Recently I geared up for my three consecutive bedside shifts, knowing that back to back to back shifts can be challenging. I looked forward to caring for at least one same patient for those shifts, to make it a bit predictable. That is where my challenge began....I overlooked that ICU nursing is full of the unpredictable.
"Death"- FRIDAY: I arrived to work, ready to help heal. My patient was a vascular patient who was sick enough to require me to only take care of her. Critical care at its best. I spent those twelve hours checking that her extremities were continually receiving adequate blood flow, adjusting blood pressure drips to keep the average pressure high enough to provide oxygen to her brain and extremities, checking labs regularly to monitor her electrolytes and blood levels and replace what had been depleted and managing the continuous dialysis machine which was filtering waste since her kidneys were not functioning. The bleeding from her surgical sites appeared to have slowed, until I changed one saturated dressing to see fluid explode from underneath it. Pressure was applied and the wound redressed, knowing I would change it again soon. Family showed up to visit and get an update and it appeared my patient responded to them ever-so-slightly. It gave us hope. My shift came to an end and I looked forward to some rest, knowing I would be ready to continue our battle to help her heal my next shift.
"Decision"- SATURDAY: I arrived to find my patient's room empty and learned that she had not survived the night. Further tests revealed that her prognosis was poor and her family had the courage to recognize her wishes and made the decision to let her go. I was shocked and saddened by what had happened, more so than I expected to be. We worked so hard to help her and she still passed away. I felt like I had lost a battle. All this happened before my shift had even started. I would have a new patient to work with and needed to shift my focus to him.
My patient was well known to our unit, having initially come to us ten months earlier for an organ transplant. His course of recovery had many complications and he had only improved enough to make it to a long term care facility for a short time, before being readmitted to the hospital and eventually our unit. He was sick, on continuous dialysis and mentally deteriorating. His dear wife had not left his side the entire ten months, until a few days before this shift. They were from out of state and she reluctantly went home for a long weekend, only to get a phone call about needing to schedule a meeting about her husband on Monday. It was Saturday when she flew back to be by his side and found me caring for him.
I had tenderly redressed the many wounds on his frail body, but there was nothing I could do about the look of distress and discomfort on his face. His eyes did not look good and for me the eyes are always a reflection of what is in one's soul. His dear wife took in his changed countenance and said, for probably the first time, he's not going to make it, is he. I had to be so aware to keep the focus on her feelings and thoughts, not on what my opinion may be. I reminded her that she knew him best and that this appeared to be another crossroad in their journey together. We doctors and nurses have opinions, but at this point she was the one who could determine what her husband would want. We had long periods of silence, as she looked at him while holding his hand, skin to skin, taking in the situation with new perspective. She had gone home and been reminded of their life outside of the hospital. She appeared to be seeing him through fresh eyes.
She was tired and knew she needed to rest; she sincerely thanked me for being there and I supported her decision to go to the hotel to try to rest. I would be there the next day to care for husband again and help her with anything I could, after she had been able to rest and take in her difficult thoughts.
"Detour"- SUNDAY: I arrived for my third shift, tired but ready to work, knowing it would be my last shift for a few days. I was again met with an unanticipated change of patient, this time because we were short staffed and my assignment needed to change. Although disappointed, I knew I could say hi to yesterday's patient's wife and explain that I had planned on caring for her husband again and hope she would understand.
My two patients this third shift were a new transplant patient and one involved in a motor vehicle accident days ago. My focus was on the transplant recipient, as he was doing so well and would be moved out of the ICU if things continued going well. We got him up in a chair, cleaned him up, gave meds, removed unneeded lines and replaced them with those acceptable for non-ICU floors.
About four hours into my shift, my patient developed unexplained atrial fibrillation and try as we could for two hours, his heart would not return to a normal rhythm. This meant he would not be moving out of the ICU. Such a disappointment for everyone involved, especially to the patient and his nurse (me). This was a roller coaster ride, which I was disappointed had to happen. Not the way I had envisioned my shift ending, but, again, all in an intensive care nurse's days work.
SUMMARY: Three challenging shifts which took me a couple of days to recover from. When I returned to work, I saw a note from my Saturday's patient's wife written on the white board saying that our nurses were the best and soon thereafter learned she had been able to comfortably decide it was time to end her husbands quest to recover and let him go. She believed his life would no longer return to what he would want. I would have liked to have had closure with her, but I learned long ago that in this ICU nursing world that is a rare occurrence. Back to work I go.....
