Wednesday, March 29, 2006


When I work (I do generally 5 or 6 night stretches) a lot of the time I end up with the same patients during that stretch. I take ownership of those patients... Having a patient for 6 nights in a row can be both a blessing and a curse. A blessing because - the continuity of care is a good thing - you "KNOW" the patient, the family knows you, and there's a certain comfort level that comes with those things... a curse - because you can become attached, the patient may be a pita, the family may be pita, the patient may just be weird, or the doctors may just drive you bonkers. The other curse is that no matter what you do right not every patient will survive what has brought them to the hospital. This curse is tough... as a nurse we're here to help, to fix things so to speak. Switching from taking care of the patient and "fixing" things to comfort and taking care of the family is a complete 180 degree turn.

End of life things - are hard to describe. I think as a nurse it is an honor or a privilege that a family gives you to care for their loved one at the end of their life. I think my job as a nurse is to make sure that all of the patient's and family's needs are met. That the patient is allowed to die with dignity and pain free. Here's an example... I apologize in advance...

Probably a year or so ago I had the pleasure of taking care of an individual who was involved in a car accident. He was truly in an accident - he wasn't drinking, someone else hit him. He was a good person and his family was devestated by the initial news. The father who had raised him was devestated. When his parents had divorced his father was the one who had primary custody and raised him. This man truly loved his children. The injury report he was given was bad... very bad. I spent 6 nights talking and praying and educating and listening as this father wrestled with the decision of what to do. He knew what his son would want, but he was terrified if he made the choice to "withdraw support" that his other son would hate him. He was fearful that his injured son would end up in a nursing home alone - that the family as a whole would visit but that they would get on with their lives. It was a very realistic fear and he knew it. He didn't need me to tell him that but he needed me to validate what he was saying.

Every now and again you get lucky... you get lucky in that you can see/feel this palpable love... this was the case his dad would be there during the night and generally go get some sleep and show up again around 4-5 in the morning and we'd talk about his son, about what kind of person he was, and you could feel that love that he had for his son and the love he had for his other children. It was heartbreaking to watch - but also a privilege.

Eventually we found out why his brother was having such a hard time with this - they (meaning the pt and the brother) had had an argument - neither one ever got the chance to apologize. Guilt can be a tremendous thing to overcome... and fortunately the patient's brother was able to do that. The patient's mother had a tremendous amount of guilt because she'd been a pretty lousy mom... The patient's father was wrestling with the guilt of wanting to do what the patient would want - withdrawing support.

Ultimately everyone in the family came to the same conclusion based on numerous conversations, hours of prayer, and I believe God's hand was all over this - because we were able to arrange hospice and the patient managed to survive a 3 hour ride to his father's home, he died about an hour after getting there. After that stretch I was emotionally bankrupt. I had nothing left to give - but I did and I still do.

I don't love death, but I do think end of life care as a nurse is one of the hardest things to do as well as the most important things to do. In nursing school they discourage you from crying with families... in reality a lot of nurses cry with families - including me. I don't normally allow family members to hug me. Every now and again one gets through and it solidifies and reminds me that I was meant to be a nurse. It validates what I do. I may not get thank you notes, or even an update card telling me how that patient and their family are doing, but that moment, that day I know that I've done some great things and helped this family in whatever they are dealing with.

I love my job. I think it's a privilege to be able to help families and patients when they need it most. I'm not going to say it isn't easy, but it's something I hope I'm good at. I hope this post makes you think. Advanced directives or durable power of attorneys for health care are wonderful things... make sure your loved ones know what you do and don't want - it is truly important to do. The other thing I'd like you to think about is...

Everyone always tells people to live each day as if it was your last, but truly how many of us do? I don't always, but I try. I never let the sun go down without letting my husband know I love him. I always hang up the phone with loved ones letting them know I love them. So live today as if it was your last. It's kind of liberating isn't it?


Marz said...

Wow, that is truly a tough job you have. Never really thought of nursing in the aspect you explained here.
You are a rock.

Sami said...

A rock? No, definitely not a rock a human yes... I think that this particular aspect of my job is the hardest- more difficult than dealing with a critical patient that you're titrating drugs on and more heart breaking...

I probably should have added that while it would have been wonderful for that particular patient to be my only patient he wasn't. Rarely do you get just 1 patient... that's the real unfortunate part. Patient's and families always feel as if the nurse doesn't have time for them just to talk... You can't tell them the reason you have to leave is someone is sicker than them, that you're short staffed, that another patient needs you, that you have to chart, etc. That's the more frustrating aspect of all this.

I hope I haven't turned anyone off of nursing... I do love my job or profession as some would call it.

Jill said...

This is a wonderful post on several levels, and it has made me think about many issues, such as appreciating each day, getting around to writing an advance directive, and career satisfaction.

I'm glad to hear that you love your job, even though it's hard. (I don't love mine, and I have been putting off making a change for way too long.)

You sound like a great nurse, and with your attitude toward your job I'm sure that you have been a blessing to countless patients and their families.