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The Patients Who Break Your Heart

Nurses Article   (3,257 Views 25 Comments 528 Words)
219 Likes; 8 Followers; 141 Articles; 246,785 Visitors; 9,499 Posts
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From the earliest days of nursing school, when we were taught never to become "too involved" with our patients, we nurses find ourselves balancing precariously on the gossamer thread that separates caring for people and caring about them.

The Patients Who Break Your Heart

OK, so I'm a little jaded after having been a med/surg nurse for awhile and seen a lot of noncompliant medical patients, addicts and alcoholics returning for their umpteenth detox, and the usual assortment of frail, sickly, demented elderly patients whose families won't give up no matter how poor their loved one's quality of life.

And then there are patients like this one.

Twenty-nine-year-old female with four children, a husband who just got deported to Mexico, and an advanced case of cervical cancer with distant metastases to the bones, liver, pelvic organs, stomach, and now possibly the brain. She is hospitalized now for acute renal failure with a BUN in the 200s and creatinine nearing 20. She is still a full code, but in her few lucid moments she must know that her prognosis is terminal; all the operative options have been done, and she's had all the radiation and chemo her failing organs can handle. Essentially she is out of options and has a month to live if she can get dialysis, but only a few days if not.

She lies in bed with her eyes closed, the butterfly-yellow prayer shawl given her by the parish nurse spread over her wasted flesh. She does not complaining about pain or anything else. She also does not eat, drink, get up and walk around, or ask for anything. Her mother, who is my age or a couple of years older, is in almost constant attendance while her children, who range in age from 1 1/2 to 10, play on the other bed and dance around the room, seemingly oblivious to the fact that she is leaving them very soon, no matter what anyone does to try to save her. They do not know that even our strongest weapons are powerless against the enemy, that the battle was lost long before it began in earnest.

This suffering soul is the patient who gets to me, the one whose silent anguish makes me feel petty for ever thinking I was in pain or going through hard times. She has so many things to think about, so many decisions to make, and so little time. Why can't her husband be here, the one who should make her last days a little easier and give their children a stable home when she takes her final journey? Why must these children be split up at a time when they need each other the most---the two eldest to their grandmother's, while the two youngest must go to foster care? And why, oh why, is this girl dying in a hospital bed when she should be raising her babies, finding out what she wants from life, and looking forward to the future with eyes undimmed by pain?

This is the patient who will haunt my dreams, tonight and for nights to come. There should be answers for her. I am outraged because there are none. And as I work with her, I scream silently at the unfairness of it all. :stone

This is the patient who breaks my heart. Who is yours?

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I'm a Registered Nurse and writer who, in better times, has enjoyed a busy and varied career which includes stints as a Med/Surg floor nurse, a director of nursing, a nurse consultant, and an assistant administrator. And when I'm not working as a nurse, I'm writing about nursing right here at allnurses.com and putting together the chapters for a future book about---what else?---nursing.

219 Likes, 8 Followers, 141 Articles, 246,785 Visitors, and 9,499 Posts.

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MJ.....I give you the biggest hug I can. Having read your thread, I cannot even attempt to think straight. :crying2: Give the best care that you can. Peace...Sue

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Pt was late 70's, alzheimers, bone cancer, on hospice in a nursing home.

I was a nursing student.

Staff always said she was combative.

She was the first total care patient I ever had.

That first day, I couldn't get her BP because she was fighting me, she just kept saying something over and over in German. My instructor came to help me...and my instructor knew German. She was saying "killme, kill me, it hurts." over and over. Turns out that her morphine was only PRN, and the MED AIDE hadn't given her any in over 3 days. Med aide stated "well if she feels good enough to stick her tongue out at me, then she can't be hurting". Remember, the pt was dx with alzheimers. My instructor when straight to the DON. She got the morphine, and we had her orders changed to around the clock sustained release with Prn also. After that, she slept for over a day per notes.

The next week I had her again, and then the next week also. Apparently, I was the only person who could bath her without her being extremely combative.I was new, and I asked for a different pt the following week because I was getting too close. A week after that my classmate had her and needed help, the patient had been in and out of consciousness off and on, I went in to help, and held her hand. After a bit the pt looked at me and said in perfect English, "Where were you last week." She also said something about my appearance that was definite enough to all that she remembered me. She died the next day.

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A three month old baby girl. I wasn't there when the paramedics brought her in but I was there right after. She had slept through the night for the first time. Her parents woke up to find her not breathing. Her father started CPR and her mother called 911. There was nothing we could do.

You can never get the sound of the parents screaming out of your mind. Her mother kept screaming don't put my baby in a box.

