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?