And heaven help the soul who arrives at the end of shift and can't find her brain sheet. That's painful in a way only a nurse can understand.
Not too long ago I stopped to help at the scene of a vehicular accident as I was driving into work. Looking at the single car involved, it was a miracle anyone survived, much less had a patent airway. One of the other first responders had gloves for us but PPE can be a bit limited when you're standing in the middle of a highway. Back to the point, I got back in my car and got to work a little late; as I was driving in, I noticed a smear of blood up my arm that wasn't mine. Not ideal, but it happens.
I got to work, gave everything a good scrub, and got thinking.
All these things I've mentioned are visible things we nurses carry with us, sometimes permanently and others not. But we carry so much with us that no one will ever see or know about. It's usually a mix of (to quote a classic movie) the good, the bad, and the ugly.
What do I carry?
I carry with me the tears of a father that he cried over his baby who never had a chance to take his first breath. The baby they'd tried for four years to have.
I carry with me the woman who had lived with domestic violence for over two decades, her arms covered in scars from shielding herself as he attempted to stab her to death. "No matter where I go, he will find me and kill me," she said.
I carry the gratitude of a twenty-something man who had what was then called 'full-blown AIDS' and still being written off by too many as a 'gay plague' and other nonsense. He was dying and he knew it, suffering from horrible neuropathy and on amounts of morphine that would knock everyone I know into the next world. It barely touched his pain. No one ever came to see him. I'm not sure which hurt him worse. We bonded over the course of several days and he mentioned in passing that he was really craving a Butterfinger. Hospital policy dictated that we weren't supposed to bring food to patients, but I pretended not to know that when I got a couple of Butterfingers from the gift shop (yes, he was still on a regular diet). The look on his face when I snuck them into him.....I can still see it. He died a couple of weeks later.
There are the twin daughters of a patient who was with us for months before she died. I remember their names and faces. They were never anything but kind and grateful for the care their mother received, even when they had their grief over her impending death to smack them in the face every day.
I carry the exhilaration and happy tears shed when men and women become fathers and mothers. The delight that overtakes a new mom when her baby looks at her like he's known her forever, or a daddy when a contented baby falls asleep on his chest, is something that can't be bought.
I take with me the fact that my very first code was my mother, even though they (there were multiple times over three months) were successful, I always wondered if we should have let her go. Even though she survived 13 years after a heart transplant, she was never the same.
I take with me walking in to view mother's body for the first time at the funeral home, there was a strange woman in mother's clothes and in mother's casket.
I take with me holding my dad in my arms, begging him to stay with me while we waited on the ambulance to get to the funeral home. And I take with me that I held my dad in my arms as he died.
I take with me the numerous patients that called me their "angel". And the lengths I went to in order to see that they were kept comfortable.
I take with me the patients that I sat at bedside and held their hands as they left this world when their families couldn't take the final moments.
Most of all, I take with me my memories of nursing over the years, the good, the bad and the ugly. For everyone of my patients, they all taught me and helped form me into the nurse I am today
I had been lent to a cancer ward for a few months while they got a few much-needed trainees oriented in (I came from a surgical floor). I got to know this one man, a patient named "Charlie," quite well over the course of about a week, talking and laughing, and connecting in a way that I connect with very few people even outside of the hospital. He mentioned that his feet, swollen with tons of excess fluid, were very sore.
On my regular floor, we give foot massages to patients that ask. Charlie was in with pneumonia secondary to his cancer. But I didn't think about that, didn't consider where the excess fluid I rubbed out of his sore and swollen feet would have to go. I just had a man with sore feet, and I had the time to maybe help fix that.
Later on that shift, or possibly the next day, I don't remember exactly, Charlie's breathing began to get worse, shorter, more labored, more oxygen needs. I called for the rapid response team to come and assess him, and he was taken up to the ICU immediately. I fully expected him to recover and come back down in a day or two -- that was my experience with the ICU up to that point, working as I did on a post op floor for patients who volunteered for the surgery...healthy people, in other words.
Charlie wasn't healthy.
I rode up in the elevator with his wife, taking their things along, just in case it stretched out. I tried to reassure her, while in the pit of my stomach was the gnawing certainty that I'd screwed up big time with that foot massage. She looked in my eyes and thanked me for helping her husband, for getting him up to the ICU so fast.
I left at the end of my shift, praying for Charlie.
My prayer was about half an hour too late. He died just before my shift ended, still struggling to breathe.
I went home the night I found out and sobbed.
