The trauma I cant let go of

[ER_JEN_RN]

I admit as a new ED nurse, I definately have that rush when the EMS call comes over the radio that they are a few minutes out with a good trauma, but one recent call is more than I know how to let go of.

Im not going to go into a lot of details about the incident, but there was a 25 year old kid who was involved with a freak accident with a cement mixer. Needless to say, he did not survive. This was one of those cases where death was so much more merciful than survival would have been, and my saddness and grief are not so much related to his death, but I cant stop thinking about the absolute terror that this poor kid must have felt in the last few seconds of his life. It nearly brings me to tears when I do think about it.

So my question is this; when you have that patient whose story just rips your heart out, how have you dealt with it? How do you learn to let go of the hard cases so you can move on to help the next person who walks through the door? During nursing school, it was always a joke with my clinical group that if there was a trauma somewhere, I was probably near by and standing in the middle of it trying to help. I love what I do, and I honestly feel that the ED is where I am meant to be, but for the past week I havent been able to stop thinking about this patient. I actually had to choke back tears today when I started thinking about it.

[cjcsoon2bnp, MSN, RN, NP]

I'm not sure if this helps but I work in a Peds. ED and we have quite a few of "those" traumas where it really gets to you even after you leave work. There are a few that come to mind, the worst is when I had to do CPR on a 10 year old who eventually passed and then I sat with the family for the next 6 hours while they grieved over the child's body. It was really intense and I still think about it sometimes. The best thing you can do is know that you did you very best to help this person in the capacity that you could and now it is out of your hands. Depending on your personal beliefs about death and the afterlife this will affect how you think about this issue. This can be really difficult if you have to continue working your shift after the trauma has occurred, in that case you need to take a few minutes to collect yourself and put the issue on the back-burner in you mind until you are finished with your shift. It might help to talk to someone professionally (like a grief councilor or therapist) or ask a trusted coworker how they deal with the issue. I know some nurses will go out after a trauma and have a drink in memory of the child who has passed, note that I said "a drink" that doesn't mean drowning yourself in a bottle of Jack Daniels. Personally, I'm not sure I would recommend alcohol as a coping mechanism but you have to do what works for you, just make sure not to let it get out of hand. I take solace in the fact that I have done my best, with the knowledge and skills that I have, to help my trauma patients and I believe that they have gone to a place where they are no longer in pain or are suffering.

!Chris

[TennBSN]

I worked in a few different Trauma ICUs for about 5 years and I saw many horrible stories like the one you described. There are a few of the bad ones that I think about every now and then, the worst being a 16 year old girl that was water skiing and wiped out and sustained a head injury. Her brain herniated during the night when I was taking care of her and she died. I was a new nurse at the time. Had been out of nursing school for about a year. I can't count the hundreds of times I have wiped out while water skiing and I couldn't belive something so simple like that killed her.

My best advice for you is to talk about it. You are taking a great step by talking about it on this blog and getting the thoughts out of your head and trying to deal with the feelings this tragedy has left you with. Open up to friends or family. The memory of this patient may stay with you for a long time but the feelings you are feeling right now should fade away over time. If they don't you might want to think about a different area of nursing. You can't carry these feelings around with you. If you do, your performance at work will suffer and it will most likely take a toll on your personal life in one way or another.

Most healthcare workers have at least one patient they will never forget. Maybe this one will be yours. Just make sure that it doesn't effect you for too long. I hope this helps.

[ImThatGuy, BSN, RN]

Speaking from EMS and law enforcement experience, with time you become somewhat callous and de-sensitized. I think that imparts some of the sense of cynicism and jadedness that a lot of us in public safety share.

Example:

The biggest one for me was a smashed head to the point of pulverization. That's been six years. Sure, decapitations are one thing, but when it's smashed and fully intact with the body which was as "healthy" as your's and mine it's kind of weird. I still see and smell it from time to time, but I'm not melancholy or anything. I think I'm on top of old Maslow's pyramid, lol. You just learn to live with it. I can't explain how or why. The same goes with the other traumas I've seen. You just cope. Us in blue even have to inflict those traumas sometimes.

[futurern7370]

From the view point of a paramedic I agree with the above post in knowing that you did the best you could and knowing that all else was out of your control. What you take away from the trauma is some of the most important life experiences. A lot of people will tell you eventually you will become desensitized and to somethings you will but others will stick with you. You are human first, then a professional nurse. As a medic people often asked me what was the worse thing I have ever seen and I already know they were looking for the gore, the trauma but for me it was always the emotional calls that broke my heart. Where a spouse loses the other one after 50 years of marriage or the young mother that dies from cancer. Hang in there and take what you see and learn and cultivate it into your strength, best of luck.

