I've been a nurse for almost 12 years now. 12. Freaking. Years. I can't get over how fast the time has gone, and how much I've experienced so far in my career as a nurse. There have been ups, there have been downs, there have been a lot of in-betweens. Every now and again, there is a situation that I encounter at work that shakes the very foundation of why I became a nurse, who I want to become as a nurse, and where I'm going from here on out. Some time ago, I had one of those situations.
Because of privacy stuff, I can't say too much specifically about the situation, but I'll say what I can. I was caring for a little old lady…I've taken care of my fair share of little old ladies and little old men throughout the years. I like taking care of little old people. Their life experience is invaluable, and I always find myself learning something new with each little old person who crosses my path. Another reason I think I like them so much is because a good number of them remind me of my Grandma Ellringer. She's been gone for over three years now, but I still miss her terribly, and every now and again I see a little bit of her in the wrinkled faces of my patients. So my little old lady…my poor, sweet, sick little old lady, who I think was more sick than any of us realized, and more sick than her family had led us to believe. The shift had started out decently well, but at some point in the night, things started going terribly wrong. I called in support from my follow nurses, the respiratory therapists, and the physician on call. We were managing it…we were just barely staying ahead of her symptoms, but still, we were staying ahead. Until we weren't. I called her family to let them know what was going on, because if I was her family, I would want to know, and I would want to be there to support her. I think there's got to be almost nothing worse than being surrounded by strangers during a medical emergency. Sometimes a familiar face makes a huge difference to someone who is struggling. So they came, and they sat with her, and she calmed a bit, but continued to struggle. By the end of my shift she had transferred to the ICU, and I just had a horrible, sinking feeling about it. Sometimes it's like that…patients take a turn for the worst, they go to ICU, and sometimes they get better and we see them again on our unit a few days later. But, sometimes they don't get better, and we don't see them again. And to be honest, most of the time we can tell who's going to come back and who isn't…there's just this feeling, I guess…I don't know how else to describe it, because it's not something that I can put a finger on or quantitate…but it's still there all the same.
So I went home after my shift feeling defeated, horrible, and sad. What had I done wrong? What had I missed? What, in the name of everything out there in world, freaking happened? And you know, the worst part about this situation, is that there is no closure on my end once a patient leaves my unit to go to the ICU. Because of privacy laws, I'm not allowed to access a patient's chart once he or she leaves my unit for a higher level of care. A lot of times, I don't even know if the patient lives or dies unless a family member makes a point to track me down and give me an update. Sometimes if I have a personal relationship with a nurse in the ICU, I can get updates that way, but even that is probably breaking some sort of privacy law. And I hate it. Watching someone cling to the very edges of their life, doing everything I can to keep them here with us is such an emotional experience. I'll spend hours at a patient's bedside, helping them to breathe, helping to keep their heart in a stable rhythm, keeping them awake, keeping them alive, for Christ's sake...helping their family understand what's going on and what's going to be done, looking in their eyes and seeing the despair and the struggle, and the fear…there is sometimes a point when I will lock eyes with a patient who is not doing well, and sometimes there is a moment where we both know what's coming, and it's something that neither of us want to acknowledge or admit…because to admit to impending defeat means that we've already lost the battle. And then they go to the ICU and I'm supposed to just carry on like it never happened. And I can't. I just can't do it. It seems like a huge injustice to the patient to not acknowledge what happened. And it's not fair to me to sit and wonder…did I do something wrong? Was there something that I missed? What could I have done differently? What actually happened? Did the patient choke? Did the patient have a heart attack? Cardiac arrest? Septic shock? Blood clot? What can I do next time to get a better handle on the situation? What do I need to look for? These are all questions that go unanswered for me because I'm not allowed to follow up, I'm not allowed to talk about it, I'm not allowed to ask about it…I'm supposed to just suck it up and pretend like it never happened.
