What happens after spending a decade of caring for critically ill patients and suffering their losses? Does a nurse remain optimistic or angry at what has been endured? And what happens if a nurse decides to take this sweet pain and try to help other nurses be better care givers?It was such a cold day in December and I could not find the church, the biggest Catholic Church in the downtown area I'd lived in for the last fifteen years. What was I doing? Already had to beg my supervisor in the Medicine ICU for the morning off to pay my respects to a former patient and I couldn't even figure out where to go. After passing several smaller churches, I finally found one promising yet intimidating church on Short St. I pulled into a parking spot and hiked through the falling snow, trying to avoid the giant puddles from last night's torrential downpour. The cold water soaked through my shoes anyway. I discovered a side entrance and entered, making sure I didn't let the heavy wood door slam behind me.
There was a small entry way leading to the main sanctuary with a rack filled with dark coats and a bench. A clear glass door led to the inner Church but I couldn't bear to look or to even take off my jacket. Yet the name on the guest register told me I was in the right place. I was shaking with cold but also with such a powerful sense of guilt and loss that all I could do was to sit on a bench and listen to the organ play its sad song. Soon, another late visitor entered the hall and proceeded through the glass doors after briefly glancing over at me huddled in the corner. I knew that I had to be back at work in a few hours and remembered a song we used to listen to all the time:
"A cool evening dance
Listening to the bluegrass band takes the chill
From the air till they play the last song
I'll do my time keeping you off my mind but there's moments
That I find, I'm not feeling so strong."
So finally, I approached the glass door, opened it and snuck into the last row, just in time to see his casket being surrounded with incense. I was too afraid to move up, closer to the others, so I sat still and just remembered him again. I remembered how skinny he was when I saw him at the funeral home the night before. Not the heavy man who was initially admitted after suffering a leg injury from falling at home. I thought of sitting on a stool in his room in my ICU while watching a football or basketball game with him so many months before. I took care of him every weekend and knew ahead of time what time his favorite team, the Wildcats, had games that were on TV so I could make sure he could watch. Most times, his Mom and brother and sister would visit, but often it was just the two of us. He couldn't talk or move, just mouth words which can be pretty frustrating for all involved in the communication: a victim of quadriplegia and a permanent dependency on a ventilator to breathe weeks after his admission. His body didn't work but his mind sure did. It just seemed after a while that I knew what he wanted and needed and he was my patient. Mine. No one else wanted him so he was who I took care of each Saturday and Sunday.
Turns out besides our love of sports, he loved rock n' roll. I learned that he was a big fan of Bruce Hornsby. I loved Bruce too, so I began playing his favorite music on the bedside computer via Pandora in his room. The lyrics about a Bluegrass band made us both smile. I'd ask the next shift to play him music but usually it was silent when I came in the next morning. He'd always keep his eyes closed like he was sleeping but he really wasn't. He'd open them as soon as I walked in and said, "Hey, buddy". I would feel guilty about not being around during the week and wondered if anyone else really cared about him. He did not need a cat scan of his brain due to decreased level of consciousness: he needed someone to talk to him like he was a person and not pass his wonderful personality over because it was hard to understand what he was trying to say.
It was horrible to watch his body being carried down the stairs that cold December day to the waiting hearse just as silent as it was after I went in each evening to say good bye to him. I could only think of those big eyes closing when I left each night, the almost exact same eyes his mother stared at me with when she reached for me while following the coffin at the back of the church, those eyes full of loss, sadness, and such sweet pain. Those eyes had been watching me for a year and asking me, pleading me to help him, to give her son back to her. I could not. I did my best but it was beyond me and I had no one to blame. I closed my eyes when she finally reached me.
It was then that I decided to try to climb up to a better, happier place. Away from the death and dying who I was employed to transition from this world to the next. To somehow make those eyes, all those eyes, not be so hollow and haunting. Not climb into the dark hole which my mind really wanted to dive deep into and surrender myself forever more to. To avoid those eyes staring at me all the time. Am I going to live or am I going to die they always want to know. I chose to focus on helping my fellow nurses take a greater interest in their profession and how to stand up for not only their patients, but their own selves as well. I was instead caught up in a swift current that would lead to the peak of agony that I wish someone would have seen and helped me to fight against. I found out, too late, that standing up for the sick and their caregivers is not in the best interest of administration. Those raging icy waters of ravaging emotions flooded down that steep mountain of experience I had built up to my utter shock and despair.
