Wednesday, October 22, 2008

Nurse Follies: On Death and Dying

Aside from being verbally assaulted by a psych patient, the weekend went okay. Oh, and there was that incident where Toph came up and pulled the Code Blue button in an empty patient room. While I was trying to put the pysch patient back into bed. I didn't run to the source of the code blue like one of Pavlov's dogs because I had my hands full, but the other nurses did. That boy is lucky to still be alive. As much as I hate codes, he probably would have ended up with a size 7 clog up his ass had I been one of the first responders.

I think I told him as much

Monday morning, an alarm went off, and I looked at one of the central monitors. A B/P of 53/38. For you lay people out there, this is not good. So, I haul ass to the room to find Smo, another nurse who actually was assigned the patient, a resident, and the patient, who didn't look so hot.

"DNR/DNI," Smo muttered to me while the resident attempted arouse the patient. Sometimes, sternal rubs can work, but he was just shaking the patient's shoulder and yelling, "Wake up!"

Dude. When you have someone who is non-responsive, a crashing blood pressure and heart rate, collectively gray in color, and one eye open...THEY ARE NOT SLEEPING!

So, hands legally tying us from doing anything to save the patient, we just stood around the bed and watched the numbers on the monitor tumble until everything hit zero, which is only a matter of minutes. So, yes, we watched as this patient died. After the fact, we helped the nurse fill out the added paperwork, then went about our work as if nothing happened.

I don't know of too many professions where you can watch someone die, and then go about your business without a second thought. Most people would freak after seeing something like that, but not us. I've talked to other nurses about this, and it seems that the new ones have a harder time dealing with dying than those who have been in the trenches for a while.

Is it cold-hearted? Or is it a defense mechanism?

It's not to say that we don't care, nor have have compassion. I'm quite protective of my palliative care patients and their family members, but I don't become emotionally involved.

I guess if all nurses took each death to heart, letting it rip them apart from the insides, we'd all have nervous breakdowns at some point. Probably sooner than later. Perhaps there is a part of our minds that shield us from the horrors we see, the worst of the human condition, so that we can live sanely. Is it any wonder that so many nurses face some sort of addiction down the road?

I try to keep my addictions closely tied to chocolate.

There was an episode on That 70's Show where Eric went to work with his mom (who was a nurse) for the day. One of her patients had died, and Eric remembered how she talked about him and his family at dinner. Kitty maintained a smile and kept upbeat, leaving Eric to wonder how one could cope with something like that. Kitty never answered, she just kept singing to the radio.

Reality is a lot like that.

Nurses have their own ways of coping, and not all of it self-destructive. It doesn't mean we don't feel bad. It doesn't mean that we don't care. At some point, we personally experience loss in our own families or close friends. It's at that point, we cease being the nurse, and go back to being the sister, daughter, wife, mother. To grieve the loss of one person in our lives is a lot easier than to grieve for humanity. The mind and heart can only take so much.

This is the job we do. Warts, death, and all.


bobbie said...

It is so hard for 'outsiders' to understand how we deal with death & dying on a (fairly) regular basis.

And I know some nurses can't handle it at all. Doesn't make them a bad nurse at all.

But I think some of us just have a gene that lets us care (sometimes deeply), without losing our souls.

Some of the BEST ICU nursing I ever did was at the bedside of a patient we were letting go, or with their families.
Again, just an ability some are born with.

Spyder said...

I have the highest respect for nurses. Bless you all for what you do.

Midtown Miscreant said...

Couple of things. I've lived with 2 nurses, still live with one, so I've listened to them both talk about some patient or another that died. The thing that stood out was the ability to disconnect, insulate themselves from it. Seems like you would have to have that ability to do the job.

I go to the VA for my health care needs. The doctors seem to have a half assed , fast food approach to their jobs. I'm always relieved when I get lucky and get to see a nurse practitioner, rather than a doc. They just seem to be more aware, and they include the patient, let them know whats what.
Great post.

Hound Doggy said...

IMO...many times, there are worse things than death.
If someone has a DNR order...perhaps they know this.

Suzy said...

When my dad was in ICU they asked us if we wanted to sign a DNR. My sister and I felt unable to make that decision and the nurses said they were not allowed to advise us. So I said, if it was YOUR dad, would you sign? And they all said yes. And we did.