I’ll always remember my first.
It hurt. A lot. He was 87-years-old, and his name was Joseph. It was uncomfortable nearly to the point of unbearable, but I made it through the cold and gray afternoon. I survived the experience, and I was a changed woman because of it.
Every nurse remembers his or her first patient death. I’ve seen dozens and dozens of patients die since that chilly November afternoon, but I will always remember Joe as the one who shaped how I would respond to these moments in the future.
Most people don’t go to work and see dead people. Most people have careers that might be challenging and interesting, exciting and on the cutting edge, but generally speaking, nobody dies from an unanswered email. That is the thing about being a critical care nurse that has both helped me find perspective in some situations, and frustrated the hell out of me during others. You see, nurses are an odd bunch. There are so many different sectors of nursing: working in a hospital is just the tip of the iceberg. However, in my three years as a nurse – two of them in cardiac surgery intensive care – I have become keenly aware of the reality that most people don’t understand the importance of a nurse until they truly need one. Us nurses, we are not just an anomaly in healthcare: we are a unique brand of individuals in our personal lives, too. Though we have ebbed and flowed throughout the shifting undercurrents of healthcare as a whole, nurses are still attached to the antiquated and unrealistic Florence Nightingale dilemma: while we are highly skilled, educated, and seek professional equality, we are often our own worst enemies when it comes to professional progress. Nursing is a dynamic profession, one that has shape-shifted in its technological advances and evidence-based techniques, yet for as far as we have come, we all-too often insist on treating one another with disrespect and condescension.
Nurses are a**holes. Not angels. Not saviors. Not guardians. Many times heroes, yes, but all too often – a**holes. How is it that a workforce filled with millions of men and women touted for their code of ethics, integrity, and compassion, can be so damn mean to one another?
Well, I’m not sure. But it’s something that I’m working hard to figure out. And I must. Because for every life I have saved, and each I have lost, I have come to depend on my colleagues as though they are the air I breathe when I’m stifled by the circumstances of ICU. I truly believe that we have grown into a pleasantly dysfunctional group of type-A adrenaline junkies who would work through ninety-nine bad days just for that one amazing one. But much like every family, we experience drama. We see infighting, back-stabbing, and bullying of the schoolyard variety. What makes it so easy for us to write off this piss-poor behavior? Why do we enable, if not encourage, this vicious cycle that – I guarantee you – takes place on every unit in every hospital across the country? Are we so singed by the stress, so blinded by the chaos, that we must turn against our own to protect ourselves from the flames that burn around us every single shift? Nurses are a**holes – but is it because we have to be?
I don’t go to church. I know that I was raised as a Christian, and my fondest memories of Christmas and Easter as a child was a few presents and mass candy-consumption. I understand the gist of the Bible and its teachings, but I’m a bit fuzzy on things like actual scripture, who said what, the literal nature of things, etc. As a matter of fact, I could probably better quote lines from a late 90’s comedy than anything having to do with Biblical teachings.
But that doesn’t mean I am not a “believer.” As a matter of fact, I’m hard-pressed to find a nurse that isn’t. Because you see — what I’ve seen, what I’ve experienced, what I’ve lived through in my 13 hour days: those moments would shake the average person to their very core. I can’t explain why, but working in the intensive care unit has been almost a greater test of my spirituality than my academic competence or clinical prowess. Most people live their entire lives never seeing someone die. They may even live for decades before they see someone propped and made up in a casket at a funeral. And that’s only for a few minutes or hours at most. Yet what we do — every single day, in so many mediums across the country — what we do is not the norm. I don’t know exactly how many patients I’ve lost, partly because I refuse to keep track, and partly because it’s better not to remember. My first, though? Well, you get the point.
Let’s keep something in perspective here. I’ve been a nurse for only three years. I know nurses who have worked in this field for more than three decades. What keeps them coming back? How do they sift through the slurry of emotions and pick out only what feels rational, reasonable, and still human at the end of it all? It’s a question that has plagued my mind since my very first shift in the intensive care unit. It’s an intricate piece to my “nurses as a**holes” puzzle.
