Hui-Wen (Alina) Sato, MSN, MPH, RN, CCRN

With the recent devastation and loss around our local Los Angeles wildfires as well as our country’s political disarray, one of the most difficult things about trying to remain empathetic, engaged, and informed as an individual and a nurse has been a sense of utter overwhelmedness.

I think most nurses are both empathetic and action-oriented, traits which can be helpful—but also sometimes crippling when we see needs for help and advocacy everywhere and don’t know where to start. Any action feels like such a miniscule drop in the bucket.

I was carrying this emotional, mental, and spiritual heaviness into work with me a couple of days ago. I sat down to get report on my patient assignment. My patient was so sick, so complicated; she’d been teetering between life and death in recent days. Her parents had been on a roller coaster of the worst kind. ‘Two weeks into this hospitalization, are we still holding onto hope for recovery? Are we gathering relatives to say goodbye?’

I knew I was walking into a space that was very loaded for the parents. They had seen many nurses, respiratory therapists, and doctors come through their doors. For as long as they had been in our unit, this was my first time being bedside nurse with them.

I entered the room quietly. There was so much to do for this patient. Lines, tubes, drains everywhere. So many medications to give. So many critical things to assess. I wanted to be empathetic, engaged, and informed for this patient and her parents in particular, but I already felt overwhelmed.

I heard the parents stir behind the curtain that covered the cramped family sleeping corner of the room. As I was hanging IV antibiotics and electrolyte replacements, the dad emerged from behind the curtain and greeted me with a soft smile before going into the bathroom. The mom stayed half-hidden behind the curtain. They seemed too accustomed to hospital life; I was yet another nurse they would be adjusting to and getting to know for the day. I could be good, or I could be not so great for them. I could be connected or disengaged, caring or apathetic. They didn’t necessarily know what kind of nurse they were getting in me.

When I finished hanging medications and assessing the patient, I approached the mom and introduced myself.

“I understand you guys have been through such a roller coaster these last couple of weeks, and have had so many different faces come into the room, me being another new face to you.”

Her smile was both weary and gracious. “Yeah…”

“What do I need to know about your family so that I can provide you and your daughter with the best care that I can today?”

She was noticeably taken aback by the question, which made me wonder how infrequently we invite these families to really share and incorporate who they uniquely are into our approaches and plans as the health care team.

I saw her trying to quickly process the question and come up with a response.

“Well…we have a lot of relatives coming today, to say . . . umm, to come see her.”

(To say goodbye? I wondered. Just yesterday, they thought their daughter might be at the end of the road.)

I waited to see if the mom wanted to share more.

“Her older brother is also coming this afternoon. It’ll be his first time seeing her since she got this sick. He’s been really emotional and anxious about it all. We’re trying to help prepare him.”

“It’s a lot on you, to try to be with your daughter here in the ICU, and also try to parent her brother through this experience.”

“Yeah. . . . we’re trying to do our best with it all. ”

I worked with our social worker to coordinate all the visitors, and with our child life specialist to help meet with the brother before he came into the room so that he had a better idea of what to expect before seeing his sister unconscious and hooked up to so many medical devices. I also coordinated with other medical services to hold off on nonurgent things they needed to do with the patient so that the family could have more quality time together.

It strikes me that the mom’s answer to my wide-open question about what I should know about their family could have gone in any direction.

“We really value X, Y, and Z happening when a family member is really sick, and we don’t feel like we’ve had space to do express those values in this hospital stay.”

“We’ve been quietly frustrated for the past week about A and B happening, and haven’t known when to bring up our confusion and concern about why A and B happened.”

“We feel pressured by the medical team to look at this situation this way, when we honestly are looking at it this whole other way.”

I was grateful for the opportunity to hear what came to mind for her, and to accommodate for her needs and concerns as well as I could that day. I was grateful that I even remembered to ask that question.

In a time when I as a human, a citizen of Los Angeles and the USA, and a PICU nurse, feel hugely overwhelmed by multitudes of needs and issues, I am trying to come back to one intentional act, one intentional question at a time, with the people right in front of me.

A version of this post was originally published on author Hui-wen Sato’s personal blog, The Heart of Nursing.