What you didn't know

[Ballistex]

You knew I was late at bringing you the ice water you had asked for. I know you knew this because the nurse who relieved me that day told me about how you complained for quite some time about it. How you couldn't believe I couldn't keep up with the two patients I had in the CDU. You knew you didn't want to be in the hospital on Christmas Eve. You knew you had more important things to be doing. You knew you had family waiting for you to get home. But here are a few things you didn't know.

You didn't know that my other patient, just across the hall from you, a 23 year old daughter of a loving family, mother of a 3 year old boy, had just gone from bad to very much worse. You didn't know how I kept my voice calm in the room as I told my aide to call for the doctor even though my internal voice was screeching. You didn't know how many times I kept telling myself this wasn't happening. I had taken a job away from my usual ICU so this wouldn't happen. You didn't know, as I did, that her heart was going to fail her three seconds before she did. You didn't know the fear in her mother's eyes as I caught her gaze as I was compressing her daughter's chest. You didn't know about the controlled chaos that the code team always brings with it, the intubation, the bagging, the endless rounds of code drugs. You didn't know the word I uttered when the doctor finally gave up, nor the hatred with which it was uttered.

You didn't know how I begged him for one more minute even though I knew it would make no difference. You didn't know I was left alone in the room to clean up the aftermath, to make a very unnatural scene look somewhat natural for the family when they came back in. You didn't know that while I was getting that ice water that you received late I was thinking about what I could have possibly missed that would have made a difference. You didn't know that by the time I gave you that ice water I was blaming myself. You didn't know that after the family left I sat by her and told her how sorry I was that I failed. You didn't know how incredibly heavy her body was as I assisted the funeral home worker transfer it from my bed to his stretcher.

You didn't know that on that Christmas morning I wouldn't be thinking of my son and his third Christmas, but of another 3 year old boy instead, a boy who would forever remember Christmas not as a time of joy, but instead as the day he lost his mother. You didn't know that a part of me will always remember it that way as well.

You didn't know any of these things because I didn't let you see them as I gave you that ice water, late as it was. I simply apologized and asked if there was anything else I could do for you. The fact that you didn't know any of those things is a source of pride to me. It proves that I can go about my duties with a calm demeanor, regardless of what calamity may have happened. That fact says something about me, but as I get older I'm not sure it says anything positive. In fact, it seems to point to something very tiring indeed.

[Candwloc, LVN, RN]

Thanks for sharing! I've dealt with similar many times. Nurses like you are my true heroes

[3ringnursing, BSN]

I wish I could take this burden from you. We often see things as nurses most people would never imagine, or ever want to experience. We provide care, we ease pain, and we carry the weight of the world. We are the buffer, but not without cost to ourselves. Each one that slips through our finger despite our best efforts ends up taking a little piece of our heart away with them. No matter how hard our armour is, there will always be patient's that get through to the tender soul underneath. After all, we are only human.

[mimibrown, ADN, BSN]

Thank you for working so hard for your patients. You are the kind of nurse every patient should have!

[Kristiernbsn]

Every once in a while, I read something like this and think that maybe I DON'T want to be a Labor and Delivery nurse (I have 10 years of experience in the OB/Gyn area and always thought that when I graduate with my BSN next year, I would go that direction)

Maybe I am more of an ICU personality. I know that I'm not anywhere close to being ready skills- and knowledge- wise, but I have a calm exterior, and I don't get emotionally involved in my patients like some nurses I know. I have a ton of life experience, I'm not easily shocked or rattled, and I'm one of the top students in my class. I perform well on tests, but also in patient care experiences.

What other traits or prerequisites does a good ICU nurse need, besides a year or two of Med/Surg experience? That's a real question by the way-- I'd love to know what an experienced ICU nurse thinks it takes to survive and thrive in Critical Care.

God bless you for your skilled dedication to your patients.

[dec2007]

Excellent!! And to say it should be on the first Press Ganey is soon true!!

I agree, it should be on the Press Ganey; however, experience tells me that the complaint about the "late" drink of water will getmore attention from management than the stellar work you did trying to save the young mom. And that makes me very sad!

[cm8816]

Wow! That's why I left ICU. My son is now going through the same thing as an ICU nurse. You should send this story to NY Times. It is beautifully written and maybe will wake up those folks who think that nurses are there to bring ice water. Thank you for this beautiful story.

[justavolunteer]

My heart breaks to read an article like this. I am 'justavolunteer' & I've seen this kind of thing often. Patients on a restricted diet raising a ruckus because they can't have a cheeseburger & fries on a lowfat or cardiac diet. ADA pts howling because they can't order a sugary dessert. The hospitals get rated low on stuff like this when the rating should cover things such as "did the RN's move heaven and earth to get you better", "did the staff do a thorough job cleaning up Aunt Minnie after she pooped all over the place yet again". I can avoid most of the grief, but it's happened to me on occasion. The thing these types don't seem to realize is that they will likely get longer response time because no one wants to walk in their room & get more grief.

[cocoa_puff]

I had a similar experience when one of my patients coded and died, and then afterwards a FAMILY MEMBER for an elderly dementia patient yelled at me because "the call light has been on for over thirty minutes and mom need to be woken up to get pain medicine right now!" (the patient was sleeping peacefully)

[Double Dunker]

Wonderful article. Thank you for sharing it.

[WKShadowNP, DNP, APRN]

For once today, my speech about treating the sickest first actually changed someone's tune after complaining they hadn't been seen yet in a very crazy day in my er.

[Ballistex]

Thank you for all of your kind words. There are few in this world who can really appreciate my story. I've had people tell me that I should look for another "job". They don't understand that if this were my "job" I would have ditched it a long time ago. It's not a job, it's who I am and I believe every good nurse feels the same way. We give of ourselves to the extreme and it takes a huge toll. I was a picu nurse for most of my career and still think of myself as a pediatric nurse. I needed a break and stepped away from the picu and into a CDU but you can not hide from tragedy. You must look it right in the eye and never back down. Nurse on my family, for few will understand.

[purplegal]

Well written! I feel this is something that most, if not all nurses, can relate to, even those that don't work in the ICU.

As long as you have more than one patient, you'll always be struggling to balance who needs you more while making sure everyone receives the attention they deserve. My workload sometimes exceeds 20 patients (obviously I'm not in ICU), and have had similar experiences where I've had to take care of someone in an emergent state while someone else waits for something simple, unpleased. It can be hard to be friendly and caring when someone gets angry with you because they were waiting while you were doing something more important, but it takes a good nurse to be able to do that. Thank you for sharing your story of a job well done.