A good friend is a cardiac intensive care nurse. She’s been working for 3-4 years now, so she’s not a newbie, but not a seasoned veteran, either. She just called me in tears because every one of her patients has died in the last two weeks, including two today. She’s starting to blame herself, thinking she’s “missing something”.
She’s doing paperwork and holding the families’ hands now, but coming over for a late lunch this afternoon to talk. Any advice? My plan is to order Thai food and beer and make lots of sympathetic noises. Are there any Dr. Coxesque words of wisdom you received that I can pass on?
You’re a good friend to be there for someone in such a stressful line of work!
After reassuring her that she’s not “missing something” - the doctors would be all over her if she had - you might want to suggest that she try another field of nursing. All nursing is stressful (my husband is a RN) but some fields are less traumatic than others.
I’m very sorry to hear that.
Please feel free to pass on my story.
My Mum was caring for my Dad at home when they were both in their eighties. Dad had a number of conditions (Parkinson’s disease, arthritis, high blood pressure, macular degeneration), while Mum was still very active.
Suddenly Mum fell ill, then collapsed. She was rushed to hospital, where terminal bowel cancer was diagnosed. (Dad had to go into care.)
Mum declined an operation (which only had a 50% chance of success and would have prolonged her life for a few months at best) and went into a hospice.
She died a few weeks later, and Dad passed about a month after that (no particular physical symptoms - just a broken heart).
Although this was a terrible blow for the family, I cannot speak highly enough of the nursing staff.
From the sympathetic hospital consultant who gently broke the news, through the hospice nurses who made Mum very comfortable right up to the end, to the nursing care staff who looked after Dad so well (he described the home as a luxury hotel), they were all magnificent.
You cannot prevent death - all you can do is give the patients care and dignity.
I don’t know how medical staff cope with all the sadness, but I am incredibly grateful to them.
I’m not a medical professional, obviously, and the following might fall in the category of cold comfort but . . . .
She may have lost sight of the rather obvious fact that people in cardiac intensive care are extremely ill. Doctors perform miracles in such units every day, but statistically the prognosis for anyone with an actute cardiac problem is very grim. General outcomes for anyone requiring intensive care are not good, and acute cardiac problems have limited options for treatment. Heart disease remains the number one cause of death for both men and women in the U.S.
The bottom line is that there’s a limit to what modern medicine can do. It often cannot fix a seriously broken major organ like the heart or brain. The hard truth is that many of those patients are going to die, regardless of the best efforts of the doctors, the nursing staff, the family, everyone. You can’t work long enough on, or give enough drugs to, or pray hard enough for, someone who’s heart is simply giving out.
You know that scene from Groundhog Day where Bill Murray’s character keeps going back again and again to try to save the homeless guy? But no matter how many chances he gets, he cannot prevent the guy from dying. It is likely that if your friend had 100 chances to do things differently, these patients would still pass away. For many of them, what is broken simply cannot be fixed.
So I agree with those who might gently point out that if dealing with a high rate of mortality is emotionally difficult for her – Lord knows it would be for me – she might be happier in another nursing specialty.
I’ve tried to pull some statistics on intensive care mortality / cardiac mortality but all I can find on the internet is abstracts.
Thanks guys. Yes, you’re right that cardiac intensive care loses more patients than probably anyone else. She herself has told me that, and most times, she’s a fantastic nurse with a great outlook who can handle it. She’s just having a rough patch, thanks to this most likely coincidental losing streak. In her 4 years, this is the second time she’s really sounded beat - the first was when her first patient died, which I think is totally normal. Usually she loves what she does.
If she seems open to it, I think I might just ask her what she could have missed. It’s possible, sure. She’s human, she’s got an infant at home, maybe she is too tired and getting careless. Maybe for a few months she should look at, I don’t know, podiatry or something. But my guess is that she’s not doing anything wrong, and that she’s just being a bit irrational right now. Which is fine, and that’s what I’m here for - to help her get her craziness out in my dining room where she won’t hurt anyone. Lord knows she’s been there for me when I’ve lost my mind.
You’ve also (collectively) reminded me of an actual Dr. Cox speech from Scrubs. I don’t remember it verbatim, but this gist was, “Everything we do is a stall. Every single one of these people is going to die, and so are you. All we medical people can do is delay the inevitable long enough to make a difference to the people who love them.”
She’s an amazing woman and I know she’s a great nurse who has made a lot of difference in a lot of people’s lives. 9 times out of 10 when she talks about work, she’s not talking about the patient, but her responsibility to the family. And I know those families appreciate what she’s doing for them, I just know it.
Hmm…I think I’m going to go write some thank you notes to the nurses who took care of the baby and I when we were in the hospital. Seems like it would be appreciated.
A friend of mine used to be a used to be a neonatal intensive care nurse. She got so she lost sight of the fact that most babies are born healthy, and don’t need intensive care.
Then she switched to Labor & Delivery. It helped with the idea that babies are often born healthy, but she still saw an awful lot of pregnancies that ended with emergency c-sections or other concerns.
Then she dropped out of nursing altogether–couldn’t take the stress. (And not the stress of working with sick people, the stress of trying to do too much with too few people, and dealing with management and beaurocracy).
So I agree with what others have said. Give her a beer and some food and make sympathetic noises, and remind her that she sees a lot of the sickest people. And encourage her to see if she could shift her work at least temporarily to dealing with less sick people.
Well, that went better than I hoped. I did suggest that she maybe look into some less stressful specialty for a bit, and she said, “but then I’d be bored!” So we laughed a little about that.
Most of the cases were really just beyond help - people in accidents or overdoses who just had no chance whatsoever. (She’s actually in regular ol’ ICU these last two weeks, I guess.) There was one kid in his early 20’s who’s been on dialysis since he was 18. Came in complaining of abdominal pain, so they diagnosed constipation, only to discover peritonitis around some hardware in his gut. So they took the hardware out, and while doing so discovered that his intestines had ruptured all over the place, so there was fecal matter and infection all over his innards. There’s just no way to recover from that. But that one, in particular, she thought she should have caught before the rupture. He died today, and his girlfriend (and mother of his infant child) thanked her for being so nice to him and upping his morphine when he was in pain, and that’s when she sort of lost it. She thought she could have done more, and was being thanked when she should have been blamed.
I reminded her that she’s not allowed to diagnose, and she hasn’t been with him for 24 hours a day and lots of people missed it, because peritonitis HURTS, and it made total sense that he hurt a lot, there was no reason to look for anything else to explain it and that’s not her job and she nodded. She gets it intellectually, she’s just feeling a bit overwhelmed, I think.
Anyhow, I don’t think I fixed her but I think she’ll be okay. Thanks for your help, guys. As I’m going to be starting nursing school within the next couple of years, it helps for me to get used to this stuff now. Though it won’t ever make total sense until I’m in the thick of it myself, I expect.
I had another thought. You, or your friend, might benefit from reading the “This I believe” essay from the first Monday in February. In it,a nurse practitioner who believes in grief, talks about how when she was younger, and uncomfortable with grief, she encouraged people by being cheerful, consoling the young woman who just had a miscarriage with the suggestion that she can try again next month,etc. Now, having experience grief herself, she encourages people to express their grief, as a way of honoring life.
(It’s not a long essay, about 3 minutes if you listen to her read it. Link on page I linked to above).
So we laughed a little about that.
but I think she’ll be okay. Thanks for your help, guys. As I’m going to be starting nursing school within the next couple of years, it helps for me to get used to this stuff now. Though it won’t ever make total sense until I’m in the thick of it myself, I expect.