How do you shake off the horrible?

FurBabyMom, MSN, RN · Mar 21, 2015

I work in the OR of a Level 1 trauma center. Even without it being a Level 1 trauma center - almost nobody has surgery for a "good" reason - it's usually because it's needed or a last resort when other options fail. I take care of many patients who receive horrible cancer diagnosis and other less than ideal outcomes. I treat my patients with respect and dignity, but in the end, I really only know the patients and families and their interactions for about 15 minutes. I don't develop the same relationship with them that I used to when I was a floor/stepdown nurse. It makes it easier to tell myself that horrible things happen, and it doesn't make any sense why it happens.

That being said, some situations that we see as a Level 1 trauma center? Catastrophic injuries and abuse cases are the worst. One of the situations engrained in my memory for forever was a Level 1 trauma that came to the OR from the helipad via the ED CT scanner (not so unusual) - and arrived in the OR with the flight crew still managing the patient. We have emergencies that happen with our inpatients that can be bad, it's not just the trauma patients. It's also - bad things can happen in any procedure, no matter how small.

I have coworkers I talk to. You discuss some of those situations with them. It's hard to explain some of the things you see in the OR to people who have no clue what the OR is like. Sometimes we "debrief" the situation and discuss what happened to process it, sometimes we are debriefing for changes to improve processes, etc. You find non-work things to focus on. You find songs you love to sing at the top of your lungs with the songs at a higher volume than you probably ought to listen to them at on the way home from work. When I have really bad days at work? I enjoy spending time with my dog (especially a long walk while listening to music).

Gooselady, BSN, RN · Mar 21, 2015

It's the most unsatisfying answer . . . but time passing always smooths over those huge gut-wrenches. I even tell myself, "Tomorrow, you will remember this but not with so much angst". It's always true. The deeper you were wrenched, the longer the time takes. It also helps to talk about it, write about it, discuss it and hear another person's feed back about it. Commiseration is a genuine healing technique .

You have to realize how 'shocked' you were, witnessing that mother mourning her son. You didn't expect your empathy to be so strong, and it's an emotional blow, like being punched in the head. It's SOMETHING. It's a real something. And like all things that hit ya and cause pain, including physical hits, your brain settles back down just like your body heals itself.

I try not to think about the future, because there will always be more of those kinds of empathic 'blows', ya can't predict them, ya can't avoid them, either. They are part of the job. The only thing that changes is how you relate to the blows, how you use them. You take the steering wheel and use THEM, rather than them using you :)

anon456, BSN, RN · Mar 21, 2015

I had to enlist the services of a professional counselor to work through a situation. Many employers will pay for mental health services, and it's worth it to take advantage of them.

kalycat, BSN, RN · Mar 21, 2015

First of all, sending you positive thoughts and support!! It sounds like a heart-wrenching situation...and sometimes it is hard to predict which cases will be emotionally challenging. No matter how much we prepare or how much self care we perform....there will always be those days.

I'm a new nurse so my perspective may be off... but I previously worked in acute adolescent psych with families dealing with not only a major mental health diagnosis, but involvement with at least one system: CPS, foster care, drug court, juvenile detention, etc. I also served as a child protection team volunteer for CPS. Many of our kiddos had major medical diagnoses as well and the situations were often psychosocially complex not to mention heartbreaking and infuriating at times. I had many, many days where I simply could not just leave it behind...some of these cases were nightmarish. So...from that perspective here are some things that have helped me in the past:

I second (or third) the power of music! I love opening the sun roof on my car, finding a country road/highway, and cranking the tunes, especially old meaningful favorites that speak to my soul. Incredibly therapeutic.

I'm a runner...but I have an autoimmune condition and sometimes I can't run long enough or hard enough to leave the day behind. Sadly, stress doesn't help my physical performance!! In those cases, I drive to the woods, the mountains, the lake...somewhere out in nature, and just hike and hike and hike. Grab my daypack, my camera, and literally head for the hills. Not sure what area of the country you're in, but there is something incredibly restorative about the woods....especially during spring thaw. (Hopefully you're not somewhere that still has a foot of snow as I suggest this!) Even if it's still cold there's benefit in getting out and getting in touch with what's happening in the green world, at least for me. For some reason I find comfort in nature's cyclical constancy and new beginnings even in the face of overwhelming tragedy. I try to take notice of all the tiny beauties...birds returning, the first signs of green, critters...fresh air.

