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It Was a Day

Dear Diary,

I’ve just returned home from a long shift. I remember when they told us shifts were 12 hours long. They never mentioned that 12 hours actually isn’t enough in many cases. To do what we do, and to do it well, it takes more than that. They say nursing is 24 hours…they’re not wrong. I truly get that.

Today presented many of the usual obstacles. A few rapid responses. A septic work-up. Inserting a Foley catheter into a 600lb patient. Giving a patient a soap suds enema and then dodging the feces that came rushing out. Then, I found myself, yet again, having to hold back tears and not-so-nice words as a family member attacked my abilities and intelligence. This list is short in comparison to the larger list of things we, as nurses, encounter during a shift.

In the grand scheme of things, those things are minimal due to how frequent they are. Your skin gets thicker. You’ve been hit so many times, that you are almost expecting it at this point. My rebound rate is much swifter and you learn to pick your battles. You realize there’s just not enough time to dwell on the hardships and hurt. It’s a harsh reality, but a lesson that was necessary and beneficial to grasp as quickly as possible.

Emotions. There are many. Most can be felt in just one shift. Highs and lows; tears and laughter; anger and empathy; fear and confidence; frustration and peace. They don’t teach you how to navigate this in nursing school. I’m not sure you could be taught how. It has proven to be a very situational and in the moment learning experience. It was a topic that might have been mentioned in passing and from what I can recall, we were basically urged to not allow ourselves to become emotionally attached. Can I let you in on a secret? That is easier said than done, and there is a lack of compassion in that approach. To those nurses that have conquered this giant, I commend you, but I also feel sorry for you. Part of why we can do this is because we DO empathize with patients. We DO share in their suffering and pain. We DO get on their level and provide emotional support they either don’t have anymore, or never had. It is both a heart-wrenching and heart-warming part of this profession.

This day was particularly difficult, emotionally. Many units have what we refer to as “frequent flyers,” and what that means is these patients are in and out of our unit multiple times within a year or over the course of a handful of years. Today, a frequent flyer of ours passed. He was battling metastatic lung cancer for many years. It is a miracle his fight lasted as long as it did, and he was pretty high-functioning up until the most recent months. Although, interactions with him were limited and challenging due to his condition, his wife was always there by his side. Every. Single. Day. And so, every single shift her husband was still here, I’d build a rapport with her, as we are meant to do as nurses.

Our conversations started very surface-level. We’d comment on the weather, or I’d inquire about her commute to the hospital. She’d ask me if the unit was busy, or if I was back for another shift the next day. As the months went on, and they were in and out of the hospital, the conversations went a little further. Conversations became about family, about life, about plans for the weekend or an upcoming holiday. I would ask about life in the past. Reminiscing is an effective way to help families cope. It allows for recalling on the happy times or the times when their loved one was at their optimal level of living and doing wonderful things in life. We want them to remember the good times.

As more and more time went on, they became family. We understood each other and I knew how to care for her husband in the particular way she preferred. You do that for your patients. You learn what works and what doesn’t for them and for you. Combined with hospital protocols and proper nursing care, you’re left with a damn good plan of care.

All that to say, on this day, this patient passed away. He’d not been looking good all morning, and when the wife was present, a discussion occurred to determine the next steps. These discussions happen quite often. They are referred to as “goals of care.” They have to happen in order to decide what is to be done for a patient that is declining or given a poor prognosis. She made the very hard, but courageous decision to make her husband comfortable. In this case, the patient was put on a drip that would continuously provide medication to keep him free of any pain or distress until his final breath.

I went and sat with her for a bit. We just talked and I offered my condolences, but I also commended her on making one of the, if not the hardest decision we could be faced with. I’ve seen it done many times, but I still can’t comprehend or begin to know what that feels like. We cried a little too. She felt like family. She expressed her gratitude to all we’d done over this long battle. She even said she was happy he would pass here and not at some nursing home. We’d become like family to her, too.

Today was a hard day and there will be plenty more like it. This profession is all of the things and all of the emotions. It is messy, chaotic, stressful, frustrating, maddening…but most of all, it is a gift. Like every profession, it takes a special kind of person to do what we do. I’m so honored to have the capacity and passion in me to keep coming back. To want to stand in the gap between life and death for my patients. To be a crutch or to become “like family.” Someone has to do it, and I’m grateful I GET to do it.

Until next time,

RN

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