It doesn’t happen too often in my critical care setting that I’m not on my guard, on high alert, and fighting for the life and well-being of my patient. I’m typically intervening and working to make a person better, and I think sometimes when a nurse isn’t actively striving for improvement they may feel a little helpless themselves. After all, that’s what nurses do. They make people better. Our goal is to leave our patients better than we found them.
But sometimes we don’t. Because sometimes we can’t.
On this particular day that I speak of I was assigned a patient who had been made comfort measures only. In other words, somewhere along the line after he had been transferred to intensive care for aggressive treatment of his life threatening condition it was determined that he would not get better no matter the actions taken by the medical team. Through difficult conversation the patient’s family had determined that no fight was left in him. They only desired a pain-free remainder of his existence. They had accepted that his disease process was chronic and unchangable. Now they just wanted peace for him.
It was hard on family, and it was also difficult for nursing for although they too understood the futility of continued treatment now they had to suddenly switch gears from one of aggressive action to a more subdued observational mode.
I don’t usually see these types of patients much anymore, and even this case was awaiting a transfer to a VIP room on a Medsurg floor where the family could have more room and the freedom to come and go as they pleased without restriction. But until then I waited with my normally busy hands clasped. I listened to his lungs and heart even though I would do little based on what I heard. I charted against a vast array of medications by mouth that the patient was too lethargic to swallow, and I watched him closely for signs of pain.
Mostly I just watched. I watched his blood pressure go down.
But somewhere that morning before he left my busy unit I was reminded of my role in his continued care. I had one; it just wasn’t solely with him.
As I sat motionless watching his monitor from my desk, and watching him use accessory muscles to breathe his wife walked up to my side. I nodded hello, and in my brief assessment of her I noticed the dark circles and blood red eyes from too many tears shed over the past twenty-four hours.
I sat and I watched her touch his brow. She watched his monitor, and again she stroked his puffy arm. He slept on.
Finally she came outside the room to where I sat watching, and she began to ask questions. I realized they were questions she already knew the answer to, but I responded kindly and thoroughly anyway. And it was then that I understood she just needed to talk. She needed someone to hear her and respond back. He slept on.
Her voice shook, the words became more incoherent, and tears that had been an intermittent trickle were suddenly full force rivers. I stood listening, nodding, smiling politely when suddenly she collapsed on my chest. Tears poured, her body racked, and I was instinctively rubbing her back.
I spoke softly, soothingly, offering prayers and encouragement that she was doing the right thing. I held her until she let go, and even then she still held a piece of my heart.
I went in search of tissues as I wanted to be doing something to help, and as I grabbed for a box in the empty supply room I noticed the large wet spot on my scrubs. A pool of her tears darkened the soft fabric, and I knew that I had done something after all.
As a previous Hospice Nurse I should have realized it sooner, but it seems that it had escaped me, albeit briefly. The job provided by a nurse goes beyond the immediate bedside intervention, and even in the moments where we may feel helpless to provide appropriate care we are performing just what’s needed for the time.
When we cannot care for a patient as we typically do we are still providing a great service. Even if we’re not alleviating pain or providing comfort to the patient we are giving it to the family. We are offering spiritual support, a shoulder to cry on, a warm hug, or a listening ear. Sometimes that’s what’s needed most.
We can’t always nurse our patient back to health, but we can nurse them whatever their health. We can’t always improve the outcome of their illness, but we can improve the circumstances of their situation. The fact is we can always do something, even when we don’t think we can.
Teena says
You are one amazing nurse. You definitely are doing what I believe God placed you her to do. You are taking care of the sick, and writing. You allow us a peak into your daily life. Yet teaching us a lesson with each post. Your amazing Brie ..
brieann.rn@gmail.com says
Thank you so much!!
Shelly Burke says
Beautiful words!
brieann.rn@gmail.com says
Thank you!
Chasity says
It often occurs to me while reading your blog how emotionally strong you have to be as a nurse. You really serve a special position in people’s lives. My thanks goes out to you and all the others like you.
brieann.rn@gmail.com says
Thank you so much.
Melissa says
I love reading your posts. It is comforting to know that there are other nurses out there that feel same way I do. I was one of those nurses on the Med Surg floor that cared for Hospice patients and their families. Now, working in the ED it’s a little different. A change that I am still getting used to. I cry every single time .
brieann.rn@gmail.com says
I understand.
Thanks for commenting.
Cassie V says
As a fellow critical care nurse working in a large hospital, I often find great comfort in your well thought out, well written blogs. Many times, you can put down in words so eloquently what is Racing around in my mind. I absolutely appreciate what you write. Your blogs often “pull” me through and reset me in a way so I can enter the next shift with a newed or positive perspective which so often gets trampled on throughout the day. So often we leave utterly exhausted physically or mentally……thanks for the reset and comraderie and also for what you do, at the bedside and online:)
brieann.rn@gmail.com says
Thank you so much!