How many times can your heart break in one week? (sorry, very long!)

[cherrybreeze, ADN, RN]

Let me start off by saying, I care for the patients under my watch, but over the years I've learned to manage my emotions pretty well (as we all know, if you let things get to you, you're gonna burn out fast). This week has just been more emotionally intense than normal, so I need to vent a little; maybe that will help me process it all!

On a (mostly) non-work related issue, my mom had surgery last weekend. She's been having abdominal pain and symptoms since October, which have gotten much worse in the last month or so. I worked last Saturday, but was off Sunday (someone had needed a trade). I was supposed to work later than normal, til 330am, but then didn't need to, but I was still up and awake til 430 or so since I had napped before my shift. Went to bed without a phone in sight (which I don't usually do, but thought to myself that no one would be calling me on Sunday morning, so why not sleep in?). Missed a call at 530am from my mom, calling to say she was on my floor, awaiting surgery for gallstones! She had gone to the ER at 2am or so (wish she had called me then, I was still awake!) because she had another bad attack and they finally did an U/S (they had been treating her for GERD until that point, and I had my suspicions that it was her gallbladder, but can't make the doc do anything he doesn't want to!). All I know is, she must have been in really severe pain to go to the ER, she NEVER does that, she rarely goes to the doctor unless it's something very bad and NEVER misses work, no matter what.

I didn't wake up until about 11am, which is rare for me, and went to find my cordless phone...I had missed about a dozen calls from my sis. When I got ahold of her, found out mom was literally waiting for surgery to call to take her. I was a wreck. I mean, I take care of lap chole patients ALL the time, we're a med/surg floor! but this was different...it's my mommy, right?? All I could do was tell her how sorry I was that I had missed all these calls, and threw on my nearest clothes to get there. I managed to meet her in the holding room, thank goodness, and was able to give her a hug before she went in. Surgery took 2 hours, and we (my sis and "stepdad") were all getting nervous (although this was a notoriously pokey surgeon). She stayed the night (he said she could go home or stay, her choice) because she'd had too many nights of pain, and was more comfortable there (and could then get Toradol through the night, which works very well for her). I stayed the night, knowing my floor was short-staffed and I could do anything for her except meds (of course). Took her for walks, helped her to the bathroom, wash up, etc. Was very glad to do it. My coworkers were WONDERFUL to her (and I've always said, I work on a great team, this proved it!) but not in the room too often (which MAY have been because I was there). Took her home Monday morning and got her settled. She's doing well. It was just a more-than-usual stressful way to start a week (and like I said, I know how common lap choles are, but it's just different when it's your loved one, and I was fearful they'd find more wrong when they went in...thank God they didn't!).

Thursday evening I floated to pediatrics, which was a first for me in almost nine years. I worked with another RN on a team (did the best I could, being so out of my element). Two of our patients were babies, one 11 months and the other 4 months, both of whose parents were NEVER there. I do not understand this! How can someone leave their child alone in the hospital?? I understand having other things (like other kids) that need your time, and it's not always possible to be there 24/7, but for the older one, a frequent flier, her parents literally drop her off when she has to be admitted and leave almost immediately. They do not come back until she's ready to go home. The younger one, the parents were there for less than an hour (and my coworker floated there Friday, and they weren't there all day). Seeing this little girl, there for RSV and IMCU status, lying alone in a big crib in a big room, crying, was SO hard. I was more than happy to feed her, change her, and rock her. I didn't want to leave her alone.

Got a post op patient yesterday that was supposed to have an esophagectomy, had finished chemo and rad for it a month or so before. Ended up being open and close, with biopsies, because they found liver mets. He's not that old, either. Wife and daughter were having an (understandably) very hard time coping, and the patient was angry (very obvious stage of grief he was going through!). I spent as much time as I could being an ear for him, and talking him through some of it. The doc thankfully came back later that evening to talk to him (he had been too sleepy right post-op to have had the conversation). Pt was angry at himself for expecting that they were going to remove the tumor (I explained that he couldn't be mad at HIMSELF for that, but that it was ok to be angry in general, and OK to feel however it was that he felt). He was angry at God for putting him through it. I offered all the support that I could. Wife wanted to stay the night, but she was a crying wreck, and he insisted she go home (I think he needed time alone to process it himself). I had pastoral care come see them before they left, and I hope it helped.

