Thank you, next

Death is a funny thing; especially from the perspective of a medical professional. The incredibly high patient census and severity of presented illnesses do not allow for effective coping with emotionally-intense situations. You’re given a patient load of 7 on any given shift; one or more “expire”, and there are 5-6 other patients requiring your undivided attention.

In my first year at this hospital, a few patient deaths have stuck with me and even haunted me. You start to build a rapport with patients and their families when you see them shift after shift. Patients come and go, but some seem to come back more frequently than the others due to their declining health. Some might refer to this as a frequent flyer situation, but I reserve that term for those who treat the hospital like their own primary doctor office or a pain medication dispensary.

These are patients who want to get better, but ultimately will not.

One of the first deaths that hit me the hardest happened early on in my residency program. This patient had been in and out of the hospital for nearly two years; their heart’s functionality was practically nonexistent and it was negatively impacting the rest of their organs. This individual was chronically dependent on a cardiac drip, which is essentially reserved for those at the end of life; without the continuous infusion of medication, this patient’s heart would not be able to beat on it’s own.

The time I truly got involved and invested in this patient’s care was the second time they were admitted; I requested to have them on my assignment. They were back with congestive heart failure exacerbation and complications with their lungs. After reviewing the recently drawn labs values and the extremely low resulted ejection fraction from their echocardiogram, I quickly realized what was happening. Even being a new nurse, I knew that the lab results were indicative of kidney, heart, and lung failure.

My patient was dying.

I was in the room when the hospitalist came to tell the patient the bad news. They were blunt and straight to the point, “Your organs are failing you, and you are actively dying. You do not have much time left, I am sorry, I will give you time to discuss what you might want to plan for going forward” and they walked out. It was just me, the patient, and their spouse left in the room.

It was eerily silent; no crying, just the coarse lung sounds of an individual who was just given their death sentence. Not knowing exactly what to do, I sat down on the bed with them and did my best to comfort and be present. I know for a fact that these two did not want to give up, so I suggested they let me get them a Palliative Care consultation so that this service can be provided for both of them at home instead of the hospital. This service would allow them to live their lives together the best that they could in a place that is comfortable to them; not sharing a room with another patient and sleeping in separate beds. I explained to them that this is not them calling it quits, and that this provides them with help so they can live out the rest of their time together.

They both agreed. The next day, both the patient and their spouse left the hospital with Palliative Care services at home. The following week, I walked onto my unit and took a look at the bed board; I saw this patient’s name listed again. Being early, I asked my Charge Nurse to put this patient on my assignment. As soon as their meds were due, I went to the room and the patient was laying in the bed with their spouse at the bedside. Both of them immediately remembered me and started to cry.

Taking a look at the updated results in their chart, I knew that the end was very close and that the Palliative Care team was not going to cut it. The patient told me that they at least were able to be home for Thanksgiving and enjoy the apple pie that they raved about during the previous admission. All of my free time was spent in this patient’s room; no break to eat or pee, just sitting at their bedside and ensuring both of them were as comfortable as possible.

The next morning, I was able to get this patient a Hospice Care consultation so they can be provided the necessary medication at home to ensure the patient is as comfortable as possible when they pass away.

I did everything I possibly could to ease the pain for both the patient and spouse, but I couldn’t save their life.

I had three days off. When I walked back into work, my Charge Nurse took me aside and said that this patient never left the hospital because they were decompensating fast and that they passed away the day after I left them. I became emotional and had to step away; I came back to the unit a few minutes later and went to work as if nothing happened. In such a short amount of time, I developed a strong enough rapport with my patient and their spouse that I did not see them as my patient; they were more like a relative than anything. This loss of a patient felt as if I lost a family member.

It’s been almost a year since this happened; I still remember the room, the faces of the patient and their spouse, my conversations with the hospitalist/Palliative Care Team/Hospice Team, the conversations and the shared laughs, the face of the patient, and how I felt hearing the news.

Emotions like this occur all the time; to everyone, whether they are good or bad. The hard part is trying to compartmentalize what occurred and the associated emotions and lock them away in your head. For example, a patient passes away in room #6; the postmortem care and paperwork need to be completed as soon as possible. The patient then needs to be transported down to the frigid morgue with the rest of those who have expired. You get back up to your unit and there is an admission already on the bed board for room #6; you need to get past what just occurred and get ready to care for the new patient coming to the floor. Being in this position, there is no time to grieve, there is no time to show emotions; you have a job to do and you need to provide excellent care to six other patients on your assignment.

It is no wonder why medical professionals crack and burnout after a while; we experience trauma on a daily basis and do not have the time to seek help. We are expected to say “thank you, next” after experiencing heavy loss and often forget the lives of these humans we are treating.

We try to be the best advocates for our patients, but fail to advocate for ourselves when we truly need it. Running from my feelings and emotions is why nursing is my cardio.