[Jessie71385]

I work in LTC, and have for many years as a nurse and as an aide. I remember the first time I had a death, and of course it wasn't tragic like you experience in the ER, but it was hard none the less. You become very very close to the people you take care of in LTC, hence the reason I chose the job, I love the connection and closeness. The only thing I can say, is that if you are religious in any way, turn to God. I think God has his plan for everybody, and sometimes it isn't what we think is right or ok, but it is something that he chooses. It will get easier the longer you do what you do, and as I always say, if you lose that passion, if you don't feel anything anymore, you need to move on with your career and try something else. Passion is what makes us such great nurses, we care, and we love. Don't ever stop caring, don't ever hold back your tears, families and patients need that, they need to know you really do care about them and about what you do.

[arabianeyez83]

I've been a nurse in the ER for 4 years now, and still go through what u are going through. A young man was buried to death while plumbing, Rescue efforts started while he was only buried from the waist down, everything then collapsed, took them 12 hrs to get him out, his wife was there at the scene. He was brought to the ER in rigor, It got to me seeing him like that. It was hard to sleep that night, all i thought about was how he was buried alive and how his wife had to see it.

[sdemps]

I am a psychiatric nurse who specializes in trauma treatment, i.e. PTSD. In our training and jobs, we're expected to be able to split off our emotions and human reactions to serve the patient, then promise confidentiality and not talk about what we did at work. Oh, this patient died? Is the bed ready for an admission? So, nurses and other helpers get traumatized in their work and have no place to go with it.

You are experiencing "vicarious traumatization". You're having acute PTSD symptoms, i.e. flashbacks, identification with the victim. My recommendations are to obtain state of the art trauma treatment: Eye Movement Desensitization Reprocessing (EMDR), somato-emotional release, cognitive behavioral therapy, emotional field therapy are the top treatments. You will be released from the trauma, which is what you deserve. Untreated, trauma just piles up, and then it bleeds into the rest of your life, and eventually you can't do the work, or you become deadened. I hope you will get treatment because you have a heart and a desire to do ER nursing. We need you.

[TigerGalLE, BSN, RN]

From the view point of a paramedic I agree with the above post in knowing that you did the best you could and knowing that all else was out of your control. What you take away from the trauma is some of the most important life experiences. A lot of people will tell you eventually you will become desensitized and to somethings you will but others will stick with you. You are human first, then a professional nurse. As a medic people often asked me what was the worse thing I have ever seen and I already know they were looking for the gore, the trauma but for me it was always the emotional calls that broke my heart. Where a spouse loses the other one after 50 years of marriage or the young mother that dies from cancer. Hang in there and take what you see and learn and cultivate it into your strength, best of luck.

I agree with you that sometimes it isn't just the gore that sticks with you. I work in a medical ICU so I don't see a lot of trauma. But, this weekend I cared for a dying 86yr old man while his wife of 66 years stood by and watched. It broke my heart and I can't quit thinking about how sad she must be. Death is hard and for some reason or another certain patients stick with you more than others. I've had many of my patients die in my career but for some reason I can't get this man out of my head.

I'll say a prayer for you. What a traumatic thing to witness.

[crb613, BSN, RN]

I know exactly what you are talking about. I won't say it gets easier, but you learn how to deal with it. I have had and I am sure every nurse has & still has....certain things that get to you. I have felt like this with many pts not just traumas. You do what you can to the best of your ability but.... sometimes it is just not meant to be the way we would like...ya know?

I also know what you mean about wondering & thinking about how the last few moments were spent. That is when I find peace in prayer, I turn it all over to God. If I ever get to the point when suffering, and pain does not stir any feeling in me.....thats when I will stop doing what I do. Your patients are lucky to have such a compassionate nurse caring for them. May God bless you.

[HopeItWorksDNP]

Is that covered by Worker's Comp?

[sharkdiver]

I've never worked trauma/ED, but the two that I remember most happened decades ago in a former life as a LEO - both MVA's that happened a couple months apart.

First one, about 15 feet of guardrail went through the passenger compartment - cut the driver pretty much in half and scattered some of the pieces. After all the pics were done, the ME hands be some gloves and a bio-bag and asks me to help pick up the pieces.

Second was a teenage couple in an older VW beetle. He pulled out to pass a vehicle that slowed to make a turn, and hit a semi head-on. The gas tank in the beetle exploded and both teens burned to death.