July 10 will mark my 10th year as a nurse. When I began, I was shy and naive. Now I am already an old nurse, surprised by nothing and filled with battle stories. I’ve spent the last seven years working in a medical ICU, and I’ve seen and done so much. I counseled a bewildered husband on withdrawing care on his cancer stricken wife. I got in a fight with a hematologist who insisted we transfuse a man who kept going into pulmonary edema. I’m convinced my antagonism prevented an intubation. I’ve pushed morphine, and through tears, told a widow-to-be to hold her husband’s hand while he breathed his last. They were both 28.
A few years ago, probably to appease satisfaction scores, my hospital mandated a class in empathy training. We were instructed on how our own empathy fell short, on how we needed to learn to feel what the patient feels.
I can’t possibly feel what the patient feels. If I did, I’d be crippled with grief.
It hurts to be a nurse, especially in ICU or oncology. I remember a woman I cared for years ago who had a head and neck cancer. She was dying and before they withdrew the husband asked for a second opinion. After we took her off the ventilator, I watched her sons, 6’5” men, weeping at her bedside. Her husband, a diminutive quiet guy, never shed a tear. When I was leaving later that night, I saw the husband standing in the hallway, hunched, expectant, holding a lunch pail, looking for all the world as if her were waiting for a third opinion. I went home, ate dinner and was watching something brainless when suddenly I began to cry. I kept seeing the husband in the hallway, so bereft he couldn’t yet process it. What happens to us, I thought, after we bag the body, clean the room and admit another patient? The wheels of the hospital move on.
Yet through all of these years, I’ve been stoic. I’ve understood that there is a time to live and a time to die, and I’ve considered it a privilege to provide a person with a good death. And there is a rush to saving a life, an edge to being to intimate with death and so far, I’ve been willing to give up neither of these things.
I may have come to the end of my capacity. A trifecta of patients pushed me to my limits one Sunday. Number one was a boy with cancer. He was 26. Last year he was healthy and normal and when I met him his lungs were so bad that he had to be pharmaceutically paralyzed to allow the ventilator to do its work. On that Sunday, on my walk in, the hallway was filled with red eyed nurses from the oncology floor who’d come down to check on him. The nurse that had taken care of him yesterday was crying in the breakroom and asking if she could have a different assignment. Lisa never cries, she runs marathons and shrugs things off. The patient’s father paced the hallways.
Patient number two was a middle aged woman with a tumor on her carotid artery. She was demanding and cantankerous and I liked her. She wanted everything done as fast as possible, but I could see through her tough demeanor. She was scared out of her mind. She and her family were given options. Hospice care or a procedure that would cause complications but buy her a few weeks. She chose no more interventions.
I went in to unhook the monitor and disconnect her IV. While I was touching her, she heaved herself upright. I held her while her severed carotid bled. She lost at least a liter of blood in my arms. This is the end I thought. I called for help, but there was nothing to do. I told her family to come in, even though it was horrifying. What if it was her last moment on earth and they were waiting outside the curtain? She stopped bleeding and didn’t die that day.
Patient three was a man in alcohol withdrawal with pneumonia. He ripped off his oxygen and screamed for air. He tried to jump out of bed on unsteady legs. He was verbally abusive and if we hadn’t pinned him down, would have been physically abusive. It isn’t unusual for nurses to deal with physically violent patients; and our administration is very supportive to make sure we don’t get hurt. However. this particular man got to me, with his unpredictable outbursts and I found myself wanting to hit him back. Together with the bloodbath in patient two’s room and the knowledge that patient one was dying, I was a frazzled mess. By the time I got home, I was worn out to the core.
My sister works on the oncology floor. She texted to ask me what was going on with the young boy. The whole floor is a wreck, she said.
When I went to bed that night, I couldn’t sleep. I was nauseated, shaking and crying. I kept thinking about all of the nurses on the oncology floor, trying to take care of other patients through their grief. I kept thinking about the blood spurting out of my patient’s mouth, the sure knowledge that nothing modern medicine had cooked up could save her life. I couldn’t face the thought of going back. I called in and spent the next day on the couch, letting my mind drift.
What about all the other nurses? What about the oncology nurses who couldn’t function? What about Lisa? There’s no acknowledgement that we suffer, that we witness tragedy. We are expected to keeping passing meds, charting and being helpful and positive when we interact with our patients. No taint of another patient’s suffering should mar our demeanor. We are not given a day off to recoup, or even an hour’s break with a cup of coffee. Instead, we are told to be empathetic. To commit to being more involved with our patients so that when they fill out their surveys, they remember the nurses as caring. We are given more charting, more alarms and more demands on our already tightly managed time.
What is the end of all of this? Burnout. Our compassion tanks run dry. We either leave the profession or we become lazy and embittered. This week, while to celebrate nurses’ week, my hospital is giving us badge holders and inviting us to walk the Monday Mile, thank a nurse. If you are in administration, ask yourself if your nurses are burned out. Ask yourself if you could witness death, day in and day out and stay sane. We need to change the expectation that being a part of agonizing loss is normal and give nurses space to grieve.