Friday, January 25, 2013

On the PICU and Dying

I don't know what it has been about the past 2 months, but we have had an exorbitant amount of deaths.  Working in the PICU it can be said that death comes with the territory.  And I certainly get that, but there have never been 2 months like this in the last 8 years that I've been at this hospital.

One day in November, we had 3 deaths.  3 different kids died in one day...ONE DAY!

Never, ever, have I done compressions on two children in one day, and both did not survive.

The third death that day was a beautiful teenager who I had the privilege of taking care of since July who had cancer.  She was probably my favorite patient that I've taken care of since becoming an APN.

I admitted her over the summer when we thought she was going to die.  And yet she didn't, for another five months.  She had five months to live out a few last dreams and wishes while in the hospital.  She Skyped with Enrique Iglesias, got his cell number, and even got a through-the-computer kiss!

We had a spa day full with nail painting, boa wearing, and facial hair removal (which was almost comical because she truly didn't have much hair...anywhere...because of the chemo!)  But she wanted what little hair was above her lip off, and off it went!

After a few dance parties in which she taught me the "booty tooch" (I am not cool enough to know if that's the correct spelling...let's just say that's probably how my rendition of the dance went as well!), room decorating, pumpkin painting, and celebrating the holidays that came and went, it was finally her time.  She died so peacefully, with only her mom, her dad, myself and an attending physician in the room (so that we could adequately titrate her pain medications while titrating down her respiratory support).

As if this horrible, death-filled day in November wasn't enough, the weeks to follow were filled with much in the same.  5 deaths in one week. 2 deaths a week later.  3 after that.  They just keep coming.  Or I guess going, depending on how you look at it.

In the weeks before and after all of those, I have lost count.  Lost count of the times I've had to have horrible conversations with parents.  Lost count of the compressions that were done.  Lost count of tears I've seen shed.  Lost count of all the little ones we've lost.

And it always amazes me that not one death is remotely similar to another.  Each death of a child brings together a different family.  Each patient has a different story.  Each mother, each father has a different way of coping.  Each sibling has to process it in a way that is to the best of their ability depending on their age.

And yet each death rings hard and true to each and every PICU nurse practitioner, bedside nurse, physician, respiratory therapist and nursing assistant.  Not one death goes by that any one of the above is able to just shake it off as soon as Time of Death is pronounced.

There needs to be a time of reflection.  A time of thinking of whether or not something else could be done.  Or, in the cases of children who are DNR, could we have done anything else to make the patient and his or her family more comfortable.

More times than not, the answer is no.  Almost every time the answer is no.

No, we could not have offered the patient any other medical treatment that would have saved their life.  No, we could not have made the patient any more comfortable because their passing so was quiet, so peaceful, with almost a beauty in it.  No, we acted to the best of our ability throughout the entire patient stay.

And yet, despite the answer being "No," there is some dissatisfaction in that.  As if we could transform ourselves into magicians and magically take all of the pain away.  From the patient, from the sobbing mother, from the father sitting quietly in the corner not able to fathom how he can be the cornerstone of the family while processing the horrible event.

But we are not magicians.  We are people.  And we certainly cannot grasp the full circle of life and death until is stares us in the face.  And in the case of the last couple of months, sometimes we are faced with it more times than we would like to mention.

But one thing that I continually come away with, is life is precious.  It is a gift.  It is something not to be taken for granted.  One day you can be healthy, I can be healthy, and the next we are not.

It is with this lesson that I want to change how I spend my time, my life.  I want to be surrounded by family and best friends.  I want to have people into my home and make memories.  I want to go on vacations with family, and friends, and build memories that will last a lifetime, however long or short it may be.

I want to enjoy the long days of summer not by drowning myself with work, but enjoying a sunset stroll around the block, grilling and enjoying an ice cold drink on our balcony, and being active by playing the sports I love.  And while it's cold (oh so unbearably cold here!) I want to relish in the cozy moments of days off, and the nights I get home at a reasonable time.  Enjoy cozying up to my man with a big fluffy blanket, drinking that hot cocoa, and watching those movies that make us laugh!

Just relishing in life.  Enjoying the moments that count.  And realizing that all of it could end in a moment.  It is a reality that the parents of my patients have had to come too far to early over the past few months.  It is a reality that these patients have gone through.  And it is a reality that has made a profound impact on me.  I hope that it is able to impact you as well.

1 comment:

  1. Wow, that sounds like a lot of deaths in way to short time! It is always though when that happens. 3 in one day is just a bit to much too! I have also reflected a lot on what I want in life after I started working with children and I will never forget the guy in his 80s that wish he had lived his dream, not ending up like a unhappy (rich) guy with no real family or friends that he trusted! :(