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.