The whole ER cried all shift. It's hard to move on to that next patient when their parents are crying, because they know it could be their child. Or it could be your own.

Billie

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After thinking on a very long nursing career, I remember the lady with liver failure. Had hurt her back years ago, took regulat Tylenol, ES Tylenol, and many compounds with Tylenol, just to kill the pain. Well, it killed the liver, too. She was in sooo much pain, and there was very little we could do for her. Approximately 2 weeks before she died, she made peace with everything/everyone. She died on my day off, which was good in a way....it would have totally tore me up. I still cry thinking of her.

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A three month old baby girl. I wasn't there when the paramedics brought her in but I was there right after. She had slept through the night for the first time. Her parents woke up to find her not breathing. Her father started CPR and her mother called 911. There was nothing we could do.

You can never get the sound of the parents screaming out of your mind. Her mother kept screaming don't put my baby in a box.

The whole ER cried all shift. It's hard to move on to that next patient when their parents are crying, because they know it could be their child. Or it could be your own.

Billie

What a heartbreaking story......ulp! :crying2: That's what I feared the most as a young mother, especially after losing my second child only hours after her birth. Now, as a new grandmother, I find myself no less worried about my little grandson........I don't even want to THINK about something like that happening to him, and Lord help us all if I ever have to help my dd and SIL through such a loss. I'm not at all sure I'd be equal to the task. I pray to God I never have to find out. :crying2:

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Heartbreaking. :crying2:

The baby story gets to me. One of my biggest fears is outliving my children. I've heard the wail of a mother in heartache, and it made me want to start crying.

Mine is a 15 yo boy, brought in post-code. UNresponsive, -drugs, living in a hotel with his family. Found out sometime last week his parents were arrested for the beating that lead to the murder of the boy. At least they had the deceny to donate his organs. -Andrea

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The one situation that still brings tears to my eyes happened over 13 years ago. A man about 40ish was transfered from ICU to the unit. He had suffered a massive MI if I recall the circumstances correctly and basically there was nothing that could be done. They transferred him to a private room so that his family could be with him. This was 2 days before Christmas. His daughter was about 8-9years old and she was at his bedside begging her father not to die. The reason this struck such a chord with me is that at the age of 7 years I lost my mother to ovarian cancer 5 days before Christmas, and I never had the chance to say goodbye. It was almost like I could feel this little girl's pain. I actually hid in a utility room everytime I had to cry that day. :crying2:

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Marla, being in OB, any death is a tragedy....I can relate. I have seen so many heartbreaking stories in 8 years....and cried a river.

((((((((((((warmest regards and thoughts))))))))))))))) to you in your pain. You are so wise to bring it here, where others can understand and relate.

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Marla, being in OB, any death is a tragedy....I can relate. I have seen so many heartbreaking stories in 8 years....and cried a river.

((((((((((((warmest regards and thoughts))))))))))))))) to you in your pain. You are so wise to bring it here, where others can understand and relate.

TY Deb. I was trying to tell my husband about this last night.....the dear man hasn't a clue as to how these things kill your soul, but he listened and sympathized. What he can't do---what NO ONE who isn't in the medical field can do---is empathize, which is why I come here..........I'm the only member of my family in this field, and there is no other outlet for the expression of emotions that have no place else to go. Thank God for allnurses!

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I am not a nure yet, but I do work as a CNA on a med-surg unit...mostly with post surgical pts. I was just talking to my manager about this topic yesterday...certain pts that you just can't help but to be affected by. One of my most emotional experiences just happened last week. We had a 35 year old female who had ca that had spread to her brain, and her spine and was also in her breasts. Because of this, she is blind and paralyzed on her right side, and has very little sensation on her left side. What got me was when I was talking to her and she opened up everything to me. She has three children and wondered who would be there to take care of them after she was gone, being she was a single mother. Her youngest turned three this past Sunday and she couldn't afford a gift or party for him. This kind of expereince just makes me that God everyday I have to spend with my kids and hug them, being able to see their smile and feel their hug. I provided her with several Chuck e cheese gift certificates so her son would have a great birthday and she didn't need to worry about it. I also think these things make us stronger in our profeesion and make us better nurses for it. (or almost Nurses:)) :o :angel2:

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Hugs to all who have experienced the loss of a patient that medical science could not save. :icon_hug: I've had some of those heartbreaking patients myself.

Marla........why was the father deported? Will he be allowed to raise his four children? Why is gramma raising two of the children when the children's father is alive? And....I'd take all four of those children to keep them together if social services would allow me to. Do you know if I could or not?

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