Portal to Heaven and Hell

so, there are several hard things about working in critical care. i've mentioned a few of them in passing, things like smelly patients, patients who do stupid things to themselves, crazy family members, etcetera. also, my job has its share of crappy co-workers, management issues and other stuff that probably most every other job in the world has. there are, however, some things that i find personally very hard to deal with.

i had a case, back in nursing skool, that involved a young teen. lets say this person already had a history indicative of poor health in general, so maybe some of what eventually happened wasn't totally unexpected. lets also say that we (and by 'we' allow me to generously include myself in the care of this patient, but lets be real-the amazing ER staff at that hospital were the ones doing the real work), did everything that we could to help this patient out.

this person was a someone that we did CPR on, on and off, for a few hours. this was a pediatric case, so we were of course trying our best to stabilize this patient enough for transport to Local Huge University Childrens Hospital. the specialized childrens flight team couldn't actually fly in due to weather, so they were on their way via ambulance.

during this time, there were two ER docs , two or three respiratory therapists, as many as five nurses, a cardiologist, and three or four mid-levels (nurse practitioners or physicians assistants) in the room at one time or another, trying to work on this patient. what i'm trying to say is that the crew was professional and thorough, and working well as a team to provide the best level of care that 21st century emergency medicine could offer.

two things i want to point out from this experience. one of those things is flight nurses are the best of the best, and that experience is what led me to want to become an icu nurse. remember how many people were in that room, working on that patient? check out what happened when the flight team nurses got there.

first of all, they're really short and bitty. helicopter flight nurses need to weigh less than 220 lbs when fully loaded with gear, and they usually have 20 to 30 pounds of gear. so these two nurses (two! just two!) walk into the room exuding, in my mind, complete calm and confidence. i really didn't feel that it was at all cocky, i just felt like the A team had arrived. they asked a few questions, and then......made a few suggestions. and......the doctors LISTENED! to a coupla NURSES! the nurses suggested things in a way that was very considerate of the doctors ego's of course, and when the doctor actually said, 'hmmmm, i've never thought of that ....' and then TRIED it, i was floored. i decided right then and then and there to be the best icu nurse i could ever be. i didn't and still don't aspire to be a flight nurse, cuz, let's face it, i haven't weighed less than 220 stark naked since i got married x number of years ago....but icu nurse extraordinaire i can aim for and might actually hit.

the other thing is one of those Hard Things this post is about.

at some point in the development of emergent medical care, somebody researched and determined that when doing life-saving procedures on people, its okay to let the family observe. instead of shunting patient family away from what is going on, family members are allowed to be as close as they can stand (figuratively speaking, as long as they're not actually in the way) to their loved one as possible.

so during this four hour tour, i was standing with the house supervisor, who was charged with the task of 'recording' the code. that meant that they were writing things down as they were happening. as she was writing, she ran out of paper, and so i offered her some of mine (as a student, i was forever taking notes). she, out of the goodness of her heart and maybe the crampiness of her writing hand, let me write out the rest of the code. she stayed on my left shoulder, coaching me on what to write and 'splaining things to me as they were happening.

at some point, i turned and realized that the person standing on my right shoulder was the patients father.

watching people rhythmically thump their childs chest, put tubes in, pump drugs in, take measurements of, feel for pulses, cut clothes off, discuss in cold abstract medical language.......

just standing there. tears pouring off of his face.

he looked like he had just gotten off of work. tired. older, maybe.....late fifties? wearing a thick brown wool suit. looked too old to have teen-aged child. he had another child, older, maybe my age, the one that had brought the patient in, standing just outside the trauma room, supporting the mom, in tears, on his shoulder. the mom, a woman whose face i couldn't see because she couldn't take her face out of her other kids shoulder. i could hear her sobs, she was that close, but she couldn't go into that room.

i am proud to say that, in that moment, i kept my composure. later, when things had settled down, i had a chance to ask some of the other nurses what they did so that stuff they saw did not affect them. the answer that i got was 'you get used to it.' another answer that i got was from my clinical instructor, who said that this kid didn't even merit any sympathy. his reasoning was that there were millions of other kids suffering way worse in other parts of the country, for reasons as stupid as not having enough to eat. hmmm.........

is that a bad thing? 'getting used' to the sight of hoomin suffering? comparing the suffering of different people to find someone worse off? and this is no ordinary run-of-the-mill hoomin suffering, this is parent-losing-child kind.....

the fact of the matter is that sometimes, most times, growing such an unusual thick skin is the only way to survive. somebody at work the other day mentioned that in the ICU, we are a portal to heaven or hell, and i laughed cuz it was a great line, and in many respects, it is totally true. sometimes, the souls are already on their way to one of those places, and what we are taking care of down below may just really be the physical portion. but we are left to deal with the family, making agonizing decisions. sometimes these are decisions based on selfish reasons, sometimes there is a lot of denial, sometimes they're the 'right' reasons but regardless, there are some very hard decisions to be made.

if we take every death personally, we can do more than burn out. we can really hurt ourselves. i like the fact that i don't take my work home with me. i punch out and i'm gone man, gone. the healthiest nurses i know, the ones that have been in nursing the longest are also the ones that have full and complete 'things' away from nursing. enjoying the outdoors, being involved in politics, building paper airplanes, making music. yeah, i only work three days out of seven. yeah, i can make my 'weekends' during the week, and go shopping on tuesdays, have casual lunches on wednesday and watch movies on thurday nights, all times when there are fewer people around. because listen, the kind of contact i have with people when i am on the job...........trust me when i tell you YOU wouldn't want to be around people on your time off either.