Can’t Even Think About It: An ICU Nurse’s Personal TabooOctober 10, 2012
The weekend was busy in the ICU; several critically ill trauma patients were admitted in quick succession and the unit was filled with grieving families. The air was heavy with tragedy and misery, and it was draining to work under such weight.
I had a single day off, which didn’t feel like enough, and when I returned to work there were new patients in the beds and the mood in the unit had drastically changed. Disarming, but not surprising; the ICU is always the same and yet different.
One of the young patients from the weekend had become an organ donor, which had been anticipated and was considered a positive outcome, relatively. In discussing the weekend events and the ways in which things had resolved, one of my colleagues mentioned that, if given the opportunity, she’d embrace the chance to go to the operating room with the organ procurement team. Her beloved niece had been an organ donor and she sees organ donation as a validation and continuance of life, an ultimate example of “paying it forward.” She takes great comfort in knowing that her niece did not die in vain; lives were saved. She’d like to see, firsthand, the workings of the surgical team as they extract the organs.
“I would never do that,” I told her. She raised her eyebrows at my abrupt reply. Our exchange left me unable to dismiss a sense of unease about organ donation, one that had been there all along, lingering beneath the surface but usually avoided.
I can certainly see a family’s decision to donate their loved one’s organs as a priceless gift of life. And although it feels cold to consider organ donation as a salvage operation, with each organ a precious commodity, I see it that way, as well. Focusing on the clinical aspects of care in the hours between brain death and organ donation both requires and fosters emotional distance, and I gladly disengage. As a bedside nurse on the donation side of the process, I do what’s necessary to optimize organ perfusion, and yet I can’t quite fathom the physical removal of the organs I strive to maintain.
Perhaps I don’t disengage so well, after all, for stepping into an operating room to directly observe the process—the disassembly—would be out of the question.