A day in the life of an ICU nurse:
Patient 1 (told from the perspective of the spouse):
You're sitting drinking coffee with your spouse of 25 years. It's a normal Saturday morning. You're enjoying the quiet before you have to clean out the garage. You look up just in time to see you spouse stand up and then fall to the floor with no attempt to catch herself. You yell and rush to her side. Rolling her on her back she is an ugly shade of gray and does not appear to be breathing. You attempt to feel for a heartbeat, but can't be sure if you're feeling your own or hers. You grab the phone and dial 911. The operator walks you through doing CPR and states the ambulance is on their way. When they arrive they rush to her side and resume CPR, while attaching her to a machine. You hear "shock indicated. Clear." Her body arches off the floor. The medics immediately resume compressions. The second medic hurriedly works on an IV and medications. They eventually load your wife onto a gurney and roll her to the ambulance. You follow to the hospital. When you arrive at the front desk of the Emergency Department (ED) you are escorted to a conference room. They state they are "working on" your wife and will update you when they can. A chaplain comes to sit with you, but is unable to give you an update, yet. They ask if there's anyone they can call for you. Your kids are out of state and are busy with their own lives. You elect not to call yet, as you don't know what is happening. What feels like days later, but is really more like 30 minutes, two people in scrubs come in the room. They state your wife cardiac arrested 3 more times and had to be shocked. They state they currently have her "back," but she remains unstable. They do feel she is stable enough to move to the ICU though. They tell you, you'll be able to see her when she is stabilized in the ICU. You are led to another waiting room several floors above for the ICU. Finally another nurse in scrubs comes to get you to lead you back to the room. She states your wife is "currently stable." When you walk in the room you don't recognize the body in the bed. There's two tubes in her mouth, a large IV in her groin with a machine attached to the tubes coming from it. There are multiple pumps with clear lines attached to the same IV. There's a line in the artery in her wrist. There's multiple lines in her arms. There's a needle sticking out of the bone of her upper arm. There's a bag of what must be urine hanging on the bed. Her eyes are closed and she's very pale. There's a monitor above with multiple lines an numbers of different colors that you don't understand. There's another machine with tubes attached to the tube coming out of her mouth. You're overwhelmed. The nurse explains what's going on to you, you only absorb a few words. The nurse patiently re-explains things many times until you're able to absorb them.Many doctors come by and give you more explanations, but don't stay for long. You feel as if you're in a dream. They say words like "she was down for approximately 30 minutes," and "we're cooling her right now to try to save her brain." Save her brain? What does that mean? What's wrong with her brain? You thought it was her heart. The nurse attempts to explain that despite CPR, the brain needs blood flow and oxygen to survive and CPR does not supply the same amount as her own beating heart would have. She is currently on medication for her blood pressure, sedation, and pain medication. Meanwhile thoughts flood your brain. "Do I need to call my kids? What do I say to them? I need to call her mom and dad. This might kill them. They're already not well. If she dies, where did she put her will? How am I going to pay all our bills? She normally takes care of all of that? I don't even know where the checkbook is. How am I going to live without her?" Etc. Many people in scrubs come and go. There seems to be a lot of activity, but you understand none of it. The next day when you walk in there are even more cords and wires than before. The nurse explains they are doing an EEG. You notice your wife's face is twitching. The nurse explains this is "myoclonus" and they are doing the EEG to make sure your wife is not seizing. After the brain does not get enough blood flow and oxygen for a time, it can cause an "anoxic injury." The days come and go. You get to know the nurses pretty well as they spend a lot of time with you and you only see the doctors a couple times a day. Day 4 you come in and it's explained that they have "rewarmed" your wife and now they will start trying to wake her up to see if her brain is "ok." Your wife's nurse is no longer at her side 24-7 as she states she now has a second patient to take care of too since your wife is "rewarmed and stable." You still don't quite understand what that means.
Patient 2 (told from their own perspective and then their gf perspective):
You have tried to cut back on your drinking lately. Not because you think it's a problem, but rather because you feel it's not a problem and want to prove this to your girlfriend. You're not an alcoholic. Alcoholics have problems. You're fine. You can quit drinking anytime you want. But, you don't want to. You enjoy drinking. You notice a fine tremor in your hands this morning. That's weird. Maybe you have low blood sugar. You eat a snack just in case. You're awfully sweaty this morning too even though it's not that hot out. You wake up 7 days later, with no recollection of the past 7 days. According to your gf, you kicked a nurse, called multiple nurses some very vulgar names, hit multiple other nurses, screamed many obscenities, tore a chunk out of your own arm while flailing around, had to be held down multiple times and at one point it took 6 large males to put you in 4 point leather restraints. You had 2 seizures. You spent 4 of those days tied to the bed. You peed and pooped all over yourself. You're slightly horrified and hope your mother doesn't hear you hit a woman.
