Contemplations on Mourning & Why I’m a Nurse


I’m really horrible with dates, whether birthdays, anniversaries, or whatever, but when I was talking to my mom this morning she reminded me that exactly three years ago today my dear uncle Robert died.  I never knew my grandfather on my dad’s side of the family & because Robert was considerably older than all of my other uncles & because I spent a lot of time with him & my aunt Katherine, I always thought of him more like a grandfather than just an uncle (no to disrespect to uncles of course). special date

In any case, as soon as my mom reminded me of his passing, floods of memories came pouring to the surface.  Most intensely of course I remembered that day three years ago when I saw Robert for the very last time.  The circumstances under which that occurred were really quite significant.  Allow me to explain.  Robert had been in & out of the hospital for several months at that point, & the nurse part of me of course knew that his prognosis wasn’t very good.  I had seen him a few times here & there, but as it turned out that weekend I was scheduled to go to a Zac Brown Band concert in Roanoke, VA with a close friend of mine, so I was hoping to tag on a visit to him as well.  It just so happened that both NC & VA were subjected to a great deal of snow & ice that weekend, but I was determined to make it to VA.  So, quite foolishly I suppose, I left Raleigh in some of the worst freezing rain I’ve ever encountered.  It was so bad that I had to stop more than once to scrape the ice off my windshield just so I could see to drive!  After about an hour on the road it became clear there was absolutely no way I could safely make it to the concert in time.  My friend wasn’t so sure she could make it there either, & thankfully she was able to transfer our tickets to some folks who could go. freezing rain

Anyway, once I realized I couldn’t make it to the concert, I decided I would still go home & visit Robert & the rest of my family.  There was just a part of me that knew that this might be the last time I’d ever see Robert alive, so even though the roads were horrible & I drove by quite a few accidents, I was determined to make it home safely so I could see him.  What is normally just shy of a three hour drive turned into over a five hour drive; I don’t think I hit more than 40 mph the whole trip!  But my husband’s trusty little Chevy Cavalier, hardly the best vehicle for such dangerous wintry driving conditions, got me home in one piece, & I was able to visit my uncle in the hospital the next day.end of life quote

I still remember very clearly entering his ICU room & seeing him lying there intubated.  It hit me like a ton of bricks that, yes, this was definitely going to be the last time I ever saw Robert alive.  I’d been a nurse long enough at that point to know that this was it.  Even though it was a Sunday we were fortunate to have a palliative care doctor available to us, & I remember helping my aunt discuss various things with the doctor (e.g. whether to continue tube feedings).  In short, the decision was made to proceed with comfort care only, which was what I & the rest of us felt was best & what he would have wanted could he have spoken for himself.  When it came time for me to leave, I went over to the bed & looked my uncle in the eyes, & even though he was still intubated & fairly sedated at the time (the ventilator was actually off but the ET tube was still in place), he turned his head & opened his eyes & looked at me.  I kissed him on the forehead & told him I loved him but it was ok for him to go if he needed to.  I hugged the rest of my family & left that room knowing I would shortly receive the news of his passing.

As it turned out, it was just about an hour later that one of my cousins gave me the news that Robert had passed away peacefully.  I had to be back at work the next night I believe, so I was already back on the road to Raleigh at the time.  I will never forget pulling over on the side of 460, somewhere around Altavista, where I watched the sunset, a gorgeous one I might add, & cried.

I was put in mind of these events this past Fall when my grandfather was ill & the nurse part of me knew that he was dying as well.  For sake of time I won’t elaborate too much, but essentially the exact same scenario happened, minus the missed concert & the winter weather.  I’ll never forget kissing him good-bye & telling him I loved him but he could go if he needed to, then walking out of that hospital room knowing I’d truly just said our final good-bye.  I also distinctly remember driving home to Raleigh the next morning & pulling over somewhere in Charlotte County to watch the sunrise & cry.

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The sunrise I watched in Charlotte County, VA on the way home from seeing my grandfather for the final time

Now I’m fighting back tears of course, but I’m writing all of this to say not only that I miss these dear men very much but also that I like to think of a lot of my nursing care as being in honor of them.  Let me explain.

I’d only been a nurse for a few months when it became very apparent to me that I have a special place in my heart for palliative care & hospice.  Even though I was all of 22 when I became a nurse I seemed, even then, to have a particular affinity for working with patients & their families at the end of life.  Like many others of course, I got into nursing largely with the idea of saving lives. But it didn’t take much experience for me to realize that even with all of the advanced medical care available to us today, that doesn’t mean every life can be saved every time.  Furthermore quality of life is at the end of the day so much more important than quantity of life, at least in my mind, though I’m sure the vast majority of people would agree.  Even as a young nurse, I remember advocating for palliative care & hospice for several of my patients who clearly needed & desired that type of care to allow them a peaceful death.  I quickly realized that helping them achieve that goal & assisting their families in that process was, though difficult at times, the most rewarding part of my job.  Over four years later I still agree with that sentiment one hundred percent.hospice

In the past four, now closer to five, years of nursing, I’ve called families countless times to inform them that their loved one was in the process of dying & they needed to come see them if at all possible.  And countless times I’ve called families to say their loved one has in fact passed away.  It’s never easy, but it doesn’t scare me anymore either.

