Monday, November 3, 2008

not my finest moment

I had a real moment of shame at work the other day. Not just your everyday shame, either, but a searing flash that made me feel a little sick and disgusted with myself. It hasn't lessened in hindsight either, which really sucks. I try awfully hard to be a good person, and have to figure out a way to never let this happen again. The problem is - I don't know how.

It had been an uncharacteristically slow day. I mean slow. So slow that I voluntarily spent most of my day in Triage, which will eat you alive if it's busy, but on this particular day meant that I sat in a quiet room alone and played word games on-line. This is a double-edged sword, however, because when it's not busy the time seems to crawl. Most days I barely look up and my twelve hour shift is over. Not this one. The minutes dragged.

We all work twelve hour shifts, but we start around the clock. I had been there for hours when one of the older nurses came on duty. And before you knew it, before she had finished drinking her first cup of coffee, she got our first high-acuity patient of the day, who came in talking and nervously attempting to make jokes, and then proceeded to code on her within ten minutes. She coded once. They got her back. Twice. Back again. Three times. This was not good.

Her family was there, and growing in number by the minute. We called in the chaplain, who took them to the family room down the hall - the room you never want to be in - and tried to keep them up to date on what was going on. Her husband sat numbly in a chair, staring at the wall.

In the trauma room things were hopping. There were a ton of people in there - respiratory therapists, pharmacy, my boss, the nursing supervisor, two doctors, a physicians assistant, untold numbers of nurses and several students who were on the unit that day. The ER rotations almost always come at the end of a nursing program, right before the student is going to graduate. It's an anticipated rotation for all but a few. And this was exactly the kind of action they wanted to be in on.

I wasn't needed in the room, but I kept going in to see what was going on. And when I ran into the primary nurse who had that patient, I made some sort of comment about how all the rest of us had been sitting on our asses all day and then they came in and got the action, while we were all half-asleep. I went back in the room - because I was bored - and finally got something constructive to do to help. One of our nurses had dragged all the students to an out of the way corner and was walking them through the code. One of the doctors stood in the middle of the room and walked us through his thought process step by step, inviting questions and feedback. One by one, we let the students do the chest compressions, so they could learn how on a real person and not a rubber demonstration dummy.

A real person.

This was not a teaching moment. This was not something to keep me awake for the last two hours of my shift. This was not television. This was a woman who was going to die, no matter what we did or how well we did it. The family at the end of the hall who kept glancing fearfully at the closed curtains were not amused in the slightest, nor should they have been. The look on their faces as the doctor came out of the room and walked down that long hall toward them was a look I've come to know and dread. It was raw terror. As the doctor reached them and put a hand on her husband's shoulder...he knew. He knew before he said a word. And he slowly collapsed weeping into his son's arms as the rest of the family stood in varying degrees of stunned shock and vocal grief.

You have to walk a line. There has to be objectivity there or none of us could do our jobs effectively. You have to teach people how to handle situations like this. In nursing school, it's a badge of honor. "I was in on a code during my ER rotation" is right up there with actually seeing a baby being born during your time in OB. (Which I hated, by the way, just to add one more black mark to my name. OB, not babies).

And god knows if we didn't have some way of distancing ourselves, we'd never get through the day. And god knows that it takes a cold human being to not feel a family's agony. And god knows that I may never make it to that point. But even though I was not alone that day in my attitude, I still feel like a schmuck. From a medical and professional standpoint we were beyond reproach.

But as humans?


lv4921391 said...

RC, maybe next time take the students to a room and close the door. Learning must continue.

Maggie May said...

The students have to learn but it is not easy this kind of thing, is it?

laurie said...

i'm not entirely clear on what it was you were ashamed of....

Flutterby said...

I'm with laurie, I'm not clear on what you were ashamed of either.

Amy said...

I think you're being too hard on yourself. People die. Medical and nursing students need to learn how to do their jobs. It's nothing to be ashamed of. It's hard, but it's not shameful.

Rudee said...

Teaching hospitals can be dehumanizing in situations like this. It's where I think I'd want to be if I were the patient.

Having been in situations like this as a nurse, I do think I know what you're speaking about in terms of being flip, making jokes, etc. RC, this is how we blow off steam during stressful situations. Nothing more, nothing less. If we didn't, this job would eat us alive.

aims said...

Did you go and talk to the family and say how you feel?

If not - you know their names and still could do so.

I'm ashamed to say I could not have done any of that. Bless you for just being there.

CrazyCath said...

Don't be too hard on yourself. Guess what?
None of us are perfect. We do what we have to so that we get by. Hopefully without causing hurt. Sometimes we do. We don't mean to.

We are not perfect.
Be a little kinder to yourself.

Iota said...

I'm with Laurie. Not quite sure why you're so ashamed of yourself.

I love my kids. I love them to the bottom of the sea and to the top of Everest. I know their emotional health and development depends, to a large part, on their relationship to me. Sometimes I lose patience and shout at them, and say things I shouldn't. I feel ashamed.

You're human. You're not perfect. Let it go. What is wrong with treating a job like a job, even yours, once in a while?

Kaycie said...

I lost as to your shame as well, RC.

Devon said...

You give compassion, guidance and help daily. Don't be too hard on yourself. You were seriously falling asleep and life or death emergencies will wake anyone up.

I had and EMT student in my room as I was pushing out baby #2. I always let students in when asked. They need to learn and I apparently have a total lack of modesty!

laurie said...

black humor (if that's what you're ashamed of??) is a gift from god.

so says elizabeth mccracken, and i think she's right.

black humor reminds us that there is light at the end of the tunnel, that there's good in the world, even during the bleakest of situations.

black humor is the weapon and the cloak of anyone who has to deal with trauma.

Akelamalu said...

It's a very difficult job you do and from what I've read you do it very well. If you think you made a human mistake you will learn by it, don't beat yourself up honey. x

Anna Lea said...

While I am sure those people are grieving, and may have been unnerved at the sight, nurses and doctors MUST take every opportunity to learn. Otherwise we wouldn't be in the position we are to save people. What if the doctor didn't let them try it on a real person, and the first time the had to do it in an emergency they made a mistake. Nothing you did was shameful. Being able to distance yourself from the reality makes you a better nurse. If you broke down with grief and sadness every time a patient died, or took a turn for the worse, you would be a very ineffective healer. I have great respect for nurses and doctors, and their ability to do their jobs 100% in such stressful situations. Thank you!

Anonymous said...

Don't even think about being ashamed, not for one second. The patients that you work with are so very lucky to have you there. You put your entire heart and soul into your work, into the care of your patients. Focus on the amazing, incredibly hard job you do every single day.

Iota said...

I think, actually, it helps us normal people to think of medics as "professionals" rather than human beings. The last thing we want it for a nurse or doctor being our emotional buddy. We need them to be "out there" for our own sanity.

Just a theory.

Tiggerlane said...

Sad to say, but my husband has had these same feelings when he used to work in the ER.

Nursing is for special people, and you are certainly one.

Anonymous said...

Frankly, my dear, I would love to have the chance to be that woman. If I'm going to die anyway, and I'm unaware of what's going on (dead, comatose, whatever), and there are a bunch of student nurses/doctors/whatever there who could learn to save the NEXT person by practicing on me... Please, please do.