July, 2008 Archive

thursday night was the kind of night that made everbody say “what a night!”

i admitted my patient in bed 1 at around 2030, and i can hear the dialysis nurse talking to the patient in bed 3. i assumed it was an emergency dialysis because usually, they only dialyze till 1900, and those that can wait are done first thing in the morning.

i heard the patient answering the dialysis nurse’s question with a voice that didn’t give me any suspicion that something ominous was going to happen. there was no premonition. he sounded energetic, and was even talkative. although it was his very first dialysis experience, he didn’t sound scared, and i didn’t sense the presence of death.

a couple of hours later, i heard the call for a code. it was instinct for me to pull my patient’s curtain, like a mother trying to shield her child from seeing and knowing reality when we think they are still unprepared to face it. i wasn’t being dramatic. after all, my patient had cardiac issues. the last thing i wanted was to see him stressing out over the fact that doctors, nurses, and everyone else were running in and out of the room trying to save a life, just a few feet away from him.

i didn’t join the already crowded situation, but i clearly heard the chest compressions on going, and going, and going. i checked my patient, and for reasons i still don’t know, i apologized for the commotion. like it was my fault that somebody coded.

he told me, “all this is giving me a headache” and asked, “can i have some tylenol?” concerned that he eventually figured out his roomate was fighting for his life, i gave him darvocet. i told him it was something a little stronger, and that i hoped it will help him relax and eventually sleep. like i believed in magic.

after a while, i was pretty sure i just imagined the sound of the patient’s ribs cracking in bed 3, so i peeked. i heard the doctor ask if anybody in the code team opposed to stopping the code. there was silence, and i sighed in relief. they used up some of the meds in our code cart and somebody had to grab the code cart from the unit next door. it was THAT intense.

aside from the indescribable feeling of sadness i felt for the expired patient’s wife, the other sight that broke my heart was seeing the dialysis nurse leaning on the hallway wall, talking on the phone. she was distraught and was obviously in a state of shock. she was shaky and on the brink of tears.

later, i heard her say this was her first code and first death experience as a dialysis nurse. she was very quiet for a long time, looking beyond the walls and the faces before her, like she was somewhere else. one of the doctors finally said “things happen, you didn’t do anything wrong” or something to that effect. i think she didn’t hear. or she pretended not to, because she continued staring in space, spaced out.

i know she has been a dialysis nurse for at least over six years, because i have seen her around since i started working here. i don’t really know her, but i wanted to hug her. i didn’t, because even a hug, in that moment, seemed trivial and inadequate to reassure her. she never said it, but written in her face were an endless lists of self doubts, almost to the point of loudly owning up to the cause of the patient’s death. in reality, we all knew there was nothing she could have done to hasten or stop him from dying.

this is the thing: it boggles me that in general, nurses, myself included, tend to blame themselves when something bad unexpectedly happens to a patient who does not have a terminal illness. but, we never feel responsible if the patient gets better.

it takes a lot of empathetic talks and support to convince us that we didn’t cause the patient’s death or any of their worsening condition. we are always eager to analyze the scene over and over asking the proverbial ”what have i done wrong?” in the process. we get jolted, and although it takes a while to recover, we do move on, only to be reminded by a somewhat similar event sooner than we expect.

on the other hand, when gratitude is expressed for a job well done and a patient gets discharged in a better condition, we shy away from that pat in the back and say, “i didn’t really do anything.” if and when we sincerely accept acknowledgment that we were a part of some  good outcome, it only takes one patient going downhill to pull our spirits down and start that familiar cycle of taking the blame.

why are we so hard on ourselves like some uptight zealous idealists? why do we have to look for someone to blame all the time, and find that someone to be ourselves all of the time?

why is that?

i wasn’t even done mulling over this question, when i heard somebody pull the newly replaced code cart. again.

in the corner of my eye, as i see the people running towards another patient’s room, i saw the patient’s nurse, wearing that same face. the patient was eventually transferred to ICU, but that look was still on the nurse’s face. a look that reeked of self blame. again.

why is that?

i don’t even know how old she was. i only assumed she was in her 70s, because she has grown up daughters who looked like they were in their 50s.

they were the typical close knit family. there was always somebody at the bedside. one of the daughters, or sometimes, both of them. the very first thing they told us when their mom was admitted, was the STRICT instruction of not telling the patient what was wrong with her. under no circumstance was she supposed to find out that she had lung cancer, stage 4.

i won’t go into details of how the patient’s two daughters drained the patience and compassion of every single nurse who took care of their mom, because that would be a boring, redundant story. i will also spare you the details of how the doctors spent a LOT of time talking to them about every little detail of their mother’s condition, because they refused to accept the fact that she was dying.

my mom was very sick before she died and let’s just say i knew exactly what they were going through. i understood their state of denial and i knew why they were very persistent about keeping her a full code.

although i can criticize them for being rude, and it boggles me why some family members do not realize how pointless it is to be rude to someone who actually takes care fo their sick loved one, i will not criticize them. not only because i didn’t have the chance to be subjected to their unacceptable behavior (because their mom was never assigned to me), but also because i am aware that sometimes, stress and the anticipation of grief make people do and say unacceptable things.

what i can’t wrap my head around however, was their insistence to keep their mother’s illness a secret. i honestly think it was very unfair, to say the least. there she was, gasping for air, surrounded by healthcare people all the time, unable to speak and understand a word of english, lost in the translation of it all, unaware of why she felt like her life was slowy but surely drifting away.

they reasoned that their mother was a very pessimistic human being who, as far as they were concerned will not benefit from finding out the truth. they said the minute she finds out she had cancer, she will just give up hope and that will surely hasten her death. they strongly believe that with the help of eastern treatments and medicine, she will still make it and live longer. they believed that every western doctor had predicted the wrong outcome.

granted this was true, i still do not agree with the idea of leaving their mother in the dark. if you ask me, it was cruel, inhuman, and unfair that even in her last hours, she didn’t know what was killing her. it wasn’t enough that she might have had the idea. it was not right that they knew exactly why, and they never told her.

but then again, within families, there’s probably no definite rules about what is right and what is wrong.