My First: Sometimes It’s Out Of Our Hands

Nurses are meant to heal, or at least that's what we are taught. It's practically ingrained in you. We take the sickest of the sick, put them back together, piece by piece, and make them whole again.

However, what happens when despite every effort, saving a life becomes futile? It's like you're in one of those scary movies where you are running, but there is "death" right behind you...ever so slowly, nonchalantly walking, and you can't manage to pull your patient out of its grasps? No one seems to prepare you for that and I surely wasn't prepared for a certain patient who fell into my care a little less than 5 years ago.

These were the days of my "baby" nursing. I literally had just been off orientation for a few months and was working in a step-down intensive care unit. I remember being told by my charge, "Heidi, you're getting an admit"...oh man...my tummy was already turning. Being a new nurse, an admit was already scary enough. I began to play this mental torture game of "what's coming my way? Am I going to be able to handle it??" (a game I still play to this very day). I looked down at my admission slip and saw written "35-year-old male, high potassium, and low platelets.” Humm...okay. I already began to plan out in my mind all my interventions even before calling to get report. I'll never forget that report...even to this day, it seems like I can so clearly hear the sadness in the ER nurse's voice. The first words out of her mouth were "Oh man, this is a sad one.”

She began to paint a picture of a young man, married, two little girls, diagnosed with cancer a few years back and it had unfortunately metastasized almost everywhere except his brain. He was at the end of his life when his little family decided to take one last adventure together. They were from the east coast and had never seen a western sunset. They were making one last road trip and were planning to spend his last few days watching the ocean swallow up a golden western sun. Unfortunately, along their journey, he had become very ill and landed in a Modesto hospital, a few hours short of their destination. After receiving report, I immediately felt a pit in my stomach. I was up against the challenge of my life. I felt somewhat responsible for making sure this dying man made it to his final destination. I'll never forget how he looked as the ER transport team wheeled him to his room.

He was about 6 feet tall, probably had a nice build at one time, but here in front of me was a pale, sunken in, bald and fragile man. His eyes were what I really remembered. He had these dark brown eyes and his pupils were so large that it made his eyes almost seem like sunken dark holes against his pale skin. His wife tiredly followed alongside, a blanket wrapped around her, staring at her feet as she walked. Thankfully, they knew a family friend in the area who had taken their two little girls home for the night. The rest of the night seemed to go by so fast. We tried everything to get his potassium down, transfused platelet after platelet, and his body just seemed to eat them up. After redrawing labs and seeing that we were making no progress, I called again to his doctor. They could try hemodialysis to get his potassium down, however, he had so few clotting factors, that the doctors did not feel comfortable placing the large dialysis line that would be needed.

I remember listening to the doctor as he came to the patient's bedside to explain his options. The patient agreed. No hemodialysis and at that time, he expressed his wishes to be made a DNR. He wasn't giving up though. He agreed to comply with more interventions to try and get his potassium levels down. I can still see his wife's face as I walked into his room with yet another round of insulin and dextrose, Lasix, calcium gluconate, followed with more kayexalate. She tiredly lifted her head off her pillow as she watched me hold a cup of this gross tasting substance to her husband’s lips, which he tried with all his might to drink down. I think he knew this was the end for him, but he wanted to show his family that he was still going to fight.

I left work that morning, after giving a defeated report to my day shift nurse, and slowly made my way home. When I finally reached my house, I just sat there on my couch for a good 5 minutes, taking everything in that had just happened, and then everything I had been holding back flooded over me, consumed me, and swallowed me right up. I began to let all my tears loose, the tears I had spent countless hours holding back and just...well...cried. For some reason, I picked up my computer, logged onto Facebook, and entered my patient’s name...and before I knew it, there he was. I almost didn't recognize him. There was MY patient, with picture after picture of him with his little beautiful family, all smiling, laughing and he looked so...alive. ALIVE. Nothing like the man I had seen. I tried real hard to understand why this all had to happen to him. Why he had to end up in our hospital, SO close to his final destination. As I tiredly walked into work that next night, I noticed his room was empty. I immediately found the nurse I had given report to that morning and inquired about him. Sadly, at around 11:00 that morning, he had gone into a fatal heart rhythm and passed away. Thankfully, his little girls had been able to see him that morning and did not witness him passing. The news hit me hard. I excused myself to the restroom, sat on the floor, hung my head in defeat and cried for him and his family. It took me a long time to come to terms with why this happened to him.

It was the first time that no matter what I did, nothing would have changed his outcome. I now work in the Intensive Care Unit where I come across this situation often, where I have hung all the drips I can, maxed out on everything, and then just left it up to fate. It's still a struggle. It feels almost unnatural and nurses are programmed to heal, and when we can't, on some level, it still gets to us. This was my first patient I couldn't heal. As badly as I wanted to save him and help him see his western sunset, I just couldn't. It was out of my hands. I'm not a superhero, I don't have magical powers, I was just a nurse, doing all she could to try and save a life. It taught me a hard lesson, but one I needed to learn in order to survive in the profession I have chosen.

And still, to this very day, I hope my patient gets to see his beautiful western sunset every evening from heaven.