Friday, April 30, 2010

Big holes

Sometimes, they leave big holes in you.

The people who die--that is, the patients you can't save--generally leave little holes, the sort that punctuate a baby Swiss cheese. If you gave them any more space than that, you wouldn't have a soul left.

But one time in a hundred, you get a really big hole.

The patient had a big hole in her. She was split from breastbone to pubis, and from one side of her ribcage to the other. They'd had to take out both of her kidneys and most of her large intestine, and a few bits and bobs in her mesentery, as well. What had been gut was now Gore-Tex. What had worked--however marginally--was now gone, and she was going to be on dialysis for the rest of her very short life.

"I think I'm going to die", she said, and I checked her color. It was good--her cheeks were pink and her eyes were bright. "I'm okay with that," she said, "I'm just scared of pain."

So I hit the button on the Dilaudid pump and prepared to listen.

The one thing nursing at night teaches you is listening. For some reason, patients are more prepared to talk about their fears and hopes at two a.m. than they are at any other time.

We talked about dying. She talked about her family, about her husband, with whom she'd shared forty-one years. It hadn't always been easy; she had secrets she'd kept from all of them that she told me that morning, in the quiet space between lab draws and rounds. Sometimes you're the nurse. Sometimes you're the confessor.

She died. She ended up dying. She passed. She coded, and we couldn't bring her back.

She left a big hole in my chest. As bad as things are, I wanted to tell her, they are still better than they could be; you have somebody at the side of the bed who loves you. You have your faith--with that, you ought to go to Heaven. You have children to remember you, and grandkids who will remember you, too, without the static of discipline and daily life to complicate their affection.

Put bluntly, without sentimentality or the rosy glow of blogging, something cut loose in her belly. She bled to death internally, probably experiencing a fifteen- or twenty-minute period of intense pain. We tried to bring her back with artificial respirations and chest compressions, but that only made the bleeding worse and hastened her death.

A fifteen- or twenty-minute period of intense pain would be welcome right now, as I contemplate the hole in my belly that matches hers. You can't always catch everything. You can't prevent every complication. You can't be enough.

She was mine, and she's dead, and I wonder what I missed, what I lacked.

Sometimes, you are not enough. It's an interesting process, to learn how to live with that.


messymimi said...

You missed nothing. It was her time, plain and simple.

You are an amazing woman.

TheSchaft said...

I don't think you missed anything that you could have seen, and I certainly don't believe that you lack in any way.

You and the hospital did the best anyone could - modern medicine isn't flawless or magic.

You're right when you say "Sometimes, you are not enough". None of us can ever be enough all the time, but you have shown that you are "enough" more often than most of the rest of us.

I hope the hole heals.

I'm glad there are people like you who feel the hole. Thank you.

nurseXY said...

I'm a little scared of this part of nursing.

I only hope to make myself as available as you seem to be.

me said...


Mel said...

You were there when she needed you most, as a listener and a confessor. The world could use more nurses like you, Jo.

Anonymous said...

You ARE enough. YOU were the one who was there for her in the dark hours that night, and you were the one who listened to her say aloud all that she needed to say, to be able to let go of the physical body that was no longer useful to her. And you did what you could to minimize the pain - and the fear, which was worse.
Not sure which philosopher/theologian said "we are not physical beings having a spiritual experience. we are spiritual beings having a physical experience."
Peace to you, Jo. Be gentle with yourself.
Another nurse

Dr. Alice said...

Playing the confessor is part of healthcare. It's a very important part, but I think it's also the hardest part. You did all you could, and that's what counts.

tottergirl said...

Jo, be easy on yourself. You gave her what she really needed, a kind listening ear and a bit of relief from the pain. We should all be so blessed.

Anonymous said...

The philosophy that allows me to keep going is to do the best that I can for my patients always. Not to always cure them or to take perfect care of them, but to do the best that I can. This includes learning from mistakes and always striving to be better, not perfect, but never complacent in care.

They still hurt though, the holes. I know exactly what you mean. When I think of the holes I can still see, plainly in my mind's eye painful as ever, the patients who left them...

Swapna Raghu Sanand said...

You tried your best. That's what counts.

Anonymous said...

If I ever find myself in that patient's shoes. I hope that I'm lucky enough to have a caring nurse like yourself, who will listen to me and care as much as you do !

Geosomin said...

My Mum was a nurse for 30 years...most of it in palliative care. She would always tell me - "do your best and what will be will be. If you dwell on what you could have done you'll lose your mind bit by bit."

The ability to give compassionate bedside care to someone who is dying is a gift. One you obviously have. Take comfort in that. The fact that you gave her comfort as well as physical help. The fact that this still hurts you is a sign that you are a very capable and compassionate nurse...

Anonymous said...

what was the point of doing surgery like that ???

- was not in anyone's best interest, particularly the patient's

- did not make anything better - even for a while