-1 Thess. 5:16
When a solider takes a bullet or lives through a battle, the medical community rightfully looks at his resulting anxiety and calls it post-traumatic stress disorder. When a nurse works on a unit with high acuity, gives herself to each and every patient, and watches those patients die, what do you call the resulting anxiety and depression that follow her throughout her job?
Only now are we…
I have compassion burnout.
"We need to bring her over now. They can do report when they get here.” the manager of the other unit said a look of taut worry on her face. We nodded and quickly got our room ready.
You could hear the moans of pain as they pushed the stretcher down the hall. As they aligned the stretcher to the bed, my stomach clenched. A tech was holding pressure on the biggest hematoma I had ever seen. I glanced at the patient and my heart ached for her.
Her eyes were clenched shut as a steady trail of tears slid down her weathered cheeks. Her lip was quivering and a continuous verbalization of how much pain she was in tripped from her mouth. She was elderly, her short curly hair was matted down and her glasses askew as she sobbed. We pulled her into our bed and I quickly applied pressure above the hematoma in an attempt to stop the blood from accumulating. The tech continued to express the hematoma as I crushed my hand into her groin. Blood coated our gloves. Her blood pressure was low and her cries of pain heart wrenching.
The cardiologist walked in and I asked for pain meds.
"Uh… her blood pressure… I just don’t feel comfortable. She got something earlier." He said brushing me off.
"Well, She doesn’t feel comfortable either. This is torture. We already have her on fluids and pressors- we can turn them up… give her something." I said firmly, staring him down.
The patient whimpered under my hand and began a mantra that no nurse ever wants to hear.
"Oh please… PLEASE… just let me die. It hurts too much. I can’t do this. Please let me die." Her voice silenced us in the room. I glanced at the other nurses.
"No Ma’am. I know this is agony. We are going to get you something for pain…and we are going to try and get you better, OK?" I said softly and looked pointedly at the doctor hovering at the doorway. He nodded assent and a nurse scurried off to get morphine.
I continued to speak softly to her. As the minutes ticked by, the vascular surgeon walked in and out, restlessly awaiting the OR teams arrival. The groin started softening up, the hematoma stopped spreading and her blood pressure started creeping up. The morphine calmed her and though she was still hurting, she felt better.
She was in no way stable but between the tech and I, we had her groin under control. I held pressure until my hand lost all feeling and it was no longer safe for me to hold pressure. I turned her over to her primary nurse. I stripped my bloody gloves off and ran my hands under water to restore feeling. Not long after I relinquished control, her bp slipped again and the hematoma started growing. I felt a profound frustration and despite my hand still tingling I helped hold pressure again on the growing hematoma. As the vascular surgeon went to put in an arterial line, our little patient started gasping and couldn’t breath. Her heart started slowing and I started bagging her as they called a code overhead. The room was soon flooded with doctors of every genre. I spoke to the patient and her eyes flickered and she nodded. I held the ambu mask over her and gave her extra oxygen by blow by. A doctor started preparing to intubate her and I tried to stop him.
"She is awake!" I told him as the patient blinked.
"What?" He said as he tried to take the ambu from me.
"She is awake…Hey… Can you hear me?" I said looking at the patient.
She blinked at me and said in a tiny little voice.
"I am alright."
I looked at the doctor and he hesitated and then shrugged.
"I am alright" She said again.
The OR team arrived and in a whirlwind of white coats, green scrubs and anxious faces she was pushed towards the door.
"Thank you… for saving me." She said weakly as they pushed her down the hall.
The cluster of navy blue clad nurses stood and watched the procession from the doorway of the now eeriely quiet room. The pause felt heavy and each gathered their thoughts until a voice broke through.
"Hey… I need some help in here." Said another nurse.
In unison we moved into the next room, into the next crisis, into the next moment.
I can’t be alone in this. I can’t be the only nurse who wonders sometimes what makes a good nurse. I can’t be the only one who wonders why you can take an excellent ICU nurse to a step-down unit and see them fall apart. I can’t be the only one who wonders why you see the panic on the face of a step-down nurse when they start on an ICU floor. I can’t be the only one who is baffled at the resiliency of med-surg nurses who deal with so many patients with such patience.
I have been contemplating a change and yet, when I do, I feel almost panicked when I think about not being in the ICU. I don’t really consider myself a great nurse, but I work hard and I am good at my job. I was thinking about why I thrive in the ICU as I drove home from work the other day. Patient after patient had gone bad that shift and I could so vividly see the deterioration as it was starting.
