I had written this and posted it to Facebook, about a month ago. I am reposting it because I have come across another situation as a volunteer trauma relief nurse, where I couldn't save a 17 year old boy. Please don't get this confused. I am not blaming myself right now. But I cannot stop thinking about his 22 year old brother who I saved, who will wake up, or has woken up, to find out that his brother is dead.
How do you code a patient and then leave, without the baggage?
Other nurses, medics, cops, etc. Please tell me: How am I supposed to GO HOME, and actually BE HOME?
I can leave the situation, physically, but emotionally I can't. I can't go back, and I can't move forward. I get stuck.
I can't shut it off, even after its played out. So where is this mysterious, "turn off" button after a code or rapid response?
No matter how many times this has happened, I seem to take it all on, and internalize it for a while. Even after I leave, I am still there with my patient.
Between different jobs and experiences, I have not yet learned how to leave a tragic/unexpected situation behind me. If I couldn't save them, I blame myself. If I did save them, I feel too much empathy and worry about them at home. i can't leave my patients. I wonder if I ever will.
I came home and cried recently, not just once but throughout the whole day. And I cried myself to sleep. My poor fiance has dealt with my anxiety and night terrors and I am so lucky to have him, but I wish no one had to deal with this.
My patient had very calmly told me that she was going to die. And then started to look very scared. She grabbed my hand and asked me to stay with her. While assessing her she went into sudden onset of acute distress that required rapid response.
Although my heart always races in the moment, my interventions are not the "difficult part" for me. It's the aftermath and even after I stabilize them I am haunted by what they went through, and what they may still be feeling.
I held her hand after rapid intervention, we were not out of the woods yet but I knew that I at least bought her some more time. I made her keep eye contact with me during and after I intervened. I kept telling her that she's okay, and that I am not leaving. Although emotional, that wasn't the difficult part either.
She expressed intense anxiety throughout the situation, and I began to internalize it. I get too attached and I begin to feel, what I think the patients feel. This happens with every response, every patient.
Her face was tense, her hand was tightly clenching mine, the sound of her struggle to breathe - That was the MOST difficult part of everything and it always is.. no matter what the situation. And that is what plays on repeat in my head, when I am "home"
Whatever it is - this empathic transference of suffering and anxiety - it lingers. And as I toss and turn, the sounds and the images feel real, as if they are still happening, and I am still with my patient.
Maybe for others this mostly only happen during unsuccessful codes and responses? I can only speak for myself, that the panic I feel happens with any outcome, and strange enough, it is most severe after I preserve a life.
I noticed that my state of anxiety and depression doesn't happen when I provide end of life care to dying patients. When a patient dies in a more peaceful and predictable way, it is sad and I care very much, but I also feel that they are not suffering anymore which puts me at ease.
It is not even death that triggers my emotional spiraling. it happens when the situation is unexpected, and when the patient suddenly experiences inconsolable anxiety or physical suffering. And even when I safe their lives I cannot stop wondering if they are okay now when I am home and cannot help them anymore. I try so hard to distract myself but I always put myself in their shoes and I panic.
The patient had asked me not to let her die. And I didn't let her. She did not die, and I did my job. I am well aware of that. But it didn't stop the emotion I felt afterward.
I have spent so much of my personal time, not only replaying these situations in my head, but wondering if patients still felt that anxiety after the fact, if they will have to go through it again, and how bad that must feel.
It must be indescribable, knowing that you're in a life threatening situation, and knowing that you are helpless. So you watch the nurse run to the crash cart and rush back to stick you with needles, force oxygen into you, nebulizers, machines, tubing, wires, rigorously checking vitals - do they see everything little thing happening? That must be traumatic, and whatever I feel when I put myself in their shoes probably doesn't even compare. But the way I feel still breaks my heart, no matter what patient, no matter what job, no matter what outcome.
And sometimes one situation makes me think of another, and then I think of my first "rapid response" - my Aunt Sue.
I moved in with her when I was 15. It was just the two of us. And we were close my whole life. I woke up one day and found her on her back in the living room, barely breathing. She looked like she was already gone, despite the loud struggles to breath. She was in a coma from an unexpected massive brain hemorrhage. There was nothing they could do. But I stayed with her. I was there.
"Maybe if I had been a nurse at that time, maybe I could have successfully saved her. Maybe I could have. I would have. I should have."
But I know that's not so.
I still became a nurse. And now I am not only employed as one, but I am a volunteer trauma/disaster nurse. Was this against better judgement?! I really don't know. But I am good at it. And there is a lot more to the job that isn't mentioned here. This is one struggle, one negative impact that I need to learn how to cope with, but the positives things outweigh this by far.
I accepted my Aunt's passing on, a long time ago. But for a while, I did ask myself, "Could I have done more? Did I miss something? Could I have acted sooner?"
I am starting to realize that I ask myself the same questions about my patients.
I want to be able to shut that off, the noise of the aftermath, but I do not know how. I try and will keep trying, but It isn't as simple as just lifting the pin on a broken record.
I DO know, that I am a good nurse. But I hate the fact that I cannot have complete control over every outcome. I want every patient to live. I want no patient to suffer. Yet I know that I am not God.
Wanting those things for everyone is nice, but at the same time, it is extremely irrational, and beyond stressful.
Do other people feel this way? Or am I just simply crazy!?
Well I have no idea what types of responses I will get, if any, but it sure felt good to get that all out.