Nursing PTSD Is Real

[Guest1119933]

Never would I have thought as a nurse having PTSD until you experience that one patient or event you will never forget. Mine happened three years ago. Totally thought I had caused the demise of my patient. Did I also mention I have severe anxiety?

It seemed everywhere I turned at the time, my nurse manager, my director, the medical director, no one would hear me (they listened) but would say, “it’s nothing you did”. I didn’t really get the closure and talking or debriefing. It was six rough months of me reliving every moment of that event. Every now and then it will pop in my mind. I find myself at times still going into a brief panic, asking “did I do this”, “was I sure it was the right med” (lord knows half the meds don’t scan anyway) “did I check this”. Am I the only one this happens to? Everyone has said it is because you care so much that it is hard to just release. Tell me your stories!! 

[JBMmom, MSN, NP]

You're not alone. April 22nd will be the four year anniversary of a patient death that has weighed on me ever since it happened. The 39 year old (relatively healthy) patient arrived in our ICU from the ED on 6 mcg/min of levophed on a non-rebreather at 2:15am. He was awake and alert but Chinese speaking so exact level of orientation is unclear. When I walked out at 8:42am they had just pronounced him dead after six codes and a trip to the OR in between.

I was a newer charge nurse, with just over a year of experience in ICU and I was the senior staff member on that night except for one traveler. The nurse that had the patient was on her first night off orientation. The final cause of death was reported as necrotizing fasciitis, but like you, I second guessed my own care, my ability to support a brand new ICU nurse, and ultimately the care the patient received for just over six hours in our unit. I can easily recount almost everything that happened in those six hours and if I think about it too long I can still hear his wife screaming as we did compressions. Every time we did a pulse check she would scream "Don't stop, you go faster!", and she was ultimately taken to the ED after he passed. I heard they had three young children.

There have been some others that stick with me, too. Yesterday was two years since the passing of our first COVID patient. I was holding his hand as he died. Again, the final four hours of his life are so clear in my mind and I wonder whether there's anything else I could have done. And just a couple weeks ago I admitted a lovely lady who appeared to be improving over the course of the night. I spoke with her husband about 6:30am and gave an uncharacteristically positive update, I'm generally very cautious to be sure I'm not giving false hope. But when I walked out that morning I thought truly she would be downgraded from ICU by the time I got back that night. Unfortunately, not long after I updated him she coded and was intubated. He was never able to speak with her again and she died the next day. I feel badly that I gave him what was an accurate update at the time, but it turned out to be not at all indicative of what actually came to pass. 

I guess I made a long story long, but wanted to tell you that you're not alone. We work in an environment where anything can happen and we do our best with what he have for knowledge, resources, and time. Be kind to yourself and remember that whatever happened, you were doing your best. Clearly you are conscientious and caring, without knowing the exact situation, I would say you did everything you could. 

[Davey Do]

2 hours ago, New_Nurse_18 said:

I didn’t really get the closure and talking or debriefing. It was six rough months of me reliving every moment of that event. Every now and then it will pop in my mind. I find myself at times still going into a brief panic

"Reliving every moment" is a cyclic mental process called rumination, in the same way a cow chews its cud over and over and over again. It's our way of trying to find the answer, or even a clue, which will mentally and emotionally appease us.

Not "getting closure" as you so aptly put it, New_Nurse, is necessary in order to deal with our psyche pain. Debriefing and talking about the situation, verbal listening and support from another is a good way to begin the healing process, however, we can be our own best therapists.

In order to "get it out of put heads", we need to make the situation tangible through handwriting and/or art. Once we create the situation in a tangible form, we gain a different, and sometimes new, perspective about it.

In handwritten words, we initially need to purge our thoughts and feelings without regard to spelling, grammar, punctuation or penmanship. Let the words flow out in a stream of consciousness without regard to chronological order. Just get it out.

Some have tidied up this stream of consciousness prose for others to read and discuss, for example, with a close friend or therapist. This can be a truly cathartic and cleansing experience, a closure of sorts.

After diagnosed with PTSD due to a stabbing by a client back in '98, I went through several months of art therapy and learned these, and other techniques that were life changing.

Since '98, I have experienced and dealt with a few major life crises and utilized these techniques, and many others, which buoyed me through some rough waters.

I wish the very best for you, New_Nurse.

 

[amoLucia]

Retirement 12 yrs ago (after 36 yrs active practice) still hasn't erased the memories of several pts who died on my watch. Deaths, expected or not, I still remember many of them. Initially, I asked myself the same questions as you. But that passes.

I believe myself to have been a safe & conscientious practitioner, so their deaths were part of the circle of life. 

You may still be able to consult your EAP services for assist with your psychic distress.

Best wishes for you.

[Davey Do]

Deaths have never really bothered me, granted I was never involved in caring for anyone who died that was not an adult.