The patient down the hall is in cardiac arrest and your nurse goes to help, because that's what they do. The one next door to them has a tracheostomy (breathing tube in their throat), a PEG (feeding tube in their stomach), they cannot communicate anymore, they have a stage IV ulcer (bedsore that goes down to the bone) that you can smell from the doorway. They have a tube in their bladder, one in their rectum, and another in their arm for multiple IVs. They will never wake up and be who they once were. Yet, their family insists that the nurses and doctors "save them." The patient next door to them tried to take a bunch of pills to end their life. They were molested by a family member for 10 years and now live with an abusive significant other.
These are just a small sample of the patient's we, as ICU nurses, take care of everyday. Keeping track of 15 different lines, tubes, and drips is normal. There is meaning and purpose to what we do. We save lives, but lately I frequently feel as if I am doing more harm than good to people. I can't remember how many times I've said "please don't make me save this person." Then, I faithfully will start CPR on them because it's what I do. CPR is not like they show on TV. It's one of the most barbaric things we do in medicine. Every time we do CPR we break multiple ribs. The feeling of the crunch of ribs under your hands is incomparable to anything else. It always makes me cringe. I was talking to another nurse recently about how the older nurses we were working with have made it through 30 years in an ICU. She stated "20 years ago the people that are now in the ICU would have been in the morgue and the people who were in the ICU are now on the floor (regular hospital unit)." How true this is. We can save almost anyone these days. But should we? The ethics in this job are a big part of burnout. Sure we can save them, but what does that really mean. Years of debility and being bed bound, breathing through a tube, being fed through a tube, bed sores, chronic urinary tract infections and pneumonia, extreme constant pain, and inability to communicate their needs and wants, are only a few of the chronic consequences of "saving" someone. Would they want this for themselves? What exactly is their family's reasoning for saving them? Money, selfishness, inability to say goodbye, waiting for an apology they will never get, religious beliefs, etc. My job is not to judge. I know this. But, as an empath and experienced ICU nurse, I feel for these patients. Frequently, we are limited in ICU on what drugs we can give d/t the patient's vital signs, mental status, etc. This means limited sedatives and pain meds. We are literally causing pain, instead of relieving it. Recently, a family asked for a few more days before making an end of life decision. While I understood their viewpoint, I felt deep horror at what this meant for the patient. 2 more days of agitation, pain, sleeplessness, and inability to communicate. 2 more days of delirium, being tied to a bed, endangering themselves with their restlessness. I felt sick to my stomach. I started crying. I was devastated for this patient. I knew that in 2 days they would not have made any medical progress. Their family would only see their struggle for about 2 hours a day, when they felt like visiting, while their nurses would see it 24-7 and have zero ability to ease their suffering. No compassionate nurse gets into this career for this. This causing of pain and suffering. The anxiety that comes with trying to keep a patient "safe" when they seem to be doing everything to not be safe. I have seen too many patient's harm themselves in their altered mental states. It's immensely frustrating to not be able to prevent harm despite all that is in place to do so.
These challenges are why nurses take up all kinds of "coping mechanisms," many of which we preach to our patient's about the dangers of. Drinking, smoking, and eating unhealthy among many more. We all cope differently, but universally we establish ways to maintain a balance between our work life and home life. I, for instance, read, write, play with my dogs, exercise, and use a sick sense of humor, to cope among other things. It works for me, until it stops working. That's when I know I've pushed too hard, for too long. I need a break. Burnout looms like an ominous storm cloud on the horizon. I love storms, but this one threatens real harm. Danger. Brokenness.
I have 8 more shifts at this assignment and then I get to take a few weeks off. Yes, I am counting. I love being a nurse. I do not want to do anything else. I absolutely LOVE being an ICU nurse. This job was made for me, or maybe I was made for it. I love being a part of someone's story. I love easing pain, comforting a family and a patient, helping someone heal, saving a life. I LOVE LOVE LOVE saving a life. I believe in doing this job with "passion or not at all." I am a deeply feeling and emotional person. I feel the pain of the patient and family. I will continue to do this job to the best of my ability, but for today, I desperately need a break. Compassion fatigue is real. ICU burnout is real. I will continue to critical think and try my best to prevent a patient from getting worse. I will process 100s of pieces of data every minute to save a life. I will attempt to do this compassionately. I will continue to pray "Dear God, don't let me kill anyone today. Or even cause them harm." I will continue to treat the patient's with no hope for a meaningful recovery. I pray that their suffering and pain will be eased. Sometimes letting someone go is the most compassionate thing we can do for them, but since that is not my decision to make, I will continue to "save them" as much as it may break my heart to do so.