Lastly, we have a gentleman on hospice that was admitted a few weeks ago with a sacral ulcer. He hasn't been eating for months, and was also dx'd with failure to thrive (he is in his 90's). Was transferred to hospice several days ago, since he has been declining. I have taken care of hospice/comfort measure patients before, both as a CNA in the nursing home, and we get them on the floor occasionally (pretty rare, though). He was calling out, so I went to check on him (he wasn't assigned to me last night). He said he could smell something burning, wanted his blankets off. I reassured him everything was ok, got him something to drink (he asked for something). He was calling out a little later so I went back in, and he was complaining about his breathing, said he felt like he was suffocating (his lungs are full, and he's big-time third spacing). I checked with his nurse, and got him some morphine and robinul. I told him to hang in there after I finished pushing them, that they'd start working soon and it would help. He looked at me, wide-eyed, and said...."will you stay?" OMG. Of course I'd stay! I sat and talked to him and held his hand until things started to settle down. He still was in some distress, so after checking with RN again, I gave some Ativan. I told him I'd be leaving the room just for as long as it took to go get it, and I'd be right back, if that was ok. He said it was. By the time everything started working, he wasn't responding, it did a good job of sedating him (he was breathing much more easily, and I couldn't hear the fluid like I had prior to). I was glad to have the time to help, but that look and question just did me in. I hope his meds are enough to keep him comfortable, and that things are peaceful...I can't imagine how it feels to drown in your own fluid. I am off til Monday, and I am pretty sure he won't be there anymore.

Well, if anyone I work with is on the board, they'll know who I am by reading this!

Sorry this was so long, the combo of all these things left me emotionally drained, and it feels good just to type it out (even if it's too long for anyone to handle reading!).

[realnursealso/LPN, LPN]

Hugs to you. What a rough week you've had. Hope your mom is feeling alot better. The kindness you showed to the elderly man was wonderful. I hope next week is better for you.:hug:

[Nurse SMS, MSN, RN]

That's some beautiful patient care you provided this week. I am sure it took an emotional toll, but you did a wonderful job and I am so glad there are nurses out there like you. Big big hugs to you. I hope your Mom continues to improve and that this week is a little easier on you.

[guiltysins]

The one about the two kids in peds made me angry. Even if both of them couldn't stay, at least one of them I think would have been able to stay, even if it were just for the day or just for the night, something! I couldn't imagine having a baby in the hospital and just going back home and back to my normal routine.

[cherrybreeze, ADN, RN]

Thank you for your support, guys. It really does help. Reading over my post made me tear up again....I guess no matter how much time you've been at your job, some days and events still really get to you.

The patient with the esophagectomy, after his wife left, had a jolly time telling me dirty jokes (lol...it wasn't a creepy situation, don't get me wrong). He did seem to be happy doing it, too, his smile seemed absolutely genuine. He kept worrying about crossing the line (I told him it takes a lot to offend me ) and he'd stop and say, "do you know what I'm saying?" during a joke...I'd say yes, and he'd say, of course, you're a smart girl, now if I was sitting at the bar telling these jokes, the dumb ones would be lost by now. LOL. He was much more calm after his family left, and I truly do think that their outburst (again, while TOTALLY understandable) were just too distracting and upsetting to him. I was glad to make him smile and give him a chance to focus on something else. I had to stop him so I could go answer a call light, and he said, yea, sure, you just don't want to hear a dirty old man tell you jokes anymore. I assured him that this was not the case, and that I'd come back. I got caught up then with the hospice gentleman, and when I checked back in, he was asleep. I asked the nurse I reported off to to let him know that I hadn't wanted to wake him....I hope she let him know!

Guiltysins, that is exactly it. The gal that floated there Friday night and took care of the same RSV baby, was also very upset by it (she was near tears telling us, she has babies at home, so it hit her even harder than it did me). What chance do these little ones have if at this point, their parents don't care enough??

[onetiredmomma]

Sometimes it all closes in on us dosen't it? A basic surgery is anything but basic when it is your family (esp your momma!). I would guess that your co workers knew you were there and would call for help if needed and so felt ok using their time for their other pts. Thank you for being so loving to babies and the elderly! At our facility, we require an adult family member stay with pedi pts. I hope you can relax and regroup this weekend and that your mom is doing better. I also hope if I ever have to be in the hospital, I get a nurse like you!

[SuesquatchRN, BSN, RN]

:kiss

[vlurye1]

I don't usually comment on posts, just read them but your post made me want to write something. The compassion and care you demonstrated to the elderly patient made me tear up, what a wonderful nurse you must be. I am currently taking 2 out of my 3 pre reqs before I apply to nursing school and I aspire to become the kind of nurse you demonstrated to be in your post. Thank you for sharing your story, I hope the elderly man is okay and I hope your mom is better. Take care.

[PostOpPrincess, BSN, RN]

I sincerely hope you have a good spiritual, mental system in place for when you have stressful times.

You sound like a good, caring nurse and I wouldn't want to lose you to burnout.

Remember, you must conserve some of your own emotional energy to take CARE OF YOURSELF. Because no one else is going to do it for you.

