How do you cope with depressing patient situations?

[Codeblue1982]

I was wondering how everyone deals with those patients that hit you on an emotional level. I had a patient recently who received an unexpected cancer dx over a months time he ping ponged back and forth between the floor and the icu. I cared for this patient near the beginning of his admission he started to stabilize and went to the floor. We now have him back in our unit knocking on deaths door.... This is a younger person who 6 weeks ago was living life. Now he is bleeding into a chest tube on maximum oxygen support and hardly any family support. Hearing this patient tell me he is scared and that he needs someone to stay with him breaks my heart. I have called the little family he has nobody would come in, pastoral services comes to see him but that visit is short and I do what I can but have another busy patient to attend to which makes me feel terrible. Seeing somebody hurting on so many levels like this breaks my heart and follows me home at night which makes me not a fun person for my family. Some advice on dealing with these situations would be great.

[DalekRN]

It's okay to cry/show emotions, and I think it actually can comfort people. When I was caring for a dying baby on comfort care, I really cried when I was talking with her trying to arrange organ donation. We are all human first and foremost. Don't try to hold it in or be fake, I mean don't necessarily bawl in front of them or anything (ok to do that before seeing the pt) but genuine shows of emotion can create a supportive bond.

[roser13, ASN, RN]

Is there a Hospice program in your facility? Perhaps a hospice volunteer could sit with the patient at times? Is social services involved?

[nurseprnRN, BSN, RN]

One of the Fat Man's Laws: The patient is the one with the disease.

This is a reminder that we have to maintain some modicum of emotional distance to prevent our decompensating and being of no use to anyone. It is not heartless. It is not an indication of being an uncaring person with no passion for helping people. It is a recognition that we are not here to be family members. We are here to be caregivers. We can empathize, we can tear up, we can hug. But we can't forget we are not family.

For your immediate situation, see if you can get the physician to prescribe a sitter. Tell the chaplain that the patient needs longer visits.

There are people who touch our hearts and never leave it after forty or more years. However, if you find yourself with intrusive thoughts, feeling as if you only had done X things would be better, thinking about how you could have or will interact with them outside the hospital ... this way lies madness. Do not find yourself now, or two days after he is dead, paralyzed, unable to go to work, unable to look into the room, numb, not able to explain yourself to your own loved one(s), with no appetite, too much appetite for self-medicating with alcohol or other substances ...The hospice people can help you with these feelings even if the patient is not on service; your chaplain/other spiritual advisor/therapist is also a good idea.

This won't be your first lonely and tragic death. This is the first time you learn to live after it.