Two years in the ICU

A little background: I have spent the last 2 years working in a medical ICU working with a wide array of patients and their diagnoses from detoxing, diabetic ketoacidosis, congestive heart failure exacerbation, GI bleeds, terminal cancer, sepsis, respiratory failure, and even a couple of West Nile virus cases. I have learned so much about the human body and the journeys it is capable of surviving, but I have also learned so much about myself. I needed a place to write my thoughts and so I have returned to SageBrushRN to explore those ideas.

ICUs are able to combat and correct a lot of things. I am most proud of my moments when I've had a chance to feel like I made a real difference. I've had patients come back in a say thank you for getting them through a pneumonia, a heart attack, a freak infection that came out of no where, and various other maladies. 

However, what I was not prepared for in ICU was the torture care of terminal patients. When I say "torture care" I mean cares that are done to a patient that is very clearly not going to survive but we are still doing everything possible like we still have a chance to cure. 

I have cared for people for weeks with tubes coming out of every orifice that are unable to communicate but still grimace with every position change every 2 hours. I have lost a little of my soul to these patients that will spend the last hours of their precious lives being poked and prodded under fluorescent lights in the ICU. I have wept when we have coded the same person time after time because the family has no idea the violence of a code and would rather subject their love one to another Code Blue rather than hold their hand and savor what time is left. 

I have recently read Atul Gawande's book Being Mortal and it gave voice to all these feelings I have been grappling with over the last 24 months. Our medical culture is inept at dealing with mortality and we rather flail helplessly against certain death in an attempt to make ourselves, not our patients feel better. 

Gawande sites a study about palliative care where patients with Stage IV lung cancer  were randomly assigned to receive either usual oncology care or usual oncology care plus palliative care specialist care. The following is astounding,

"...those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experience less suffering at the end of their lives - and lived 25 percent longer (his emphasis, not mine). In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality (Gawande, Being Mortal, 2014)"

I got into ICU to save lives, but the longer I am there I realize the majority of what I do is prolong suffering of both patients and their families. I got into nursing to serve others, to relieve their suffering, to make the world a better place. I do not fear death, I fear suffering as a patient's last memory of this world. 

When I've worked with families and doctors wise enough to recognize and accept the end of life I have been honored to be death's midwife and remove the trappings of ICU and provide relief from pain and suffering to let someone pass. When I can remove the lines and let a mother hold her child one last time, or a spouse snuggle in for one last hug that is the comfort my patients deserve - to feel love and security from those who matter most to them.

It is with relief that I am now leaving CCU. It was an honor to work with such brilliant nurses and to be part of a such an efficient team. However, I have found that my nursing practice and my nursing soul need a change and will find that change in the new journey of PACU nursing...