For some reason getting out helps me even more than just venting to my support peeps...but I usually do that too! :)

I write. If the weather simply will not cooperate, I try to do some yoga inside and then spend some time writing. For me, writing and reflecting really helps me cope with tragedy, whether it is something I've experienced at work or if it's more personal. The act of writing and creating is therapeutic for me, even if I never share the writing with anyone. If I can't journal just yet, sometimes sketching or drafting a short story (related or unrelated to the situation) helps. I can put the thoughts down and do a brain dump...then simply walk away from them for a time until I'm ready to revisit the situation and try to reflect on it.

I wish you all the best and will be thinking of you! Thought I would share a couple of my favorite spots with you "virtually"...not that that will help much but your situation called to mind a family I was working with when I took these last year. It was quite a difficult case that I've never forgotten. --kaly

jadelpn, LPN, EMT-B · Mar 21, 2015

Take advantage of any debriefing. If you have a group in your facility that meets to discuss post traumatic stress issues, join it. If not, start one. It helps to talk it out.

At the same time, realize that family dynamics are an odd lot. We never know the history that gets someone to the place that they are, we can only see what is before us and have a goal of peace, integrity, and painlessness.

To look at it a different way--know your patient's goals. No one (or very few) are with the intent that dying is a good thing. It is a process. And to facilitate the process within the desires of the patient is what the goal should be for you as the patient's nurse.

It can be gut wrenching when you see dynamics gone bad. The would have, should have, could haves that any number of families face. But know that in your job, you would, and could....and don't leave room for should have.

In your personal life, make it as complete as you need to. Celebrate you. Hug your kids tighter, be mindful and careful. And make sure that if you are overwhelmed in your life as a result of your work, recognize it and do something about it. Whether that be counseling, a support group--there are even debriefing groups that may be part of your community resources. For instance, most fire departments and police departments have them. And you could ask to join one of them. Sometimes a different perspective helps.

Wishing you nothing but the best, and there are many of us, myself included, just find such integrity in nurses who do what you do. Thank you.

MollyJ · Mar 21, 2015

Most of my shifts are with elderly patients, and this particular patient was elderly as well. I was able to handle it until my last day with him, when the mom came in. She hadn't seen him in years and didn't know he was the way he was (which was pretty horrifying by his own doing). Her devastated reaction and uncontrollable crying did me in completely. Sometimes I wonder if being a parent makes this job even harder. We don't consider our children as old people normally. But when I see elderly parents with the same love I have, or children watching their parents die, it makes me feel this job in a different way. Again, I can normally check that at the door. Walk away. This time is different.

I think you are reacting to the parent-child dynamic here. The pain of a mom who could not "make it better" (even before this time) for her child.

You might try writing out your thoughts. _Pretend_ you are going to submit it for the writing contest that allnurses sponsors.

Here is a mantra that I sometimes invoke. My DH introduced me to this one and he says it is Buddhist in origin.

Imperfection is part of the perfection of things.

Many situations cannot be made "all right" and they can become the stuff of what makes us softer, more compassionate, more understanding of how love is always expressed imperfectly.

Here.I.Stand, BSN, RN · Mar 21, 2015

((((hugs)))) I'm a mom too, and I also find the parent-child grief particularly difficult. Working in trauma like I do, I find the grief uniquely difficult (not necessarily MORE difficult, but different) because the loss is so sudden. Sure there are situations where the person has been in the ICU for weeks and then succumbs, but often times they go from perfectly fine and healthy, to dead, in the span of a few hours. I've been an RN for 12 years, and I still have cases where I cry on the way home. A few weeks ago, I even had a dream about this especially heart-wrenching case.

Years ago when I worked in a CVICU, I remember taking a call from an 80-something mother, wanting an update on her 60-something son who'd had a CABG the day before. "How's my boy?" she said. Before we hung up, she said "No matter how old they are, they're still our babies. A mother never stops worrying." Fortunately he did very well. :)

But back to your question. I'm not one who can easily just let it go. I listen to feel-good music on my way home; there is evidence supporting music therapy after all. I talk it out. I always involve our hospital chaplains; they are amazing in helping with these difficult situations, and it takes some of the pressure off us if we're not the only one at that bedside. And I remind myself that tragedies happen every day; at least in these cases, I can feel good about doing what I could to help.

All that said, if you find these situations are affecting your everyday functioning and thoughts, please consider talking to someone. We nurses can be at risk of secondary traumatic stress, as we are so close to our pts' and families' suffering.

ixchel · Mar 21, 2015

I think you are reacting to the parent-child dynamic here. The pain of a mom who could not "make it better" (even before this time) for her child.