Fast forward to exactly a week later. It was a quiet shift (no one said it, everyone was thinking it, and no one bothered to knock on wood...) when I hear a soft voice calling, "Can I get some help in here?" Six of us respond, with me in the lead. The patient, "Don," was seizing, and his wife was panicking. I had the CNA help me turn him to his side in case of vomiting until the stiffness started to abate, when his wife suddenly said, "Is he breathing? Last time he stopped breathing." We turned him over fast, to find his lips blue and the rest of his face turning cyanotic. I felt for a pulse while the CNA was getting the backboard. No pulse, started CPR, started yelling for an ambu bag (I have no idea if I actually called for a code. People disappeared after the start of the seizure and the code team showed up, so I must have, but honestly, I don't remember...) I was reluctant to perform mouth-to-mouth on a patient, so compressions continued until a bag arrived, at the same time as the AED... All I can remember from the CPR was thinking, damn, this is easier than the stupid manikins! I hope I'm not going too deep. How fast am I supposed to go? (For the record, I'm pretty sure I was a bit faster than the recommended rate. This was "Stayin' Alive" played on fast forward!) We got him two breaths, let the machine analyze him, and were about to restart CPR when the code team arrived and asked, "Does he have a pulse?" I tried to check, but my fingers were bouncing with their own beat, thanks to the adrenaline coursing through my veins. I ceded the arm to the professionals, and they determined that he was alive. By the time he was taken upstairs to the ICU, he was awake. He caught my eye as he was wheeled past, and he smiled.
I was sobbing that night again, but for a different reason. I had lost one. I had saved one. I had to pull off the side of the road so I didn't wreck one. That was when I decided that I was a damn good nurse, and I could damn well be a better one. I lost Charlie because I didn't know enough. I didn't lose Don because I did.
Charlie and Don ride with me. One is a ghost, the other is a memory. Each man reminds me to think. Each man reminds me to prepare. Both of them together tell me that I'm worth more than I ever gave myself credit for, and isn't it about damn time?
I've heard of people talking about the ghosts they carry, and how it is a burden. But my ghosts help me become better, determined to fulfill my purpose in my profession. I will not lay these two men down, who have helped me so profoundly. But Charlie's wife... She rides along too. She thanked me for helping, even as I was trying to figure out if there was a way I could have killed her husband.... she rode along even as I came to the conclusion that I certainly had a hand in his death.... and she thanks me anyway, reminding me that while we are not the supermen we nurses wish we were, we do what we can, the best that we know. We owe our best, and when our best fails to measure up, we give what's left over, and it is enough. I carry my helpers along with me, my lessons and experiences and memories. It is to Charlie and Don and Charlies' wife that I bring my failures, and I learn from them, so that they may be learned from and not repeated, or else repeated more spectacularly, when it might help. I rather like my own personal judge and jury: They're merciful, when I would have excoriated myself, and they deal with me harshly when I wish they would let me skate by on a technicality.
These are the people I carry: The one I lost. The one I saved. And the woman who saw me doing my best to fix it.
Well said! The way you handle each of these moments, whether joyous or painful, is what truly defines you as a nurse. Here's to all those incredible nurses out there!
My first patient dx with terminal cancer...he refused all pain meds and worked thru the pain on his own because through his faith, he knew he was already healed.....oh to have faith like that.
The anger of my first of what will be many pain med seekers...and the anger she felt not having what she needs.
The patient who begged me to help him die...I told him I couldn't do that but I could help him to feel better...so I cleaned up his room, brushed his hair, wiped his face and then held his hand, smiled and asked him how he felt...he said 'bless you'...
Seeing a patient, a friend of mine, deteriorate because that is what happens when you are older and you are stuck in the hospital for 4 weeks, unable to communicate well because you are hard of hearing and because he is so confused that he cannot remember what happened 5 minutes ago....and to work with his for weeks and have his wife so angry that she blames 'the hospital' for everything...we worked so hard with him.
The patient that walked out AMA and I couldn't reason with him...
Then I remember the patients who have told me I'm the best nurse they have ever had, the hope of the patient when I gave her the ice she asked for (ng tube on suction and all), the child that I 'taught' why I give meds the way I do (my thinking is that maybe if he ever has to be in a hospital that he won't be scared), the patient that I talked to while she was having a procedure done and how she thanked me for keeping her mind off of it...
and so much more...and I just got my license and first job this year
Specializes in Nephrology, Dialysis, Plasmapheresis.
