Dear Dr. _______,
You retire in a month and I wanted to write you a note to let you know how much the last 3 years has affected me. To be completely direct, you terrified me. I spent the better part of my first year hiding from you and hoping you were not taking care of my patients. I worked weekends to avoid doing rounds with you and I would turn 100 shades of red when you asked me a question.
Then one day, you challenged me to stand up for my patients in a way that told me that you knew I was holding back and being too timid. That day changed everything about who I am as a nurse and what being a nurse means to me.
Last week after talking to you on the phone about the poor prognosis and imminent death of my patient, I was able to speak frankly with the family. It changed the entire course of treatment for that patient for the better… and you didn’t even realize it was because of your words.
I have gone from being a nurse who followed every order and got nervous about saying anything to physicians… to a nurse that makes a list of everything the patient needs to survive, thrive and avoid complications… and I don’t rest until the needs are met. I have gone from a nurse who would never offer a thought about a treatment to a nurse that will ask any doctor to explain their plan, rationale and offer my own plan if necessary. I have gone from accepting that it is a lost cause when the doctors say so to refusing to give up unless it is the patient’s idea or interventions are futile.
Dr. ______, because of you, I have become what I always wanted to be… A nurse.
You have made a difference in so many patient’s lives and in the lives of the people you work with.
I sincerely thank you,
It’s smeared across TVs, movies, books and the internet. People crave it, hope for it, and say it all the time. I have seen Hollywood love. I have seen the running in the rain or driving madly to the airport love where people fall into each others arms. I have seen that version a thousand times. As a single woman, I have wished for that version. And for that, I feel ashamed.
I know what love is… I know what it really is. I have seen the real thing only a few times…but, it’s different than what people usually think.
8207- Love is Patient. “That’s my baby. She is a fighter. Don’t you think so? Isn’t she amazing? I’m gonna marry that woman.” He said with fierce pride emanating from his blue eyes. She had withstood intubation, cardiogenic shock, septic shock and now major abdominal surgery. She was still with us. Still fighting against all odds.
“I’ll be here.” He said looking at her. “You hear me, baby? I’ll be here… no matter how long it takes to get you better…”
8204. Love is not self seeking. It was in the grasp of her hand and the tears trailing down her cheeks as I stood beside her turning off what little support he had. It was in the way she looked at me in complete desperation and asked with her heart breaking.
“What do I do now? What do I do? Just go home… without him?”
It was in the way her husband had given a crooked grin the day before and stated, “She is the best thing that ever happened to me…With her- I’ve had the best years of my life.”
She hadn’t been in the room to hear, he didn’t have to say it. That’s how I knew he meant it. He wasn’t getting better, his heart, lungs, kidneys and body were failing. They decided together to choose comfort and peace. She held his hand the whole time, loved him through every breath.
8207.Love always hopes, it always perseveres. It was in the way he walked to her bedside and then turned to me.
“I can’t give up on her… She is the love of my life. I refuse to give up on her.” His eyes had looked at me with such love for his wife that I wanted more than anything for her to survive. She was beyond medical help and yet she was fighting for him and I knew he was fighting for her. Irrationally, pointlessly…but, neither was ready to let go of each other.
8201.Love never fails.
It was in her face as she turned to smile at me while she helped her husband eat. They greeted me cheerfully and we chatted. Days later, the vigilance took its toll and she was admitted as well. The look she gave him when she saw him was indescribable. She lectured him gently about taking care of himself as she lay in a hospital bed , the unflattering gown hanging around her small frame. He nodded and squeezed her hand. He blew her kisses as they wheeled him from the room and she brushed a tear from her eye.
Love. It is unexpected in today’s selfish world. We envision the butterflies and the Hollywood whirlwind. But, love isn’t that simple. It is work, dedication and truly putting someone else in first place. Love is not easy to find and true love even harder to spot… but, my job as an ICU nurse allows me to see just how easy it is to separate the butterflies from the real thing.
And, the real thing… is absolutely beautiful.
The squeak of the IV pole’s wheels contrasted with the grind of the wheelchair as we rolled down the hall. I had volunteered to help transport but only for one reason- I wanted to see the look on her face.
He was a complete sweetheart who stole all of our hearts immediately. He would smile, laugh and wave every time we walked by his room. His darling wife was just as pleasant and equally joyous.
We had learned that morning that while he was recovering in our cardiac ICU, she was admitted to our step-down tele floor with syncope. He was stable and being transferred to another pod on that floor so I told his nurse that we needed to take him calling on his sweetheart.
We knocked on the door and in the seconds following the door opening, her face and the family’s faces made every nursing nightmare disappear. His wife’s damp eyes and extended hand towards her husband made us all smile.
"Oh! I just KNEW you guys would bring him!" She said smiling.
The family in the room wiped their eyes as we wheeled him close enough to grasp her hand. The moment was the sweetest I have seen. He was overjoyed to see her and they sat smiling at each other.
We remembered why we like to do our job. We remembered that nursing is not just about the labs and the drips. It isn’t about the medications and the doctors orders.