Now I’ve said all of that to finally say this:

Yes, I’ve been told by plenty of folks that I’m “smart enough to be a doctor.”  And, yes, I agree one hundred percent with that sentiment.  But let me tell you why I am so, so glad I chose to be a nurse instead.nurse pic

In case you didn’t know, doctors don’t round at night (& even during the day they usually only see each patient once or twice).  There are doctors on call at night of course, but they are there to handle admissions & emergencies.  Otherwise it is completely up to us as nurses to monitor our patients & advocate for them when the need arises.  If your loved one’s condition is deteriorating, believe me, the doctor isn’t coming around every hour to check on them.  That just isn’t feasible.  But the nurse is doing exactly that.  It is up to our eyes & ears & critical thinking to manage those patients & to know when to call the doctor & what to ask for when we do.  I can’t tell you the number of times I’ve quite literally saved a life by intervening on the behalf of a patient who had acute hypoglycemia, A Fib-RVR, SVT, acute respiratory distress, or any number of other life-threatening conditions.  Knowing I’ve been part of such efforts is of course incredibly rewarding.

smart nurse

But the most rewarding thing of all to me is when I help someone achieve a peaceful death.  I know that may sound very bizarre but it’s just the truth.  Though none of us likes to admit it, the truth is we’re all going to die someday, & I think all of us hope that when our time comes, it will be peaceful & as painless as possible.  So when I can be a part of making that happen, I feel like I’ve accomplished something truly meaningful in this world. hospice 1

Of course there are situations when patients & families are contemplating comfort care/hospice but haven’t quite made a decision yet.  And of course sometimes things change drastically overnight & suddenly that decision cannot be put off any longer.  Especially overnight when the doctors aren’t rounding, it becomes up to the nurse to advocate for that patient.  Though it is challenging, multiple times I have been the one who has called a family member to say that a choice needs to be made.  I have facilitated conversations between family members & doctors so that a choice for comfort care could be made official & we could begin to work towards a peaceful passing.  Yes, ultimately the doctor is the one giving the orders, whether it’s for comfort care or otherwise, but believe me, even the best doctors are relying very heavily on us as nurses to guide them.  This is especially true at night when we are quite literally their eyes & ears.nursing quote

Anyway, maybe this all sounds morbid & strange to you if you aren’t part of the healthcare field (or perhaps even if you are).  But when I care for patients & their families at the end of life, I think about my own loved ones I’ve lost.  I remember Robert & PawPaw (my grandfather) & Granny & their suffering & the relief I could see in their eyes when they heard us tell them we loved them but we could let them go if they needed to.  And I remember the nurses who cared for them during their last days & made them as comfortable as they could be. end of life

Yes, I’m sure I could have been a doctor & to some people maybe I’m “not living up my full potential” by being a nurse.  But the folks who say/think that have no idea what I do on a daily basis.  They have no idea the difference I’ve made in the lives of countless patients, both those I’ve helped to save & those I’ve helped to achieve a peaceful death.  As I’ve said, I’ve long since lost count of the number of times when I’ve been the one who has intervened for a patient & made a tremendous difference in their life, again whether it was helping to save them or helping them achieve a peaceful passing.  Particularly when the situation is the latter, I often remember my own loved ones who’ve passed away & I like to think I am serving others in honor of them.

In summary, yes, nursing is frequently stressful, overwhelming, & emotionally & physically taxing.  But every night that I work I know I make a meaningful difference.

And that, my friends, is why I’m a nurse.

Why Nurses Cry: Musings on the Loss of a Patient


Recently I found out that two of my former patients died.  Yes, like many other nurses, I scan the local obituaries every so often looking for names I recognize.  I don’t know why I do this because it inevitably leads to a few tears if I see the name of a patient I really liked, & this happens a lot more often than you might think.  But in an odd way I think reading these obituaries also brings me a bit of closure because it allows me to know that a person whose suffering I witnessed first-hand is now freed from their earthly turmoil.empathy