I carry the memory of one of my favorite chronic dialysis patients. She used to come in on a stretcher, no legs, one eye, and missing fingers. She waved to everyone, as pleasant and cheerful as ever, with her big hollywood sunglasses on. She passed out Christmas cards to all the staff and patients, and brought them in halloween candy. The doctors told her she wouldn't live much more then a year. 5 years later she made me promise to come to her funeral, which she knew would be soon. She died 2 weeks later and I met her mom, who knew who I was, although I'd never met her. I tear up just thinking about her.
I carry the 21 year old boy, with Good Pasture's Syndrome, who woke up one day, not feeling good. He called off work and told his parents. They later found him unable to stand up at his home. He was brought to the ER, joking around. 8 hours later, he was on the vent with ARDS and renal failure. After weeks of agonizing dialysis treatment, apheresis, ventilated, and on the roto bed with many drips, he coded and died, right before my eyes. I stood in the corner of the room, writing things down as they happened. But the screams I heard from the sister and parents running down the ICU hallways is something I will never forget.
I carry the many memories, of holding someone's wife's hands, as she comes to the realization that this may be it. Although her husband is 84 years old, his CHF, ESRD, CAD, and vascular disease is so bad, we can barely keep his BP above 75/40. The only options are quadruple bypass or letting things go naturally. The patient is still reading Newsweek, playing on his Ipad, and telling very interesting stories. His body is gone, but mind is sharp as ever.
On the alternative, I see patients who are 80 years old, with advanced dementia, who have hardly any medical history other then GERD and HTN.
Health is here today, gone tomorrow. I hurt for my patients, and their families. I hurt everyday, but must keep on living without a permanent fear. I fear that what I see, will happen to MY loved ones. I keep on truckin' and knowing that fear does no one any good, as my patients have very clearly showed me. They have given me strength, when I didn't know where else to find it. My patients help me grow and learn, they inspire me. I have asked several that I knew well, "how do you do it?", and their answer is always the same, "because I have no choice and being miserable does no one any good". They are my inspiration. Some days, I cannot take the sadness, but most days, they give me every reason to keep on living and hug the ones I love. They have changed my life.
I've only had a short career so far, but I know I will always carry the first young man who I had to tell had tested positive for HIV. I'll carry his denial and bargaining - "I had a negative test 6 months ago, I've only been with my boyfriend since then, how could this happen?" and his realization that he'd have to tell his partner to get tested as well.
I carry the dementia patient who had extensive family but never any visitors. She would care for her "baby" (a doll) and get frustrated with being unable to communicate - but I carry her delighted laughter when a fellow student nurse had the babydoll start doing the Dougie.
I carry my grandfather, who was unable to leave the casket of my grandmother for her entire wake, just weeping and asking for her to open her eyes. I carry my own regret, when a few years later I waited too long to go visit him in the hospital.
I carry with me the big brown eyes of a hospice patient white knuckles gripped to the edge of the bed, tears streaming down her face who had originally asked the hospice team for no pain medication because of her religion. I asked her if she changed her mind and could I bring her something for pain. She could barely nod "yes" but the look in her eyes made me know that is what she needed. I called the hospice to ask for pain meds and they refused based on her earlier decision. It took me hours to convince them she had changed her mind. We tried everything else. She finally got some pain meds and was peaceful for 45 minutes before she passed away.
I carry the the thanks from her family to finally see her peaceful and I carry my guilt for not being able to help her sooner.
I carry her memory with me when I am advocating for my patients as I decided that day I would never allow another patient to suffer that much, no matter how much I have to do, I will keep trying. She taught me a lot about nursing and I thank her for that.
Specializes in Emergency/Trauma/Critical Care Nursing.
I carry with me the big brown eyes of a hospice patient white knuckles gripped to the edge of the bed, tears streaming down her face who had originally asked the hospice team for no pain medication because of her religion. I asked her if she changed her mind and could I bring her something for pain. She could barely nod "yes" but the look in her eyes made me know that is what she needed. I called the hospice to ask for pain meds and they refused based on her earlier decision. It took me hours to convince them she had changed her mind. We tried everything else. She finally got some pain meds and was peaceful for 45 minutes before she passed away.
I carry the the thanks from her family to finally see her peaceful and I carry my guilt for not being able to help her sooner.
I carry her memory with me when I am advocating for my patients as I decided that day I would never allow another patient to suffer that much, no matter how much I have to do, I will keep trying. She taught me a lot about nursing and I thank her for that.
Not to hijack the thread, but out of curiosity, which religion says no pain meds? Just so I can be aware for any future situations.
LVN_it1995, BSN, RN
27 Posts
I carry the cry of a woman patient calling for Jesus to take her now as I walk into her room to give her medications and check on her.
"Take me now LORD! Take me Jesus! Oh LORD, OH LORD!"