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.