What possesses someone to try to climb the world's tallest mountain? I became fascinated after reading a book about the tragic climb to Mt. Everest in 2006 which led to an incredible loss of many climbers and guides. What would drive someone to trudge steadily up towards a freezing cold, potentially deadly, peak? I guessed the challenge, the prestige, and the pure physical glory of accomplishing something that is so far beyond most anyone. Army Rangers in training spend three weeks with only one meal a day and two hours of sleep. Why do they do this? They want to be the best. And they are willing to put themselves through all sorts of physical and mental pressure to prove it. Why did soldiers drop out of perfectly good airplanes on D-day? Why did our soldiers land on remote beaches in the Pacific to fight? Because that was what they needed to do in order to keep their families safe at home. It was the right thing to do. I grew up with this doctrine, this hope, this belief. Do my best, always, and so I reached for the sky and that big mountain. I wanted to do the right thing for my patients and my co-workers. I wanted to be the best, smartest, and most compassionate nurse I could be. But I ended up losing myself on the way up.
Every nurse has a story or two to tell. Generally, these stories are not accepted during normal day activities with non-medical people but they are freely shared amongst health care workers to try to help cope with the utter physical destruction of the human body we see every day. Yet, we are expected to contain our emotions since it is just part of the job. Remember that patient whose stomach we couldn't decompress after a car accident since it was Thanksgiving and full of turkey? We had to open his belly and manually scoop corn and potatoes out of it. Remember that patient who was in a car accident that had a history of a heart valve replacement and almost bled to death even though we infused about 20 blood products in 12 hours? Yeah, a bit weird when his wife showed up finally a few days later asking why he wasn't dead the same time his Coumadin levels were 10 times the normal amount. How did he take that much Coumadin on his own? Most folks look at you like you are crazy when you end that story with a laugh and think it is funny.
But, to me the funny thing is when a US soldier dies, whether in action or fifty year after their service, we all stand at attention and remember their heroism. I can't talk about what I've seen or done as a nurse because it isn't professional, tolerated, could cause me to lose my job, and not even be considered for the next. I have been strongly discouraged to even express that a patient or incident may bother me on a personal level. There are no plans by my hospital to evaluate how I may be reacting to a tragic situation. In fact, many states actually ask on their registered nurse license application, if you have ever been treated for depression. Not a lot of people are going to want to admit that pumping on a 98 year old chest makes them feel sad when they know that death is inevitable and that this patient could have been surrounded by loved ones instead of a team of strangers. Why can't nurses stick together and create the same professional respect that our soldiers do, regardless of their nursing position, rank, or title? Didn't we all go to school to do the same thing?
Sitting in morning report in the Medicine ICU is a joy. Most nurses want to take care of the super sick patient with no family so they only have a one patient assignment instead of two. No one wants to care about the other patients in the unit. No one wants the quadriplegic patient or the pregnant comatose lady. No one wants to stick up for their patients and possibly upset a doctor, family member, or an administration that may not have a vested interest in the person, but in the enterprise that is a hospital instead. Everyone just wants an easy day with few orders and little interaction. But I always remembered that each patient is someone's son or daughter. Everyone is someone's baby. I did not care to take the scraps. I wanted to be extraordinary, one of those few people who find more glory in making a patient or a coworker's life better somehow, by helping them climb their own mountain.
When you are descending from a high mountain peak, it is breathless. You reached the top, the best and brightest nurse ever, but now you have to work your way back down. Why? Why not just stay at the top? Because sometimes it hurts so bad you can't breathe. The sweet pain and suffering reflected in the eyes of a patient, or a family member, are so very hard to ignore. Or there is not enough room at the top and you get basically kicked off the summit to make room for others who think they know what it is like to be a compassionate nurse. And maybe sometimes you are just kicked right off because someone higher up the lifeline worried about their own reputation. It doesn't matter. Not like you can stand up there all day anyway. So you get washed away in the cold rushing waters. Back to what? Nothing is ever going to be the same as you felt at the top. And those haunting eyes will still find you.
After ten years of critical care experience in surgical, trauma, and pulmonary units, I realized that the "high" from a patient who got better was overshadowed by the ghosts of all those who could not be saved. Those who probably shouldn't have been in an ICU in the first place due to their poor prognosis. Not my choice to make, but mine to deal with. So there I was, trying to cope with it and help both veteran and novice nurses handle the reality that is being an ICU nurse today and not succumb to the bitter pain that comes with this sweet job.
Joined: Nov '10; Posts: 5; Likes: 17Apr 7, '11Thank you for sharing and articulating such private and personal feelings. Some people could never put into words, with such caring and understanding, those feelings. If you are a good nurse and you have been doing the job long enough you have ghosts. Some make you smile and some make you shiver. We are very often in the unique position of making a huge difference for a patient. The pain comes when we can't. Please keep writing and sharing. We all need to be supportive of each other because frankly no one else "gets it".