Nursing is completely, 100% about the patient.
"Its exhausting. But rewarding, Definitely rewarding. I know that I have done something at the end of my day. Whether it just be administering someone some medication (…) or just give someone a hug when they needed it.”
- Kathleen Ring ( Nurses: If Florence Could see us now)
We have brushed shoulders a few times, but never officially met. I have seen your work many times though and I know you take your job seriously… But, in case you haven’t noticed…So do I.
Thank you for waiting until I left. Thank you for not being there when I was there. You avoided me didn’t you? I was prepared to fight you and clearly you weren’t ready for me.
But, after standing guard for 7 days I had to relinquish my role. You didn’t waste time. You knew she was weak… You knew she was tired.
I knew that, too. I talked to her. I talked to her family. I talked to her doctors, respiratory therapists… everyone.
You crept in today and stole her away. The one day I haven’t been with her in almost a week… but, She was ready. She knew it was time. She made decisions and wanted to go.
I was having fun with my friends and trying to shake the burden of the last 7 shifts and then my phone buzzed with the news.
I am relieved she isn’t suffering. I am relieved she decided against allowing CPR. I am relieved that she is at peace…
But, some small part of me is broken because of you, Death. I wanted to see you defeated. I wanted to see the miracle that they prayed for. I wanted to believe as strongly as her family did that you wouldn’t prevail.
But, you did.
I still believe. I still know there are miracles. But, I feel like with every loss a small piece of that is chipped and swept away.
So, Death… you won this round. But, I am not defeated. You will have all you can handle with me. Next time won’t be so easy. Next time I’ll be even more prepared. Next time I won’t even acknowledge you.
Next time, I’ll believe in miracles.
The vacant stare emanating from her eyes was almost eerie. There were moments when the rain pouring outside was reflected in the tears on her cheeks.
She was miserable.
Her mouth hung open slightly and spit trickled from her lips. A feeding tube dangled from her nose and a CPAP machine whirred. IV pumps spouted off names and doses in regular intervals. The steady hum of the continuous dialysis made the room full of the quietest sounds.
It was her eyes though that made the gray feeling in the room palpable. They were staring but not seeing. Blinking but not moving. They were tearing but not crying. They were hurting but not feeling.
She was dying a slow and painful death. A death I didn’t understand. She had been intubated twice, extubated twice and now was teetering on a third intubation. She had an unfixable cardiomyopathy and had failed medical management. Her kidneys had given up and her body was weakened.
I spoke softly to her and she nodded appropriately.
Behind the vacant eyes was a hint of life that no one but her family understood.
The doctors had approached her softly at first and repeatedly told her there was no hope.
She had refused to hear them and told them God would heal her.
They approached her again more forcefully and explained that continuing probably meant a Trach, PEG tube, and a nursing home… She again denied making herself a DNR and making herself comfortable.
Today her pressor support increased and I couldn’t remove fluid with CRRT. She was lethargic and barely moved. Her oxygen requirements increased and the emptiness in her eyes spoke volumes. We called the husband and told him again she was failing.
"She will never leave the ICU. If she were my sister, mother, aunt… I would say the same thing… We have done everything we can and we aren’t making any progress." The doctors told them repeatedly today.
Instead of heeding their sad report, she weakly said again that she would rely on God’s plan.
Don’t misunderstand…Even as a cynical ICU nurse, I have faith. I am a Christian and I do believe in God. But, something in this woman upset me. This was her choice. This was her belief and her terms. I am always pleased when a patient lives or dies on their terms.
But, she was a full code and wanted absolutely everything done- despite no hope.
She refused to spare us, her health care providers, the pain of breaking her ribs to no avail. Her body was so broken and hurting already and yet she insisted we code her if we had to and push her body to the limit. A miracle would save her, she firmly believed that.
I should admire that tenacity. That unwavering faith.
Instead, I shook my head and slumped in my chair. I watched her blood levels degrade and her body deteriorate slowly. I eyed the code cart and cringed at the thought of shocking her poor body.
Her critical care doctor looked me in the eye after looking at her and the chart and shook his head.
"You call a code… and I will call the code…" He said bluntly. I understood. I call it overhead and he would come as fast as he could to end it. I appreciated that.
I walked into my patient’s room and took in the figure wrapped in warming blankets to fend off the chill of continuous dialysis, her tired eyes now closed in sleep. Her vitals blinked in the grayness of the room and her machines blotted out the other noises of the unit.
I stood for a moment and wondered how she and her family refused to see how unnecessarily painful this was for her. I looked down at my shoes and shook my head. I was glad she could make her own choice but her choice was going to hurt so much more. She would create angst and a question of ethics with the nurses and doctors that took care of her. As ICU nurses, we strive wholeheartedly to save a life and treat to the best of our ability. And yet, we couldn’t save her. She would be a traumatic code that would ultimately end in a traumatic death for her family, the nurses, doctors and finally- herself.
I hated myself for thinking if but the thought radiated through my being… that her faith in the end would make me question my own.