As a new nurse, I worked on the floor as a cardiac nurse in a step down unit before working in ICU. Although patients were often quite sick, some decompensated and required higher levels of care — others even died — but the expectation, in general, was that we were preparing to get patients ready to graduate from the hospital and move onto their next destination: going home or to rehab. The mindset on the cardiac floor is one that everyone should make it out alive.
In the ICU, the mindset is that…perhaps no one does.
It’s unsafe to remain eternally optimistic in the intensive care unit. It’s simply poor practice to set yourself, your patients, and their families up for the belief that “everything is going to be okay.”
“They’ll be fine.”
“Surgery will go well.”
“I’m sure she will do beautifully.”
“I know we will get him a heart transplant soon.”
Could you imagine my own struggles, with my rose-colored lenses and obnoxious red frames, when I came to realize (sooner rather than later) that life in the ICU often ended there? Gone were the days of hugs goodbye and patient teaching — at least in the sense that I had known. Now my job was to keep my patients from coding, bleeding, and dying. Or, at the very least, reviving them if they tried.
Talk about a rude awakening. My cheerful demeanor and positive spirit would soon be challenged, not only by the hard and hardened, bright and brilliant nursing cohort with whom I worked, but by the nature of the work I was doing itself.
How do you leave this at the door? How do you fight tooth and nail; push every drug under the sun; do compressions for two hours; open another mans chest; pour blood in as fast as it comes out – and be expected to go home and eat dinner and take a shower and act like a normal person? How are you expected to take in the sounds and sights and smells of the pendulum between life and death that literally swings back and forth throughout the unit without needing some time to just sit down, look up to the sky, and ask, “What the f*ck just happened?”
What. The. F*ck. Am. I. Doing. Here?
Nurses can’t help but to think this through when the bad days are especially so. What the f*ck have I done? What am I doing? Why am I busting my ass for this? Why did I leave my other career? How did I end up here? What makes me so freaking special that it’s MY job to protect the life and livelihood of another human being?
It’s a lot to consider, right? The things they never tell you about in school. The system educates us about generalizations and stereotypes and archetypes of the profession, but nobody ever tells you that seeing a wife collapse in grief over the body of her suddenly passed husband will send you rushing to the restroom to throw up your lunch. Nobody explains to you that everything is different now. Everything. You can’t have fun without the worry of consequence, yet you must enjoy yourself for time is fleeting. You must live a life of honor and virtue, yet you have to drink or smoke or make dirty jokes just to keep from cracking. You’ll pray that your services aren’t needed at the gym or the grocery store or an airplane, but you’ll be the first to respond to an emergency anyway. You’ll wonder why everyone worries about such asinine and meaningless bullsh*t every day — you want to take friends and family members and children and colleagues and total f*cking strangers by the shoulders and shake some sense into them: WHAT WORRIES YOU IS NOT AN EMERGENCY! What you’re stressing out about is meaningless in the grand scheme of things! Your priorities are completely and utterly misaligned, and someday on your deathbed you will realize this! You worry that others are too worried while you worry that others don’t worry enough. It’s the weirdest and most complicated explanation, and it’s a totally bewildering paradox that nobody seems to discuss unless they’re the ones in it. Nurses vent to nurses. Nurses shit on nurses. Nurses lean on nurses. Nurses cry to nurses. Because we cannot understand how anyone else could fathom what plagues our minds during those especially bad days.
(Nurses, and God.)
Maybe we aren’t really a**holes after all. Perhaps we simply need to feel alive when others aren’t. Perhaps we are pissed off about our professional purgatory. Perhaps we would never change what we do for the world, but we can feel ourselves change because of it. Perhaps with every one we lose, we lose ourselves. With every one we save, we save our souls. With every shift that the gray area extends from another life into our own, we are not so much mean as we are misunderstood. I pray for those charged with our care. I pray for those charged with caring. God only knows how we do what we do, and listens as we whisper in our own patient rooms.