There are little things that get to me the most when a patient isn't doing well. Seeing them struggle to breathe, seeing the light go out of their eyes as they get more and more tired of fighting whatever it is that is going on in their body at that very moment. Their body becomes a prison, and there's no escape. Well, there is an escape, but it's not the one they want, it's not the one they're prepared for, and it's not the one that they admit is lurking right around the corner…and that's why we fight. As a nurse, I establish a relationship not only with my patient, but with their family members as well. What is most heart-wrenching when a patient isn't doing well is the family. Watching a husband pack his wife's shoes and clothes into a generic, plastic patient belonging bag, knowing that he's hoping and praying that she'll wear them again someday. Seeing a wife sitting at the edge of the bed, holding her husband's hand, running a cool hand across his forehead as a fever takes hold. Some families are prepared, some are not…more often they're not. How do you prepare for the death of a loved one when that's not even on your radar? Most people I know prefer not to think about the death of their loved ones…it's not pleasant, it's depressing, and I do think that a lot of people live under the assumption that if you don't think about it, then it's not there. And when death is an inevitability, it seems like maybe it's a waste of time to sit and think about it.
Through the grapevine, I did learn that my little lady eventually did pass away in the ICU. This was a small hospital…the respiratory therapist is married to a nurse whose sister is a radiologist whose husband is a lab technician whose cousin works in the ICU…you get the gist…it's like 2 degrees of Kevin Bacon. I've tried really hard over the years not to take patient deaths personally. Sometimes things just go wrong and there's nothing we can do about it. I can't help but wonder afterwards if the family members think that I am somehow responsible. In this particular situation, I had received no indicators from the patient's family that would have lead me to believe this, as they were very thankful that I had communicated with them and kept them in the loop, but still I wonder. Which causes me to question…how much personal accountability do I have for what happens? I don't know. Maybe some, maybe none...I don't think I'll ever know. Sometimes I wish that I had the time to sit at a patient's bedside all night to make sure that they don't choke, that they don't stop breathing, that they don't have a heart attack, but I can't. And that would be wasted time anyway…people don't spontaneously die in the hospital at a constant, at least not on the med-surg units.
Maybe it would be better if I didn't know what happened to my patients after they transfer to a higher level of care. Maybe it would be nice to think that they got better and left and that no news is good news. I wish I could just be content with that, but I'm not. And what does it matter if my patient lives or dies? Should the death of a complete stranger have that much bearing on my day to day life? This is one of the reasons why nursing isn't "just a job." When people's lives hang in the balance, and sometimes are affected directly by what course of action I take, that ups the stakes quite a bit. I was talking with one of my coworkers the other night about situations in which patients unexpectedly pass, and I said that I don't know how ICU nurses handle so much death. She made the comment that they probably just get used to it. They "get used to it." If it's even possible to get used to the idea of people dying, how does one go about getting there in the first place? Can anyone really "get used" to seeing people die? It sounds so cold. But…in an environment where death is frequently a very real outcome, maybe they have to. How else could you function? But no matter how much death a person sees, it has to affect them in some way…it has to.
In healthcare, there is always the very real possibility that from time to time, a patient will not make it. It's true…we can't save everyone, but that doesn't stop us from trying. There are so many ways that a patient can die in the hospital that it would be useless to list them all out. Luckily for me (and my patients), most of the time they come in, they get treated, they get better, and then they go home. But it's not like I haven't had patients die before…it's not like I haven't ever experienced death in both my personal and professional life. I do, I have…death is part of being alive, it's impossible to avoid it. It's even less avoidable than taxes. It will happen to everyone at some point. I know this. I don't know why some deaths are more difficult than others. Maybe because it's not often that I care for patients who are critically ill. I've cared for critically ill patients multiple times in multiple different hospitals…sometimes caring for multiple critically ill patients at the same time. Had a lack of caring for critically ill patients made me complacent? I've been extremely fortunate and incredibly lucky to have been a nurse for as long as I have and to have not had a patient traumatically die on my watch. Some might say that I'm going to bring bad luck upon myself by putting that statement out there, but I don't believe in that nonsense. I don't believe that patients go crazy when the moon is full either…I think patients can and do go crazy every day of the week. If a patient is going to crash, they're going to crash…if they're going to go crazy, they're going to go crazy…nothing to be done about it but weather the storm and hope everyone comes out okay in the end. And most important, to learn from it…always always keep learning, no matter how hard the lesson.
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