Lose our way,
We get back up again,
So get up get up
You gonna shine again
Never too late to get back up again
You may be knocked down,
But not out forever
“I have never had my patient code on me…" She said, leaning against the door as I gave meds to my intubated patient. She was one of the newer nurses on our unit and was telling me about a code earlier in the week. She continued after a moment.
"How long have you been a nurse? I have been a nurse 2 years and I think I am able to prevent most of what happens because I see it coming…But, she doesn’t see it and didn’t even know her patient was coding." She was referring to the nurse on the floor who had the patient that had died.
I glanced at her as she shook her head and shoved her hands into her jacket.
”I have been a nurse 4 years… all in the ICU. I have had mine code on me…Your patient has never coded and died on you?” I said skeptically.
She paused and looked to see if she had insulted me by implying that nurses who had a patient code were terrible nurses.
I eased her discomfort.
"Most often… my patients are sent to me coding. I understand what you mean- I think in this sort of environment there is a lot of gut feelings, instinct and the ability to predict what will happen and prevent it. Its looking at the labs, the patient’s change in status and knowing how to put a dam in the river to stop them from just…spiraling. It’s a lot of just knowing what the chain of events will be if you don’t stop it. You can’t always teach that."
I have a lot of friends who joke with me when I hang out with them after just getting off a shift.
"Save a life today?" They ask grinning.
"Always" I usually reply with a grin and shrug. I play their game and joke back. But, when they ask that question- a million details of the day swirl through my head. Not everyday do nurses compress a chest during CPR. Not everyday do we shock or push life saving meds.
But, every shift, every hour, every minute we analyze, adjust, accommodate, integrate and filter all the aspects of a patient’s physiological and physical parts. We watch trends in labs and treat what we can or alert the doctor. We watch changes in heart rate or rhythm, blood pressure and titrate accordingly. We can spit out almost everything about the patient by memory and most data going back a few days. We do everything we can to avoid losing a life. But, we can only do so much.
The nurse was still chatting about codes as we turned my patient.
I considered her as she talked. I had no doubt she would have a patient code on her at some point. She would have that feeling of pain and guilt that maybe she missed something. It would not make her a worse nurse or a failure. People die in the ICU because they are sick, no matter who their nurse is.
The next shift after that code…
The next hour after comforting that family…
The next moment when the doctor announces,”Time of death…”
That would show how good of a nurse someone really is.
Like falling down in any aspect in life, its when you can get back up and face another day that truly makes you stronger.
There are those who think that life has nothing left to chance
A host of holy horrors to direct our aimless dance
"Well. You did all you could do." He said as his eyes perused the paperwork.
I glanced at him and lowered my head.
"Yes…We did." I replied softly. He was referring to the death record, the proper identification tags and the fact that it was incomplete for the organ donation agency to fill in later.
I helped him slide the gurney through the door and stood for just a moment watching him maneuver down the hall. I turned back to the room and paused.
Her inquisitive brown eyes flashed in my mind. She had watched me move from side to side doing my work. I had watched her, too. The way she held his hand and prayed all day that a miracle would happen. The way she accepted his wedding ring that we had slid from his finger with a tear and a quick nod.
In my mind, I heard the finality of the beeps as I had turned off the pumps one by one, silencing what little support he had.
She had clung to a shred of hope despite what the doctors had said. She wasn’t unrealistic or overly dramatic. She simply hoped until the very end that he may come back to her.
The room was full of people and I avoided eye contact and tried to wipe my face of the obnoxious sympathetic look that is so easy to adorn.
No one saw me anyway. My voice barely broke the silence that sat so heavily as I said the dreaded words.
"I’m so sorry. He is gone."
The last shred that held her together disintegrated like my words in the quiet room. Her breath expelled quickly and a low wail escaped her. Her son slipped his arm around her and she leaned over the bed.
Her whispered pleas were all anyone could hear. I faded into the background as she hugged her son.
"He was so proud of you, son. So proud. He and I talked about it all the time and he was just… so proud of you."
No eyes were dry in the room as she leaned back over the bed.
I slipped from the room, my feet heavy as I walked to get more tissues.
My eyes burned and throat was clenched. The other nurses asked what was wrong and I shook my head.
Minutes later the son retrieved me because they were concerned the patient’s wife wasn’t doing well.
I approached her and knelt beside where her wheelchair was parked.
"You OK?" I asked stupidly, instantly regretting my words but not knowing what else to say.
Her brown eyes looked at me and she touched my hand.
"I… I am just so sad. I lost my best friend today. My best friend." She trailed off and then looked at me. "26 years. We were together 26 years and he made me laugh everyday."
Over her shoulder, her son’s cheeks glistened with tears as he listened.
I said nothing. I held her hand.
Hours later as I stared back into the now empty room, I shook my head sadly. This room would be cleaned, turned over and remade. A new soul would occupy it and never know the trail of loss, hope and sorrow that was left. The room would forget the pain and tears.
That’s the thing about being a nurse though.
We remember them all.