Last night I had an extremely sick patient. She was a 30 something woman who spent her first hours out of jail injecting her hip with drugs filled with, among other things, dirt. By default, dirt is full of a particularly nasty bacteria called Clostridium. This bug, once introduced inside a person, rapidly and systemically overruns the body, its defenses, and our ability to fix it. The infection she came in with is 100% unsurvivable. No person, ever in the history of medicine and/or IV drug abuse, has ever survived an infection of this magnitude and classification. This woman was no exception. She was dying when she came in, she was dying when I got there. She died under my care. As it went down, I knew it was inevitable. I knew it was going to happen. What I didn't know was how I would react to it. After five years of nursing, I have come to accept that there are things we have to endure. Death. Death is one of those things. Although some people do it to themselves, I always take it personally when it happens on my watch. My quantity of nursing has taught me many things. Among them, when you take care of someone, its on your oath as a nurse to do everything you can to keep that person alive and make them better. When you cant do that, it always becomes personal. That's not to say I blame myself in any way or have any doubts about my skill. I know I am a great nurse. I know I have a great supporting cast in this theatre of chaos. I don't debate what I do for a living. I would never be happy anywhere else. I always find myself surprised in the most unlikely situations.
What surprised me wasn't the 40+ units of blood products she received. Nor was it the 50+ liters of fluid. I wasn't shocked by the poor blood pressure or the terrible heart rate. It wasn't her lungs being flooded by all the fluid. It wasn't the pool of blood she lay in. What surprised me was my own seemingly anesthetized response to the whole situation.
Let me explain. As she started to code, as her heart slowed and her blood pressure dropped, I went through all the motions. All the right steps. Called the docs. Called the code. Pushed the drugs. Started CPR. Hung the blood. Pushed the fluids. Prepared for the chest tubes. This is what I do. This is what I love. When you are in the middle, there is always that stinging feeling of someone else's life in your hands. Usually, I cant help but feel a buzz, sense of euphoria, a slight tremble of hand. But this time was different. This wasn't how I normally feel. Through it all, I couldn't help but feel paralyzed. I did everything I was supposed to do. And yet, I felt nothing. I just remember thinking, why are we doing this? Why are we wasting so much on something so futile? Why are we so driven by quantity and so completely detached from quality? We knew before the code even started that she was going to die. And yet, we felt justified in pumping liter after liter of fluid into an already flooded body. We compressed and bagged an already lifeless soul. As I stood there next to the doctor, all I could think was that we are truly selfish beings. We are so wrapped up in what we can do, we don't stop and think about what we should do. We want totality. More, it seems, is better.
What about dignity? What about grace? What about plausible outcomes and quality of life? What about the baby in the ER who needs that blood? What about the teenager in the trauma unit who needs that fluid? Did I give my patient the best care by doing everything? Did I give her the dignity she deserved by letting anyone who walked by into my room to compress her chest? Does being a great nurse really have anything to do with quantity??
I say no. No it doesn't. Being a great nurse has everything to do with quality...
1 comment:
What you have to say really resonates with me. I am a nursing student about to graduate. So far, I've learned a lot about the politics of care. Yesterday I had a patient in the final stages of esophageal cancer. He was a Hospice patient, NPO, and actively dying. My only job was to suction his trach PRN and monitor his morphine pump. Near the end of the day, I went to check on him one last time before leaving. He was covered in bloody sputum and gasping. I immediately started working to clean him up and suction all the sputum out of his trach. This became an impossible task; he was gushing blood from probable tumor lysis and it would not stop. No matter how many mLs I sucked out, more just kept coming. As I worked in panic, one of my classmates ran to get the nurse covering me. She said she was busy and would come when she was free. Our instructor came in the room, took a look, and said "well, he's Hospice. Get him cleaned up and let's get out of here." This experience really opened my eyes. The nurse and my instructor just expected that we leave him there and get on with the business of caring for other patients. We as students wanted so badly to save him - to make him whole and bring him back to health. After all, it's what we've been taught. I guess the fact that the patient is dying is sometimes overlooked because we think that we can save them. Life prolonging measures that go above and beyond providing a caring, comfortable end are so often implemented that they seem normal when instead, it may be time to let go.
On another note, how are the hospitals in Seattle? I plan to move there when I graduate. Any suggestions?
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