goodbye

when i decided i was finally ready to transfer to the ICU, i knew that people would die more frequently.  i've done a decent share of palliative care in the past, and it's something that i enjoy.  but, once again, i was not prepared for the reality of dealing with that level of grief.

on orientation, my main goal needs to be to see as many things as i can.  that means that when there's a challenge, i need to take it.  it's the only way i'll get enough experience, and the only way i'll be able to survive on my own in a few months.  so when i saw that there was a patient who we were going to be withdrawing cares on, i seized the learning opportunity.

my patient was a middle aged man who fell down the stairs.  he was found by his teenaged son.  neurosurgery had determined that he has a non-survivable brain injury, so the family made the decision to terminally extubate him.

terminal extubation- not a thing that i have ever experienced before.  essentially, we remove the breathing tube that's keeping a person alive with the knowledge that they will die soon thereafter.  depending on the level that the patient needs the ventilator, death can happen quickly or take days.

so after family meetings, hospice paperwork, and a whole lot of waiting, the respiratory therapist pulled the tube.  i'm not sure what i expected to happen, but it was a bit anti-climactic.  we suctioned the patient, and gave him a ton of morphine to manage his air hunger.  his family stepped out during the extubation process, but i quickly called them to the bedside so they could be there.  i felt that things would go pretty quickly, as the patient became tachycardic and his oxygen levels immediately dropped.

i felt the way that i've felt in these situations in the past: sad, but at peace.  i knew this was the right thing to do.  and i felt that way until the patient's son came to the bedside.  and then i witnessed the most heartbreaking goodbye that i have ever experienced in my entire life.

a teenager shouldn't have to sit and hold the hand of his dying father.  it just seemed so incredibly cruel to me, the fact that less than 24 hours before everything had been normal for this kid.  i stood quietly in the corner and just watched this kid sob, apologize, and promise to be a good person who would make his dad proud.

after a half an hour, the patient died, and the family said their final goodbyes and left.  and to be honest, the enormity of the moment didn't hit me right away.  there was so much to be done...calling the donor network, getting paperwork together, preparing the body.  my preceptor and i made ink handprints of the patient and sent them along with him for his son.  we sent the patient down to the morgue, and i still had another patient to take care of along with a ton of charting that needs to be done perfectly before the body can be released.

so it wasn't until i was driving home, and couldn't stop thinking about this family, that i realized what a toll the day had taken on me.  i was physically and emotionally exhausted.  i couldn't stop thinking about the patients son, and about how he was feeling.  about what would happen to him.

i wasn't all that surprised when all of the sudden there were flashing lights behind me, because i was in a daze and didn't remember most of the ride home.  the officer came up to my car, and saw my scrubs and badge.  he asked if i was coming home from work, and must have asked me something about my day, because the next thing i knew i was sobbing on the side of the road and pouring out the whole story to this stranger.

sometimes this job just hurts.  i have seen things that i would rather forget, but will always remember.  i have so many storied locked away inside that i would never tell my family or non-nursing friends because i don't want them to have to carry that weight.  but i carry it.  most days i don't even think about it, but on a day like this one, sometimes i get so tired that i don't think i can take another step.  it's exhausting.  it's a huge responsibility.  and it scares me, because i just signed myself up as a witness to more grief and pain than i could previously imagine.  what will that do to me?  i am not a person who can just go about my life like these things never happened.  i care.  i care sometimes even when it's detrimental to myself.

how do you keep yourself separate from the pain of other people without being cold?  how to you empathize with their grief without getting hurt?  there must be a line somewhere, one that i'm going to have to learn to tip-toe up to without crossing.  i think it must be a skill like any other, one that i'll learn with time.  at least i hope so.

growing pains

so it's official, i have a new job.  that's right, after over seven years on the trauma unit, i finally decided to move on and am now a nurse in the surgical critical care area.  it's definitely challenging, and i'm learning a lot.  i'm trying to adjust to my orientation schedule, and to being brand new instead of being the resident expert.  things are going well!!

...so that's pretty much what i say to people when they ask how things are going.  i'm trying to be positive and tactful, and to avoid saying anything that will get back to the wrong people and get me in some kind of trouble with my new unit.  but the truth?

THIS IS SO HARD.

i won't say that it's the hardest thing i've ever done, because it's still better than being fresh out of nursing school.  but not by too terribly much.  first of all, i hate change.  hate it.  HATE IT.  i would much rather be warm and cozy in my familiar environment with people who love me and accept my neuroses.  instead, i'm treading lightly so these people don't think that i'm actually insane and trying to keep a handle on all my feels because, as i've been told, "there's no crying in the ICU".

to my credit, i haven't come close to crying at work.  yelling at people, maybe.  quitting to become a librarian, yes.  cursing the day that i thought i should do this, oh for sure.  i have run through every possible emotion.  and i know in my heart that this is the only way for me.  as i said before, change is not my thing.  this is how i react to it.  this is basically what i knew would happen.

but knowing it and going through it are two different things.  first of all, i'm exhausted all the time.  when i can sleep, i sleep for like 12 hours.  it's like being a newborn baby.  i also have what fellow coworker (thank God I have one friend from the floor who's doing this with me!) and I have coined as "ICU brain".  in short, the high volume of new knowledge leaves no room for anything else, including basic brain functions and motor skills.  this leads you to completely forget entire conversations, to drop pretty much everything on the floor, and to throw your car keys into garbage bins instead of actual trash.  it's debilitating.

also a delight is the 29387489723 hours of online education that i now get to enjoy.  this ensures that when i actually do have a day off, i feel either stressed or guilty.  it's a throwback to nursing school, minus large volumes of alcohol.

and of course the main issue: this people are terrifyingly sick.  this week i had a lady on nine drips.  Another patient's pressors ran out and his blood pressure tanked.  one day i was half way though pushing a med and my patient when into an unstable rhythm, then into V-fib (read: bad.  dying.), then back into an unstable rhythm, leading my preceptor to utter the terrifying words "we're going to have to code her".  um, yeah, ok.  we can do that after i finish PEEING MY PANTS.  for all of those who think that i should have expected this, duh, i thank you in advance for keeping those (very true) thoughts to yourself.

also something i've noticed about the ICU: everybody dies.  ok, not everybody.  but people die at an alarming rate.  i've been on the floor for three weeks and two of my patients are dead with one other not far behind.  again, in my head this is something i knew that i'd have to deal with.  but it's way different in practice than in theory.

so at this point you probably wonder if i'm going to
a. jump off a cliff
b. end up institutionalized or
c. quit

and the answer is...none of the above.  i am in this for better or worse.  i am doing this, i am not quitting, and i will get through it.  these are growing pains, these feelings are normal, and it will get better.  it HAS to get better.

because that thought is what is currently getting me through my days.