Monday, September 5, 2011

Thankful there wasn't a #8.

When I leave this place today, I will have worked more than 75 hours this past week. It has truly been horrendous. Probably the most intense week I have known as a nurse practitioner. Seven patients died. I had so many serious end-of-life discussions with so many families; held so many crying mothers, fathers, daughters, partners. As I sit here with the past week in review I find that it is a blur to me now. I have trouble remembering the patient names, the families’ faces.

I will be off for a mere 48 hours before I must return to this place and reengage in my work. It’s funny though, the ICU that I walked into last Monday morning is not the ICU that I will walk out of this Monday morning; there are less patients, they are less critical. It’s truly amazing how one week can be so horrendous and the next can be so ordinarily common. The ebb and flow of an ICU can be a fascinating thing. One week is hectic and horrendous and intense and the next is common and easy and of no consequence. A different Attending will walk on today and the insanity that was last week will not necessarily touch the normalcy that is this week.

How easy life goes back to normal.

Yet it really doesn’t. There are seven families who went home this past week and are now facing life in a manner in which they hadn’t anticipated. Their lives will never be the same again and their previous state of normalcy will now morph into something else, something that in time will become familiar, but is so strikingly foreign right now. I wonder how long that transition takes. I wonder if that transition really ever does take.

The Attending for this week just called. I reported off to her, told her of the horrendous week we just had, told her of the good place the ICU is currently in. We laughed about simple things in life. She is sweet. I hope that she has a good week.

…and life goes on.

Saturday, September 3, 2011

A Shield About Me

"As long as there is a beat and a breath, do all you can!”

That’s what the family told me. But I knew from the moment that I laid eyes on the patient that they wouldn’t make it through the night. I knew we would code and code and code and that eventually I would have to call it. I knew we would reach a point when there would be no beat, no breath. And in the end we did.

I don’t know that doing all we can is the best thing to do. In the last moments of life I do not want someone pounding on my chest, feeling my ribs break under the force of their arms, having air forced into my lungs, feeling hands in my groin searching for a pulse, having a central line stabbed into my neck, being repeatedly shocked by the defibrillator. I don’t know what the patient felt or knew, but I hope not much.

Doing all we can sometimes means doing harm. We worked so very hard and in the end it profited nothing. I eventually called it. The patient was dead. Had the patient really even been alive since the moment I saw them?

I think I’ve always wanted to be the go to person, the person called to come “save the day” in intense situations. I wanted to be responsible. Now, being in that position, I realize the complete weight of that responsibility; I did not previously understand the stress of that burden. This past week I worked a couple shifts and found the weight of that responsibility almost unbearable. Lives depended on my thinking, my aptitude, my knowledge, my choices. I love what I do, I find joy in my work and in my practice, but it is also a burden. Sometimes the joy outweighs the burden and sometimes it does not.

Sometimes I make inappropriate jokes during extremely stressful moments. I emotionally take myself out of the situation and converse with others in the room about the weather, the smell of vomit, the tattoos found on the patient, anything else. Joking helps. We all laugh.

But sometimes I’m already emotionally invested, there are no jokes. I feel the weight of the world on my shoulders, I crawl deep within myself, I become short with the nurses, I become the burden I feel. In moments like those I often feel all alone. Ultimately I’m the one responsible and there is no one to help me.

I don’t know why, but when I find myself in extremely critical situations at night, I usually find myself partnered with the same nurse. She’s been a nurse a long time. She does her best to help me in whatever situation we find ourselves in. Recently, we were once again in a critical situation, the patient wasn’t fairing well. I was getting frustrated. I was trying to put a central line in and I was having trouble, I couldn’t find the vein, the patient needed it quick. The room was quiet. And there she stood, this nurse, assisting me. And then, during the midst of that extreme stress, she began to pray. It was a short prayer, my eyes never left the site I was working on, but my ears were on her words and my heart soon followed.

The truth is I am the one responsible. But the greater truth is that there is someone to help me.

A dear friend recently sent me a CD. I have listened to those songs over and over lately. As I walked into work tonight, with the weight of last night still dissipating from my mind I found the words to one song filling my soul.

“Thou, O Lord, art a shield about me
You're my glory
You're the lifter of my head
Thou, O Lord, art a shield about me
You're my glory
You're the lifter of my head

You're the lifter of my head

So, tonight I will say to myself, “As long as you have a beat and a breath, do all you can!” And I will, because I’m not alone, never have been.