My advice: Eat well, sleep well, exercise, and have a good hobby where you can laugh and let go of your daily stressors.

You will end up sick if you don't.

[nursearoo]

Just a friendly word of advice......never ever judge anyone until you have been in their shoes......situations are what they are...and you don't know what the families daily life may be ........life is hard enough without passing judgement..especially these days.

A nursing instructor I once had gave us a comment to think about during clinicals....."never judge, just wonder" and went on to tell us people do not all have the luxury of staying at a hospital that have children or even husbands/wives....some HAVE to work and cannot just take off unfortunately because that could mean the difference between a roof over their head or food or having electricity etc..........I know I personally am one of those people.....and I had a double whammy...I have a severely disabled child so I know all too well about being in the hospital.......I always however, put that up front and explain, and no one has ever had a problem with it.

Maybe those parents never get a break, and unfortunately being in the hospital is the break ......sad but true because I've seen it, heck I've even had my childs nursing agency tell me to take advantage and not feel bad.there is a telephone that works if we needed to ne reached or wanted to call to check on everything......maybe they live so far that it isn't possible to be back and forth or whatever the reason may be....it is what it is.

I also have a nurse friend who has been a nicu nurse for years and has worked at my house as a nurse with my child for years, and she has great advice for young nurses that have no kids who make judgements on people where she works......she simply says "when you have a child then come talk to me because I guarantee your way of thinking will not be the same". Not taking sides at all......don't take it wrong....you need to not take work home as hard as it is at times......but just do the best you can with the situation and thats all you can do.......remember we are not here to judge we are here to provide nursing care...... you seem like a very caring nurse so don't worry so much or you'll burn yourself out fast............go with the flow so to speak:D

[Coriander, BSN, RN]

You have such a big heart. Thank you for everything you do for your patients and family.

[cherrybreeze, ADN, RN]

Just a friendly word of advice......never ever judge anyone until you have been in their shoes......situations are what they are...and you don't know what the families daily life may be ........life is hard enough without passing judgement..especially these days.

A nursing instructor I once had gave us a comment to think about during clinicals....."never judge, just wonder" and went on to tell us people do not all have the luxury of staying at a hospital that have children or even husbands/wives....some HAVE to work and cannot just take off unfortunately because that could mean the difference between a roof over their head or food or having electricity etc..........I know I personally am one of those people.....and I had a double whammy...I have a severely disabled child so I know all too well about being in the hospital.......I always however, put that up front and explain, and no one has ever had a problem with it.

Maybe those parents never get a break, and unfortunately being in the hospital is the break ......sad but true because I've seen it, heck I've even had my childs nursing agency tell me to take advantage and not feel bad.there is a telephone that works if we needed to ne reached or wanted to call to check on everything......maybe they live so far that it isn't possible to be back and forth or whatever the reason may be....it is what it is.

I also have a nurse friend who has been a nicu nurse for years and has worked at my house as a nurse with my child for years, and she has great advice for young nurses that have no kids who make judgements on people where she works......she simply says "when you have a child then come talk to me because I guarantee your way of thinking will not be the same". Not taking sides at all......don't take it wrong....you need to not take work home as hard as it is at times......but just do the best you can with the situation and thats all you can do.......remember we are not here to judge we are here to provide nursing care...... you seem like a very caring nurse so don't worry so much or you'll burn yourself out fast............go with the flow so to speak:D

I have to respond to this, especially the statement I bolded: I don't think I'm *that* young, I'm 30...I've been doing patient care half my life, was a CNA for 5 years before becoming an RN, which I've been now for close to nine years. I think this makes me....not exactly a newbie, at any rate. No, I don't have kids, but this doesn't make me clueless. The nurse who floated there who HAS kids (and a chronically ill baby!) took the situation harder than I did, so as far as knowing that parents need a break, yes, I do understand that part. I made my conclusions based on the info I received from the peds nurses, who DO know these parents and the situation at hand. I wouldn't have made those "judgements" based on my observations alone, because I know I wouldn't have known enough. I guess I just want to make that clear. I've been the victim myself over the years of judgements from people in healthcare as the patient; being one of the dreaded "chronic pain patients," believe me, I've seen judgement...so I do know what that's like. I was going by the info I was given by the nurses who know these patients and these parents well. I do believe they know the situations accurately. I know I shouldn't get defensive, but I wanted to explain myself a little bit more.

I do have a good system in place to destress, thank you for asking, also. Most of the time, I can easily manage these emotions, over the years I've learned how to. This was just a week out of the ordinary, I guess you could say. After having it start with feeling the vulnerability of being the patient's family member, I was that much closer to that empathy.

Thank you all for your kind words and support. I talk a lot to my sis when I need to vent, and she is a good ear and lets me talk, but just can't quite *get* it like I know you guys can.