How do you shake off the horrible?

anon456, BSN, RN · Mar 21, 2015

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.

I have worked with very similar cases in the peds world, too. It's very hard to cater to parents who are visiting their child and knowing they are the same parents who caused their child to be in this horrible, permanent condition in the first place. I agree that sometimes it's best not to know the end of the story. I have also found that over time, I am able to not be as emotionally affected by the stories of my patients.

calivianya, BSN, RN · Mar 21, 2015

It really gets me when the spouse is the patient's POA and they disagree with the plan of care. Had one who had been in and out of ICU for three months. I'd had her multiple times in three different rooms. She'd last 12 hours or so on a regular floor and bounce right back. She'd been intubated five or so times; our pulmonologists had told the family that they either needed to let her go or trach her because she was obviously not going to be able to breathe on her own anymore. One night, she managed to reach up and extubate herself. She had been hospitalized for so long that she was so debilitated she could barely move her arms at all; it must have taken everything she had to reach up and pull her ETT. She was fully alert and oriented, skin splitting open and weeping, massive sacral pressure ulcer, and she looked us right in the eyes and said she wanted to be DNR, that she didn't want to go on the ventilator again.

We called her husband. He said he wanted her re-intubated no matter what if she went into respiratory failure again, and he was the POA so if she had gone unconscious, we would have had to do it. The physician told us to go ahead and cut off her DNR bracelet that we had just placed. The husband showed up and guilt-tripped her into agreeing to be a full code again, spouting ten kinds of nonsense about how selfish it was of her to give up, how devastated the rest of the family would be by her decision, etc. She agreed to be a full code with tears in her eyes. She didn't get re-tubed while I was there, thankfully. I would have been so furious about her "loving" family deciding she didn't even have the right to make decisions about her own body that I probably would have said something really ugly and gotten fired. At that point I just blanked out that she was a human being and just looked at her as a list of tasks - I couldn't have gone back in that room and looked her husband in the face otherwise.

I'm also glad I don't know the ending to this story - she either transferred out or died while I was off for a few days. I have a feeling knowing would just make me more angry.

iluvivt, BSN, RN · Mar 21, 2015

Kalycat...you should read the poems written during the Romantic period..They too revered nature and believed in its restorative nature.When I read your post your description of how nature rejuvenates you made me think of those poems.

Elvish, BSN, DNP, RN, NP · Mar 22, 2015

I just want you to know you're not alone. This year marks 14 years as a nurse, and I cried in the car on the way home from work today too.

It does get better with time. You've already gotten some great advice about what to do if it doesn't. (((hugs)))

ixchel · Mar 22, 2015

I just want you to know you're not alone. This year marks 14 years as a nurse, and I cried in the car on the way home from work today too.
It does get better with time. You've already gotten some great advice about what to do if it doesn't. (((hugs)))

Hugs to you, friend. I'm sorry for the rough day and hope you get a day off today to put some distance in. â¤ï¸

TransportJockey, EMT-P · Mar 22, 2015

I go blow things up. Tannerite and firearms are a wonderful combination. I also shoot photography which helps me express myself when I can't to anyone else.

RNHospice · Mar 22, 2015

EAP or talking it out to other Nurses.

I still have memories of my first death observation experience when one of my pts was getting blood and had expired during the infusion, (Not Related!), the daughter's were there and were asked if they wanted to view the body. They came in room and while we were laying the HOB down the pt left out some withheld air. The dgt's freaked, actually hit me on the arm and stated she was still alive and to help her NOW. It took at least 5 mins for them to believe she had passed.

Things hang with you forever. Learn by it, embrace it ....you can't change it.

lasair · Mar 23, 2015

Debrief with someone, take what you can from it, try park it and move on - it is very difficult - if you feel you need it see if where you work offer employee counselling do

ixchel · Mar 23, 2015

I go blow things up. Tannerite and firearms are a wonderful combination. I also shoot photography which helps me express myself when I can't to anyone else.

I imagine blowing things up is quite cathartic!

When I was younger, anytime I felt pain that was hard to deal with, I'd get something pierced or tattooed. Not sure why your post made me think of it just now, except considering how cathartic an explosion probably feels.

ixchel · Mar 23, 2015

EAP or talking it out to other Nurses.
I still have memories of my first death observation experience when one of my pts was getting blood and had expired during the infusion, (Not Related!), the daughter's were there and were asked if they wanted to view the body. They came in room and while we were laying the HOB down the pt left out some withheld air. The dgt's freaked, actually hit me on the arm and stated she was still alive and to help her NOW. It took at least 5 mins for them to believe she had passed.
Things hang with you forever. Learn by it, embrace it ....you can't change it.

I thank my lucky stars that I've read about the sounds a body will make during those initial minutes (hours?) after death. I can't imagine how disorienting it is to hear them as a family member and not realize they're normal post-mortem sounds.

ixchel · Mar 23, 2015

Debrief with someone, take what you can from it, try park it and move on - it is very difficult - if you feel you need it see if where you work offer employee counselling do

Thankfully, time has healed my heart. I will never forget the shock and heartbreak, but I have recovered from it. Getting it off my chest and bonding with other nurses was very helpful. I also have gone back to coloring, which probably sounds ridiculous but it's mindless, easy and low-demand for actually doing a good job. ðŸ‘ I think my biggest asset in this really was time, though.

kalycat, BSN, RN · Mar 24, 2015

Thankfully, time has healed my heart. I will never forget the shock and heartbreak, but I have recovered from it. Getting it off my chest and bonding with other nurses was very helpful. I also have gone back to coloring, which probably sounds ridiculous but it's mindless, easy and low-demand for actually doing a good job. ðŸ‘ I think my biggest asset in this really was time, though.

Coloring is nowhere near ridiculous!! :)