Posts Tagged ‘dying patient’

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Road Trip: Rehab for the ICU Nurse

July 16, 2012

Courtesy of the author; all rights reserved.

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN.

I took care of Gloria when she was admitted to the ICU after being involved in a high-speed, head-on collision. Although her injuries were very serious, my initial instinct was that she’d recover. I had a good feeling about her; as it turned out, I’d made a mistake in underestimating her mortality.

But everyone did, I think.

For the first few days her plan of care was routine and she progressed as expected. After several surgeries she was being successfully weaned from the ventilator. There was a plan for extubation. Gloria was awake and cooperative with all aspects of treatment.

She had an engaging spirit, and although she was never able to communicate with us well, we became attached to her and quite protective; we often requested taking care of her as our shift assignment, and later become strained and snappish with one another as unexpected complications propelled her along a steep and steady decline. Rehabilitation was ultimately traded for an extended ICU stay; extubation plans were cancelled in lieu of a tracheostomy.

I work among a group of passionate people. We’re determined and diligent. Because of that, a patient’s death in the ICU sometimes feels like a failure. We’re not terribly emotional—or rather, we rarely express or discuss the anxiety and sense of loss we feel when our patient slowly dies in front of us.

Our passion, in Gloria’s case, is most obvious to me in hindsight. We were desperate to bring her at least a modicum of peace and comfort; where medicine fell short, we did what we could to will her spirit well, and the measures we looked to speak volumes about what we regard as essential at the end of the day: loved ones, pets, music, flowers, memories . . .

I just returned from an overdue vacation—a long road trip. As I recounted the highlights of my vacation to my dear friend the hospital chaplain, she observed that the “little things” along the way seemed to be my favorite parts of the trip. And she’s right; wildflowers and cold lakes, unexpected side trips, fireflies and the simple closeness of family have left me with a renewed sense that all is right with the world. Somewhere along the seemingly endless stretch of miles, I even found perspective on the loss of Gloria.

She’s been gone now for almost a month . . . and since I’ve returned I’m no longer bothered by a distracting tug when I pass her old room. I’ve stopped remembering her as broken and dying before our eyes. I remember her, instead, as she was in a picture a friend had taped to the wall of her room—sitting in a red convertible, laughing in the sunshine, full of life and holding her dog.

I imagine she must have been on a road trip, and thinking that brings me comfort.

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Snow

March 4, 2011

By Marcy Phipps, RN, whose essay “The Soul on the Head of a Pin” appeared in the May 2010 issue of AJN. She’s written several previous posts for this blog (here’s the most recent).

by doortoriver, via Flickr

Dusk is near, and I’m standing in the woods under a gunmetal sky, watching the snow begin to fall. I can’t get my last patient out of my head.

The struggles the man had faced were obvious. A gauze dressing was wrapped around his head, concealing the bullet wound he’d inflicted, and his skinny arms were scattered with small scars and open wounds, many of them infected. He wasn’t young, but it felt like he was.  Something about a coma
. . . the lines and wrinkles disappear from the face. He almost looked asleep.

But there was no peace here.

Breathing was all that he had; there were no other reflexes. Scant life left and no hope. There would be no organ donation. His family signed the forms to withdraw care and said goodbye.  He was left alone, breathing.

It didn’t take long for the tracings of his ECG to become irregular, the angles wider and more erratic. I rushed into his room (no one should die alone!) just in time to see him exhale with a loud and raspy sigh. I stepped toward him and put my hand on his shoulder, thinking that I’d just seen this man’s last breath, and that he was gone. So many thoughts went through my head at once; that my hand on his shoulder was wasted . . . too little, too late; that our care had been futile; and that the loss of this man was an epic failure. We came in at the end of the game, and this failure was larger than medicine.

I was shocked when one last rasp of breath escaped him and a drop of something icy cold and wet hit my arm.  I pulled my hand back with a shiver. Such a stupid thing to do, to stand right in front of the open mouth of a dying man.

A dead man.

I’m standing in the cold, and it’s beginning to snow harder. The further I look through the static of falling snow, the less I can see; the horizon blurs softly into shades of gray. It’s so quiet.

I’m struck by the sound the snowflakes make as they tap against the dead leaves that cling to trees. Cold like ice, yet they sizzle.

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