Our hospital chaplain and I were talking earlier that morning about the effect seeing human suffering has on caregivers. Over time, it can change a person; seeing so much pain, fear, and death wears you down to the point that even the most joyous times (like watching a patient you never expected to make it walk out of the hospital) are just a little less fulfilling. Fortunately, for most of us, these feelings are cyclical. The pain subsides, the joy returns, and we go on…but you have to wonder about the cumulative effect. Who would we be if we didn’t witness all the suffering?
Yesterday one of our patients died. We tried to save her and we couldn’t. Every single time we have a code, I hope that it will be the last one I ever see…odds are it won’t be.
I was on the opposite end of the unit with a couple of the other nurses when we heard the code alarm. We rushed to the patient’s room where someone opening the code cart and CPR was in progress. As I took over chest compressions (I’m usually the one in that role first just because I’m tall), I thought of the many times I’ve had my hands on someone’s chest doing those same compressions and I prayed for the lady’s heart to start beating again on its own. It didn’t.
As charge nurse, by default I have to be the nurse leader during a code until we have a designated physician leader present; I don’t want to be the leader. It’s usually for only a couple of minutes but it feels like forever. I have to make sure someone is manning the cart and defibrillator, someone else is getting defibrillator pads on the patient, that we have working IVs, someone is recording, we have a backboard under the patient, and that someone is getting the meds ready.
When one of the young doctors took over compressions, I helped a nurse ventilate the patient while the anesthesia MD was preparing to intubate. I saw the panic in her face as she struggled with the ambu-bag initially then the relief as she got it right and heard me say, “Yes, sweetheart, just like that.” I’ve been in codes where people yell and it never helps anyone.
Real-life codes are not like the ones depicted on television. We are jammed together tightly around the patient and we are covered in sweat that is not just our own. Regardless of the outcome, everyone is shaken at the end of a code and there are some tears shed. We take it personally when a patient dies.
Dr. S was our physician leader; not only did he run the code perfectly, he was very calm and set the tone for everyone else. We gave numerous rounds of meds and performed CPR continuously. Everyone in that room worked hard to save the lady’s life. Several times, Dr. S had four of us do a final pulse check before he “called” the code; if one of us even thought we felt a pulse, we began the whole cycle again. After 46 minutes, there was nothing. He had to announce the time of death and one family was changed forever.
While we prepared for the patient’s family to see her, our chaplain met with her sons. I see death only occasionally; he shares others’ grief weekly- not just the patients and their families, but also our staff. Afterward, he updated me on the family while I was charting, then said he wanted to check on the nurse whose patient had just died one last time. As I watched him take the lonely walk down the then eerily quiet hallway, I thought to myself “But who’s gonna check on you, buddy?”