I realized as I thought through the day…ICU appeals to me because I am a worst-case-scenario person. I look at sick patients and imagine the absolute worst and work to avoid it. I think about the worst complications and issues that are related to the symptoms and jump to that conclusion and work my way back.
Your patient is hypotensive?
I assume a bleed.
Your patient is acutely confused?
I assume a stroke.
Your patient is short of breath?
I assume a PE.
Your patient has a hematoma from a line pull?
I assume they will visit the OR.
Your patient is ‘just not acting right’?
I assume they will code.
It’s pessimistic. It’s negative. It’s dark.
And, it has saved countless lives.
In everyday life… no one wants to be around someone like me.
People want sparkles and cheer.
I am not completely negative all the time but, it’s interesting that a part of my personality that I never really liked… is the part that makes me very good at my job.
thewinged asked: Hi! I was particularly interested in your career as a nurse and as a nursing student myself for my school project I am conducting some questionairre interviews. Would you be interested in filling one out? Thanks in advance!
Absolutely. I am sorry if this is a delayed response, it didn’t show up that I had a new message, silly tumblr.
Let me know how I can help.
But you saw no fault, no cracks in my heart
And you knelt beside my hope torn apart
-Mumford & Sons
The shriek of the bed alarm filled the unit, in unison we pushed our chairs away from respective desks and ran towards the sound.
"LAY BACK!" The command filled the air as nurses swarmed into the room. He looked at us through filmy blue eyes. He struggled to sit on the side of the bed and we quickly placed him, kicking and yelling, back onto the bed.
This had been going on for over a week.
He garbled out some expletives at us as we settled him back down. He wanted to use the toilet we managed to understand through his southern accent, toothless mouth and dry lips. As we assisted him to the side of the bed, he paled suddenly and starting sinking backwards.
We quickly laid him back in bed and assessed his pressure. 60/40. He was mumbling incoherently and his face was drained of color. We bolused fluid and he rebounded his pressure within 30minutes.
I wandered into the room later that day and looked at him.
"What is wrong with him?" I asked his nurse.
"Oh he is fine… I think he just sat up to quickly and he had his morning blood pressure meds." She said shrugging.
I looked at her and frowned. She was a very good nurse- smart and capable. But, I disagreed. He was still subdued and that was completely unlike him.
He was a post- cardiogenic shock patient that we had been dealing with for over two weeks. Originally he was a handful because of how critically ill he was. He had a heart attack and then cardiac arrested when he was admitted to our unit. We coded him, got him back and then he got a balloon pump, intubated, vasopressors, swann… he was a wreck. Then, slowly, the machines were taken away and he began a new challenge.
Agitated, delirious, and downright combative. He hit plenty of the nurses, including me, and attempted to bite and kick us on many occasions. The only phrase that was coherent for days was “F*** YOU”. How pleasant. He went through alcohol, benzo withdrawls and he remained “crazy”. After two weeks of being on our unit, he had orders to transfer, we were simply waiting on a bed… for days. He needed to be near a nurses station and that was keeping him here.
Around change of shift, he again tanked his pressure into the 60’s. We started him on pressors and bolused fluids.
We called the cardiologist and he asked bewildered.
"What do you think is causing this?"
"I am not sure… He is on a heparin drip- can we check an H&H? Maybe he is bleeding. He has been complaining of hip pain…" I suggested.
They had done an xray earlier on his hip but as I assessed it, I avoided the actual hip and palpated all around the soft tissue- he cussed me out for hurting him and we began to suspect a spontaneous retrobleed.
We sent one H&H to the lab and confirmed by iStat… our step-down patient’s levels had plummeted by 4 grams.
He was intubated so he could tolerate a CT of his abdomen/pelvis.
Our previously stable step-down patient was now on high dose pressors, intubated and going to need multiple transfusions. The CT confirmed a retro bleed.
We left that night shaking our heads and as we walked out my charge nurse looked at me.
"Well… I am glad we didn’t transfer him." She said raising an eyebrow.
He would have surely coded had he been on another unit where vitals are taken less frequently, his antics overlooked and his complaints of hip pain rationalized or not understood….
He drove us crazy for weeks… The irony is that the delirium, combativeness and impulsiveness saved his life by delaying his transfer.
The irony is that the nurses who knew him best knew he was the worst and when he stopped fighting we knew something was wrong.
The Irony is that the very people he cursed and hit for weeks were the very people who saved his life…not once, but twice.