Where did everyone go?

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Today was a rough day. It's hard to explain exactly why. Nothing horrible happened, we didn't even have a lot of discharges or admissions to deal with. I think the main reason that today was a rough day is that the patients were so sick. When you have a lot of really sick patients on the unit...even a unit that is meant to care for them, the whole unit feels it. My assignment wasn't that bad, me being new, I'm protected from having to take the worst of the worst just yet. It didn't matter much though, because every time I turned around to ask for help, no one was there.

Nursing units work as one cohesive creature. It's part of what makes a good unit an awesome place to work, and makes a crappy one such a misery. A few people with horrible attitudes can really trash the mood for everyone. Even though we are technically able to care for a patient all on our own, it's not a job for one person. Turning, boosting, bathing, these are all practical activities that are not easily done alone, but there are many other less tangible needs.

As a new nurse, I mainly need encouragement and guidance. Often I'm doing the correct thing, but having another more experienced nurse tell me that I'm right goes a long way. This comes in the form of asking questions I already think I know the answer to "Hey Anne, I can run potassium at 20 mEq through a central line, right?" to an explanation to a more detailed process "Does anyone know where to find the order to declott a picc?"

New nurses are work. We start out being completely useless to our unit, tailing behind a preceptor, afraid touch anything unsupervised. Over the orientation process, we slowing increase our help:work ratio until we're mostly helping our unit, and very rarely requiring assistance from others. This is normal, and healthy. Having a unit where the patients are so sick that no one's available to keep an ear out for a new nurse isn't a safe situation.

Nevertheless, that's what we did today. And just like almost every day that I'm at work, nothing horrible happened because of it. Hospital managers use this as an argument that it's actually OK to strain staffing numbers to almost breaking. After all, there's really no way to prove through objective documentation that it's not....

Pretend like they're already dead

"Pretend like they're already dead," said a very experienced nurse to me. "Because without us they're going to die, so anything done here can only improve their situation."
She was trying to make me feel better. I was new to the ICU, and although I was not a new nurse, I was having trouble with the number of patients that didn't make it home. She meant that I should realize that these patients are so sick, that textbooks tell us they shouldn't have even made it to us, much less go home again. (In my time at this hospital I've come to see many many many people walking around with disease progression that any decent scientific person will tell you is incompatible with life.) She was trying to get me to...I don't know, lower my expectations I guess. I don't know a good way to make it sound. It probably sounds horrible to the layperson, but as a nurse it actually did help me a little bit.

The area that I came from was no stranger to illness or death. Indeed, those people often had serious, long-term illness for which there was no cure, only prolongation. Diseases like cancer, pancreatitis, cystic fibrosis, pulmonary fibrosis...things you certainly wouldn't want to live with. The people I cared for were very ill, but death was not an immediate and very real consequence. It was a dark cloud looming on the horizon. For some people, it was even the light at the end of the tunnel. One patient told me that she felt better having a plan for her eventual suicide. She said it made each day with a painful, debilitating, illness easier, just knowing that she could end it when it got to be too much. There are things worse than death it would seem.

In the ICU however, death is a weight. It's everywhere. Any nurse that works in an area where only a small fraction of patients survive to go home will tell you that death is always watching you. It presses for space in the patient rooms, once very large 20 years ago when they were built, but now very full with monitors, CRRT, ventilators, balloon pumps and up to a dozen IV pumps. It breathes on your neck while you try to tell their loved ones truthfully, but tactfully, what the outcomes are going to be. In the moments of speed and adrenaline, death is the biggest presence in the room. You can almost talk to Him and expect a response. On the regular hospital floor, families had already thought about death so much, that they ceased to remember his existence. He was always there...like the crappy wall paper, and their loved ones' long and complicated regiments, and they no longer thought about him often or specifically. In the ICU, I've seen family members carry on conversations with Death, and I can almost see Death listening politely and nodding at all the right spots.

I never thought I was the kind of nurse to be bothered by that. I was never the kind of nurse that holds your hands and cries with you. I'm the kind of nurse that you can sleep better at night, knowing that I'm there. I told my husband that there's many kinds of nurses, and all of them are important. I'm a smart nurse. I thrive on pharmacology, pathophysiology and chemistry. I read research articles in my free time. I'm on top of things. I'm not the kind of nurse that gets hand written notes from the patient's family, or the kind of nurse that builds such a strong relationship that the patient calls you weeks or months after discharge to update you. Although I've had moments where that bothers me a little, I've long ceased to try to be what I'm not. My contribution is important, too, and I try to live with that.

I cried a lot in my first month there. Never at work, that's a line that I just won't cross. I cried on my way home from work, or when I got home. Often when I got home was the hardest part. Especially now, in the summertime, with my son constantly out of the house and my husband (finally) working after spending this much of his life as a professional student. I come home, to an empty house, and I sit on the couch nursing my arthritis, and I think. Thinking is the worst. That's generally when it catches up with me. I don't even know exactly which part bothers me.

Starting My Blog

I've always seen blogging as a pretty selfish endeavor. Unless you write for a living, like critics, or journalists, or unless you have a rather specific and interesting view on something, I never really believed you should have a blog. Nevertheless, the world is full of people blogging about the ridiculous, the boring and the downright mundane and trying to throw greater meaning into it. Despite my earlier feelings, here I am doing the same thing. If you're reading this blog, then I have to admit that I'm confused, because I really tried my hardest to make it obscure. This blog is my personal diary and I'm in no hurry to show it to anyone except the most disconnected of strangers.

As you've probably already guessed, I'm a nurse. Apparently I'm a pretty good nurse, since I work in an ICU at a major hospital. We're talking in the top ten of all US hospitals. For obvious reasons, I won't be giving more details. It doesn't really matter. The theme of this blog is relevant among all of us in the health care industry. It doesn't matter who you work for, or what city you're in, illness and death are universal.

I apologize ahead of time for my posts. They can be graphic. Mostly because I'm not planning on having anyone actually read it, but also because my life is graphic. All of our lives are, and I see no reason to pad it up now.

If you're reading this, my email address is available, drop me a line. We all could use a little more encouragement in our work lives.