Grief and family members: Didn't know what to do!!

[Roy Fokker, BSN, RN]

I felt like a fish outta water last night.

Without getting into too much detail, I had a patient arrive by EMS last night. Very SoB, working hard to breathe, "one word dyspnea" (i.e. "I... can't...breathe... help... me" etc.) No other complaints. Was just recently discharged from the hospital (post DVT). Lungs sounded like the proverbial washing machine. Couldn't literally see the lungs on the CXR - so massive was the cancer mets. I mean, cancer everywhere....

Couldn't get access other than an itty bitty 22g.

Something about the patient strikes me as vaguely familiar and family updates me - pt. was in the ED not too long ago and I had taken care of the pt. That's when the whole story hit me like a slap in the face. I had this pt. barely 3 weeks ago and pt. was in MUCH better condition than pt. presents now. I mean, pt. was talking and cracking jokes and moving around ....

ED doc is consulted. Doc, ED nurse (myself), patient and family collectively decide to not pursue aggressive treatment - no more IVs, no more lab draws. Comfort care. Make pt. as comfortable as possible. Await primary MD assessment/consult for in-patient hospice and eventual home hospice per family request.

That's kinda when it started.

Some of the family members are having trouble 'coping' with the change in status.

Which is understandable - according to family, pt. was dancing at grandson's wedding barely 2 months ago... and now pt. is barely able to move limbs or speak. Apparently pt. has deteriorated.... FAST ... and family is having a hard time coping with it.

Now normally, I'm pretty good at this. This isn't my first dead/dying patient and associated family. Helping others to cope is one of my strong suits.... always has been (even before I became a nurse).

But for some reason last night, I just couldn't "do it." The human in me wanted to reach out to the family through the nurse in me... but for some blessed reason, it just didn't happen last night. There was no "connection" - it felt like I was just 'going through the motions'.

I feel like a rotten nurse. I feel like I let the family down.

None of them complained ... on the contrary, both patient and family were very appreciative of my efforts - but that just made things worse. Made me feel that much more guilty and ashamed. Like I cheated them out of something...

*sigh* I suppose this is a 'confessional' of sorts.

Have y'all experienced what I'm talking about? If you have, any suggestions/pointers? I mean, how do you deal with it?

- Roy

[nrsang97, BSN, RN]

Roy,

That pt family will remember you as a kind compassionate nurse. Yes, I think we have all been there at one point.

[morte, LPN, LVN]

on any given day, at any given time........it just wasnt "in you" last noc.....let it go.........take care of yourself!1

[Aneroo, LPN]

What do you think you could have done differently? What was missing that is making you feel like you didn't do a good job?

[queenjean]

Autopilot is a b**ch, isn't it?

I've been in my "nurse" mode, totally on autopilot, during similar situations. It makes me sick to think about in retrospect. Yet, family apparently didn't know the difference. Fact is, you do it long enough, instinct kicks in, and it doesn't matter whether you "feel" it or not, you still do and say the right things. Enough, anyway, for the family and pt to feel well cared for and supported. It may not have been your best moment, but you aren't at your best 100% of the time. With time and experience, even your lesser moments are more than adequate, and you still provide everything the family needs.

I don't know what to tell you; sometimes you're hot, sometimes you're not. If you find a way to always be *that awesome nurse*, you let me know. I'm still trying to figure that one out.

J

[Michifura]

Sounds like you did a great job! You were there for the family providing support while they were going through a hard time, pulling together the appropriate staff and resources, and you were there caring for the patient and making him comfortable....these are huge!!

[leslie :-D]

Autopilot is a b**ch, isn't it? J

there ya go, queen.

and that is exactly what happened, roy.

that intangible 'something' takes over which enables us to operate in crisis mode.

call it a coping or defense mechanism, but if we allowed our hearts to guide us in these types of situations, we would end up giving subpar performance.

we would burn out very early in our careers.

now, your next thread will be:

"what is wrong with me?

i was having an easy noc, no trauma or chaos, and a pt's 4 yo kid gave me a card:

and i bawled like a baby."

yep, it happens when we least expect it.

welcome to nsg.

and you are absolutely fine.

now, if this numbness started interfering w/sleeping, eating, ms, etc., then you may want to consider burn out.

but as for this event last noc, you are responding as expected.

it's all good.

leslie

[ShelleyERgirl, LPN]

Give yourself a break Roy. You did what you had to do for yourself, your patient, and the family. You can't ask for anymore than that. You sound like an excellent nurse so please don't do this to yourself, so you had an off night, it happens. I know exactly how you feel that is why I had to get out of Oncology. It got too hard and I wasn't even a nurse. :icon_hug:

[nghtfltguy, BSN, RN]

you probably did just fine roy...

from what it sounds like.. you helped the family as best you could...

i know what you mean though about that auto-pilot thing...

im an ED nurse as well.. used to work flight.. i have been in that situation many... many times and have felt exactly the same way....

its normal.....

for after all.... even ER nurses are humans as well...

*even though some ppl that come through triage think we are gods or doctors that should fix them right then!!!*

your fine... i don't know how long you have been an ER nurse... but i gurantee... that same thing will happen many more times...

it does suck.... but it is part of the job...

wish you the best....

happy holidays~

[Virgo_RN, BSN, RN]

You can't fix the situation. You can't take away their agony, and you certainly can't make an entire family suddenly able to cope. You did what you could, providing good, compassionate care to the patient. That is all anyone should expect of you.

[pagandeva2000, LPN]

It has happened to me a few times. I think it is a protective mechanism to function. I have often wondered what sort of person I have become since obtaining my license, but when I did some deep thinking, I discovered that at times, I am better at my job when I fall into automatic pilot, because this way, I can prioritize, think clearer than when my emotions get in the way. I make less mistakes and make better decisions. I believe that the really horrible person would do neither, and there is nothing in any of the posts I have seen from you since being a member indicated that to me.

[nerdtonurse?, BSN, RN]

You know, we're taught as nurses that we should be compassionate, meet the pt/family where they are, as they are, not judge, not condemn. Unfortunately, the one person that's the hardest to treat that way is....

us.

The first time I had that "I don't connect" feeling, I thought I was turning into a monster or something. We lost 4 people in one shift -- two on the floor (1 DNR, one Code), one that went to ICU and coded as we were moving them to the ICU bed off ours, one that was in the process of being transferred out(coded until pronounced). I mean, 4 sets of upset families, feeling physically worn out from 3 codes that happened within a space of 5, and when the last person coded, all I could think of is, "why couldn't you wait until next shift?!" Then I felt terrible, and went into a complete funk. All I could think of is, "I'm going to turn into one of those cold, heartless B****s that doesn't need to be a nurse."

The simple truth was, we all have our sorrow limit. We can only experience so much, before the mind says, "okay, you're done, we're taking a break." No different than running until you have to stop running and walk until you get your breath back.

No different. Not good, not evil, just what we do to survive seeing what we see.