No Explanation Required: A Preceptor’s TaleOctober 20, 2010
By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” appeared in the May issue of AJN. She has also contributed a number of thought-provoking posts to this blog (here’s the most recent).
I’ve been precepting a new ICU nurse intern, which I generally enjoy doing. The only downside (from the preceptor’s perspective) is that I’m obliged to call ahead and request “unstable” assignments. This is meant to enhance the clinical aspect of the internship, and it definitely does. Considering that I work in a trauma center, though, reserving the sickest patient in the unit feels a bit like ordering up a large serving of chaos. And although I can request the assignment, I can’t predict what will be learned.
Our most recent patient was a new admission with a traumatic brain injury. At the start of our shift he had a grim neuro prognosis and was hemodynamically unstable. His condition deteriorated throughout the day and he was eventually diagnosed as brain-dead. His family chose to donate his organs.
Taking care of an organ donor is difficult. Brain-dead patients are inherently unstable, yet certain parameters must be maintained to ensure adequate organ perfusion. It’s tedious and meticulous. It also requires a shift of perspective—ironically, even though the patient is legally dead, the medical interventions are aggressive and the stakes feel higher than ever. Despite the fact that for the patient, at least, there is nothing left to lose, the potential organ recipients weigh heavily on our minds.
Many of us don’t mind (and even sort of like) “caring for” patients who are organ donors. It’s a different kind of nursing. Without sentience, the “care” is all science, and in the wake of the storms of medicine and grief that precede and surround the diagnosis, I find it soothing to shift gears and focus primarily on numbers. My intern and I did just that: we spent our day concentrating on pathophysiology and pharmacology. We titrated and measured, quantified and tabulated, until the patient went to the operating room, never to return.
We found out later that our patient’s liver and kidneys were successfully harvested. That information left me with a sense of accomplishment and satisfaction that I was surprised to find my intern did not share. For while I had been appreciating what a perfect teaching assignment we’d received, she’d been discovering firsthand that the concept of organ donation disturbs her. She was left with a lingering unease that neither of us had expected.
One of my favorite things about nursing is how much there is to learn. There are always new evidence-based practices, drugs, and procedures. Some days I learn something new about human nature or spirituality, and some days result in self-discovery.
I prefer science; my intern does not. Or rather, she prefers more than science. She tells me she far prefers taking care of living patients and that, although she knows there’s a bigger picture out there, she’s just not feeling it and can’t explain why.