The sudden, unexpected shock of the family showing up was definitely the parent-child dynamic overwhelming me. I had been feeling so heavy about this case already before that happened. This was my third day with the patient. The patient had been a sufferer of a combination of abuse, neglect and severe depression. The level of deconditioning this patient endured has left him permanently disfigured and disabled. There is no possibility of the patient ever regaining a level of function that would give the patient any level of quality of life. And then his mother arrived totally unexpectedly. The last time she saw him was before any of this. He was her "beautiful boy", in her own words. As a nurse, it was hard enough. But then I saw it from the eyes of a mother. "Overwhelming" is an understatement.

After some distance and time away from it, I am feeling so much better. This is one of those stories that will haunt me and grow me as a nurse. I'm adjusting my thinking the best I can to remembering that I was there to help him. I treated him like a human, and to see him, others might not. I gave him dignity and respect, and I advocated for him. It was all I could do. I hope it was enough, but I can't think of that. It's the job - we get these quick moments peering into the intimate details of a person's life and then we have to move on without ever hearing the end of the story. I think in some cases that's a good thing.

bluegeegoo2, LPN · Mar 21, 2015

I have a private online journal where I can explore what I'm feeling, feel it out, mourn, cry, gain perspective and leave it. My one hard and fast rule is to never EVER revisit past entries. The point of doing it is to release and let go to the best of my ability. It works wonders for me.

ixchel · Mar 21, 2015

I had a woman dying of breast cancer. She was probably about 50. Her husband left her because she lost her breasts and he couldn't deal.
Her daughter got married and the whole wedding party came to the hospital after the wedding. The mother and daughter were devastating. The way my patient looked at her daughter, I will never forget it as long as I live. The patient died 2 days after the wedding. RIP 513-1.
Some things you NEVER forget. And that's okay.

Goodness....... This story is both tragic and beautiful.

ixchel · Mar 21, 2015

First of all, sending you positive thoughts and support!! It sounds like a heart-wrenching situation...and sometimes it is hard to predict which cases will be emotionally challenging. No matter how much we prepare or how much self care we perform....there will always be those days.
I'm a new nurse so my perspective may be off... but I previously worked in acute adolescent psych with families dealing with not only a major mental health diagnosis, but involvement with at least one system: CPS, foster care, drug court, juvenile detention, etc. I also served as a child protection team volunteer for CPS. Many of our kiddos had major medical diagnoses as well and the situations were often psychosocially complex not to mention heartbreaking and infuriating at times. I had many, many days where I simply could not just leave it behind...some of these cases were nightmarish. So...from that perspective here are some things that have helped me in the past:
I second (or third) the power of music! I love opening the sun roof on my car, finding a country road/highway, and cranking the tunes, especially old meaningful favorites that speak to my soul. Incredibly therapeutic.
I'm a runner...but I have an autoimmune condition and sometimes I can't run long enough or hard enough to leave the day behind. Sadly, stress doesn't help my physical performance!! In those cases, I drive to the woods, the mountains, the lake...somewhere out in nature, and just hike and hike and hike. Grab my daypack, my camera, and literally head for the hills. Not sure what area of the country you're in, but there is something incredibly restorative about the woods....especially during spring thaw. (Hopefully you're not somewhere that still has a foot of snow as I suggest this!) Even if it's still cold there's benefit in getting out and getting in touch with what's happening in the green world, at least for me. For some reason I find comfort in nature's cyclical constancy and new beginnings even in the face of overwhelming tragedy. I try to take notice of all the tiny beauties...birds returning, the first signs of green, critters...fresh air.
For some reason getting out helps me even more than just venting to my support peeps...but I usually do that too! :)
I write. If the weather simply will not cooperate, I try to do some yoga inside and then spend some time writing. For me, writing and reflecting really helps me cope with tragedy, whether it is something I've experienced at work or if it's more personal. The act of writing and creating is therapeutic for me, even if I never share the writing with anyone. If I can't journal just yet, sometimes sketching or drafting a short story (related or unrelated to the situation) helps. I can put the thoughts down and do a brain dump...then simply walk away from them for a time until I'm ready to revisit the situation and try to reflect on it.
I wish you all the best and will be thinking of you! Thought I would share a couple of my favorite spots with you "virtually"...not that that will help much but your situation called to mind a family I was working with when I took these last year. It was quite a difficult case that I've never forgotten. --kaly
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Being new certainly doesn't make your thoughts irrelevant and I appreciate you sharing them â˜ºï¸

P.S. I'm a woods girl, too.

wannabecnl · Mar 21, 2015

A good counselor can be amazing for asking you questions to get you processing what happened. You are a compassionate person, and sometimes you need to be compassionate to yourself. We see our patients and their families at their worst, and we see things about others that no one outside of healthcare (and I'd say especially nursing/LNAs) sees.

I was just reading a thread about whether nursing is the hardest profession. Stories like the ones I'm reading here make me say it is certainly up there.