I’ve been going through a streak over the last few months… a death streak. It seems like many of my patients are dying – definitely more so than the other nurses I work with. If I had to guess, I would say I’ve dealt with approximately 10 deaths in the last few months, which is a very high number for one nurse in a surgical ICU.
Some of the situations/patients that stand out:
- the patient I previously wrote about who had HIV and passed away moments after his dog was placed at his side; whom he had been waiting for (Emotional Strength)
- a women who didn’t fair well after a long and difficult surgery to repair two damaged heart valves; she never woke up after surgery. I took care of her on her 3rd day post-surgery; she was on maximum doses of all the medications that were keeping her heart going and was not breathing on her own (just through the ventilator). When I came in to work that morning, her heart rate was dropping quickly. I placed a call to the surgeon to let him know that the patient wasn’t doing well. He told me to get the husband there (which he already was) and that he was driving to the hospital now & his exact orders were “keep her alive until I get there”. Keeping a person alive that is trying to die is a very difficult thing… I’m adjusting medications, pushing drugs, manipulating the external pacemaker, etc. The surgeon showed up after an hour, talked to the husband, and they decided to let her go when it was her time (although we did not technically withdraw any of the life support). And her time came quickly without all my interventions- within 10 minutes.
- It was 07:15am and I was receiving report from the night nurse on my two patients. They were both relatively healthy, awaiting beds on the regular floor to be transferred out of the ICU. This particular patient was a 68 year old female, who was sitting up in the chair, waiting for the breakfast trays to be delivered. She had diseased arteries in her heart and had gone to the cath lab the day prior and they placed 2 stents in one of her vessels to keep it open for blood flow. While I was sitting outside the room with the night nurse, the patient pushed her call light then started moaning loudly. We both went into the room, and the patient was silent and unresponsive sitting up in the chair, despite her heart rate remaining steady on the monitor (signs of stroke?). We screamed for help and approximately 6 staff members lifted her back into the bed. At that time, her breathing became shallow and her heart rate dropped; we called a “code blue” and worked on her for over an hour until her family arrived (they were called by the house supervisor). There was nothing else that we, including the 3 physicians at the bedside could do, and the family was with her when we stopped our resusitation efforts.
- Most recently, we had a patient who was elderly and had advanced heart disease. She had signed DNR paperwork prior to being admitted to the hospital, but the hospital was not aware and she was intubated after arrival for respiratory failure. Her family arrived, she was not recovering, and they made the very difficult decision to withdraw life support and let her pass on, which they knew was her wish. We took the breathing tube out around 6pm and she was still in the ICU bed the next morning; unresponsive, but alive. I was not the primary nurse caring for her, but I was taking report from that nurse so I could keep an eye out on her 2 patients while she had lunch. She gave me the run-down… “she’s a DNR, we’re awaiting a hospice consult since she did not pass away quickly, her heart rate is stable at 80, and she is breathing regularly on her own.” Okay, have a good lunch, Nurse. Not even 5 minutes after the nurse when to lunch, the patient’s heart rate suddenly plummeted into the 40s, and then the flat line – asystole. I went into the room, where her 3 children sat around her bedside to check a pulse and listen for heart tones – she took 2 more gasping breaths and she was gone.
Some may say that I get the sick patients because I’ve proven that I can handle the medical and social aspects of the care, which is probably (and I hope) mostly true. But, there’s a little piece of me that can’t help but wonder…. what if it’s more than that?
I can’t imagine dealing with that much death. I know that throughout time, you can become desensitized to it all. The one thing that is important is to be as warm and sympathetic as possible but also not lose your mind from caring too much. It’s quite the tightrope to walk.
Not only does it require skill and dedication to do your job, but I believe empathy and compassion play a huge roll. Amazing how your 6th sense comes into play. It’s as though you know what the next steps should be.
I work with many Hospice organizations and volunteer as much as I can. At the end of the day, I realize that I should be thankful for this moment in my life. I never know if I have tomorrow. Great post. Thanks for sharing!
Don’t do that to yourself. Everyone has runs like that. Those folks were just so sick that it was their time to go: cliche but in this case true. Look at all the patients who got well and went home!
I can empathize with you Amy. When I was working on the fire department in Green Valley when I was in college I went through a “streak” like you. Between November first and December 19th I had 18 codes. Green Valley is about 25 minutes by ground to the closest hospital in Tucson, St. Mary’s. Only one of the 18 codes still had a viable heart rhythm when we got to the hospital. I later found out he died less than 3 hours after we transferred care.
Yes, it’s probably the most difficult thing you will deal with as a health care provider. Yes, you will begin to question your skills and abilities. Yes, your confidence will tank. But the most important thing to know is that YES, you are human, you are doing the best you can, and you are making a positive impact in the lives of your patients and their families.
I can’t tell you how many times I was thanked for doing what I did. I took it personally when my best wasn’t good enough. I even apologized to one family once. The wife told me that as she watched us work her husband, she saw the care and compassion in us and knew that we did all we could and she couldn’t ask for anything more than that. Somehow, it made it just a little bit easier to put the uniform on for the next shift and go again.