Since my own NDE at the age of nineteen, I strongly believe that when our time is up, it's up. Having been involved in several situations where I could have died, it just wasn't my time.

I have my house in order in preparation for my death. My medical nurse wife Belinda is aware of everything, from my pre-planned funeral to my living will to the will for my estate. I have told her, "No matter how I die when I die, just know that it was my time".

Perhaps coming into grips with one's own mortality helps to deal with the deaths of others.

[amoLucia]

4 minutes ago, Davey Do said:

Perhaps coming into grips with one's own mortality helps to deal with the deaths of others.

Very good point. I've made some 'final  decisions' that my family knows are in my 'RED FILE'. Documents, FYI lists, imp numbers all there. I started it right as I bought my condo - had stuff that I thought all adults, esp homeowners should have. Never worried about it.

[HiddenAngels]

13 hours ago, Davey Do said:

Deaths have never really bothered me, granted I was never involved in caring for anyone who died that was not an adult.

Since my own NDE at the age of nineteen, I strongly believe that when our time is up, it's up. Having been involved in several situations where I could have died, it just wasn't my time.

I have my house in order in preparation for my death. My medical nurse wife Belinda is aware of everything, from my pre-planned funeral to my living will to the will for my estate. I have told her, "No matter how I die when I die, just know that it was my time".

Perhaps coming into grips with one's own mortality helps to deal with the deaths of others.

I think this is important no matter what your age is.  I never thought about this as much until I started nursing.

[HiddenAngels]

 I'm generally very cautious to be sure I'm not giving false hope. But when I walked out that morning I thought truly she would be downgraded from ICU by the time I got back that night. Unfortunately, not long after I updated him she coded and was intubated.

Similar story but the family was actually at the hospital and we sent them home because the patient was making a recovery when I left.  When I got back to work that next day I found out that they had downgraded patient after I left to a med surg floor assuming they were doing fine and as soon as the patient got up to the floor and went to get off the litter and into the bed, they threw a massive PE and died.  I was sick, I cried so hard.  I loved that patient and patient's family.  I wasn't there but I went to the doctors who ran the code and asked them what had happened.  You could see it in their eyes, you could see the shock and disbelief.  It was hard.  Everyone was hurting.   I kept her patient label for a year I just couldn't get rid of it, it was all I had, but I finally had to let it go.  It was very hard.  I'm almost crying typing this uggggh...

[Davey Do]

Thank goodness for experience and desensitization.

Experiencing an NDE at such a young age, followed by multiple exposures to death, allowed me to gain a perspective on death I made not have otherwise had.

I was a 22-year-old EMT working with the Emergency Corps the first time I was exposed to death in a professional setting. Having been professionally involved in multiple deaths in multiple settings, I see death is the way of life.

Once we can separate ourselves emotionally from any situation, logic can take the foreground and the better we will fiction.

[Davey Do]

In dealing with my own diagnosis of PTSD, I learned and was blessed with a multitude of coping mechanisms from various sources.

I was working as an ACT RN when stabbed in the back by a client diagnosed with undifferentiated schizophrenia. I was talking with the team's psychiatrist, Dr. J, when he offered to write me a script for a benzodiazepine. I thanked Dr. J, but declined his offer, saying that I wanted to deal with my anxiety and other symptoms in other ways, which included therapy, art, and exercise.

Dr. J told me of one of his clients in his private practice who also suffered from symptoms of PTSD. His client had been locked in a room by men who were robbing the hotel and the client bad filed a rather large lawsuit against the hotel. The client had suffered no other harm aside from the emotional trauma caused by being locked in a room while the hotel was being robbed.

Dr. J went on to say that the client was making no progress in dealing with their symptoms and he sensed it was because of the lawsuit. He said something along the lines of, "If the client deals with their symptoms and gets better, there's no basis for the lawsuit. No lawsuit means no money".

We all feel better when we have someone or something else to blame for our pain, but it is us who are responsible for how we feel. A quote from the TV show Northern Exposure comes to mind: "When you come upon an obstacle, you go over it, you go around it, you go through it, you DO NOT sit on your butt and feel sorry for yourself!"

Guidance in dealing with our pain will come to us in various forms if we only open ourselves to it.

[PLG1988]

Thank you for your thoughtful insight @Davey Do. I have been suffering from anxiety and PTSD from a work situation due to mishandling of medication (no patient harm) and I am trying to cope with it. Making it tangible through art sounds like a good first step in healing.

[Davey Do]

13 minutes ago, PLG1988 said:

 Making it tangible through art sounds like a good first step in healing.

You're welcome, PLG.

Making our thoughts and feelings tangible through art is a good first step in healing, and it's also a good maintenance tool.

Art & exercise has buoyed me on through many stressors, such as making a med error. For example, one shift I received accolades for dealing with an acting out psychotic patient. The very next shift, I made a minor med error and drew a cartoon of myself eating a piece of humble pie.