This situation definitely left me with a few tears in my eyes even though realistically I know that death was the best option for both of these patients.  I know most people view death as the enemy, but one thing I learned very early in my nursing career is that death is NOT always the enemy.  When people are suffering the way these folks were, death can actually be quite the opposite.  And what pains me more than anything is when patients are not able to experience a dignified death that is as peaceful & painless as possible.  Things are slowly improving but unfortunately hospice & palliative care services are still very under-utilized in our society.  (As some of you may know, I actually volunteer with a local hospice group because I feel so strongly about the importance of hospice.)hospice 1

Anyhow, all of this got me to thinking about the many times I have cried as a nurse, both on the job & at home when thinking about my patients after work.  It happens less frequently than it used to because I’ve learned to develop more of a “shell” to help protect me . . . This doesn’t mean I’ve become hard-hearted & insensitive (someone please tell me the day I do so I can turn in my badge).  But as a nurse I’ve had to learn to balance my own mental sanity with showing compassion towards my patients & their families.  Throughout my life I’ve often been told I’m “sensitive” & that I “wear my heart on my sleeve” (who comes up with these expressions?!), & while I certainly hope to never lose that side of me, I’ve had to learn to “buck up” & withstand a lot of things that I probably couldn’t have faced years ago. tears

At this point in my career, I’ve lost track of the number of times I’ve seen someone die.  I’ve lost count of the number of dead bodies I’ve touched & cleaned up to send to the funeral home.  Since I’m not an ED or ICU nurse I don’t see a whole lot of codes but even so I’ve still lost track of the number of codes I’ve assisted with.  And I could probably write a whole book about the number of times I’ve helped prevent a code from happening, for example by recognizing that a patient was dangerously hypoglycemic & giving them D50 (sugar water) in their IV to raise their blood sugar or by recognizing that a patient was in pulmonary edema & needed IV Lasix STAT to pull the fluid off of their lungs, just to name a few . . . Notice a pattern here?  Nurses really do save lives, y’all.  Doctors are great & I have a huge appreciation & respect for the work they do.  But seriously, until you’re a nurse you have no idea how important nurses are.  There is a reason we are called the backbone of the healthcare industry.  We as nurses are the ones watching your lab values, your vital signs, your telemetry (heart monitor), your I&O (fluid intake & output), & your mental status (among other things) like a hawk.  More often than not we are the ones recommending/telling the doctors what needs to be done . . . Again, I am not trying to take away from the important work that doctors do.  I’m just saying that one of the biggest reasons I do not regret choosing nursing school over medical school is that I see on a daily basis just how big of a difference I really make.

Despite the challenges & frustrations of my career, I'm still glad I chose nursing over med school.

Whew, that was a tangent that I wasn’t intending to go on, but, hey, it happens sometimes.  Anyway, when I see that one of my former patients has died (or when a patient dies under my care), there is always a small part of me that feels like all of our hard work to save them has been in vain.  Realistically I know that most of these patients are coming in with so many different medical comorbidities that the chances of them surviving, or at least surviving with any real quality of life (which is after all the more important factor), are low.  But every once in a while I find myself thinking “Gosh, so much of what I do is just keeping people alive for a few more days, weeks, or months, usually with a great deal of suffering involved, until they inevitably die.” nurse pic

But then I remember that maybe in those last few days or weeks or months they might have gotten to see their grandson who lives all the way across the country for one last time.  Or maybe they got to witness another grandchild get married or graduate from college.  Or maybe they just had enough time to adequately say good-bye to all of their loves ones (as best as possible) & vice versa.  And maybe in the midst of all off their suffering, pain, & fears I was able to provide a calming presence, a small balm to ease their wounds.  Or maybe I was able to help their family understand their loved one’s disease process & how to prepare for their loved one’s death.nursing humor 1

All of this brings me to the main point of this post.  As long as I’m a nurse, my sincerest desire is that I never lose that sensitive soul, that compassionate drive which inspires me to do my best for my patients.  I know at times I am not able to grieve for my patients the way I want & need to because I just have to keep on moving to take care of the rest of my patients.  And I know at times I may seem hardened or callous because I don’t cry every time a patient dies or receives a bad diagnosis or because I laugh at things that non-nurses would find revolting.  But as I said, as nurses we do have to harden ourselves a little bit so that we can make it through our shifts.  Trust me, it’s a fine line, a very fine line, we walk trying to maintain our own sanity while still providing truly compassionate care to the patients & their families entrusted to usempathy

My challenge to myself & to anyone who’s reading this who is also a nurse (or any kind of healthcare worker) is this: next time you’re caring for a patient, particularly if they are “challenging” or “difficult” for whatever reason, take a moment to consider that there is probably a higher chance than you’d like to admit that the time you’re spending with this patient might be some of their last days on Earth.  With that in mind, may we all strive to be the best advocates we can be for our patients & to provide the most compassionate care we can, knowing ours could be the last voice they ever hear, our hand the last they ever hold on this planet.