Wednesday, February 2, 2011

finding my talents

I came to the ICU because the thought of sedated, intubated patients filled me with warm, fuzzy, relaxed feelings. I settled right in, turning my patients and giving meds without any arguments or cajoling or convincing on my part. Hey, this is the life, I thought. But after 8 months of mostly comatose patients, I was startled to find where my real talent (and passion) lies: interacting with families (and the occasional patient).

From an earlier note:
A patient I had recently, dying of cancer without treatment options, leaving a young son behind as an orphan, grabbed my hand and looked me in the eye at about 3am, and said to me, "Every moment of this life is precious. Live EVERY day as if it is your last." Those are a dying man's last words, and when I said thank you to him, he said "don't thank me, those words come from God". And I believe he may be right.

That was an awesome experience and reminded me of my old floor days, when I was always pre-selected to care for "especially difficult" patients and families. I think I did a good thing, even if all I did was listen and hold his hand. It was a unique gift to give.

I've also found another strongsuit of mine- helping families come to terms with choosing comfort care over continuing aggressive treatment, comforting family members during codes, explaining treatments and outcomes sensitively to overwhelmed family members, etc. For someone who wanted to get away from a lot of "people-interaction" by coming to the ICU, I've found that family-interaction is always the most rewarding part of my job!

Just the other day, a co-worker received a coding patient from the floor. Her very nice family waited nervously in the hall while we tried (and tried, and tried) to place a line so we could get a blood pressure. Pressors were maxed. Her family very appropriately changed her to a DNR. She was intubated, had a heartbeat, but no blood pressure that anyone could discern. The patient's daughter stood by anxiously (the rest of the family waited outside) so I went to her side and gave her a realistic, but sensitive, update. I immediately discerned that although she had wanted us to try, if our efforts weren't successful, she was ready to let her mother go. I was the one who pulled aside the senior resident, and said "the family is ready to discuss withdrawal".

The whole unit breathed a sigh of relief. The nurses and doctors had all been muttering under their breath about our wasted efforts, but no one had gone to the family members to give them a realistic picture of the patient's condition and assess them for their readiness to withdraw. The family chose to withdraw and extubate 20 minutes later. Both daughters cried and asked to hug me. She was not my patient, but I felt like the family members were all my patients.

Another man I admitted by jet (yes, I love our huge, rich hospital!) was being placed on ECMO after coding and maintaing a PO2 of 42 for more than 2 hours, without a blood pressure compatible with life. Although the surgeons refused to stop cannulating for ECMO (gotta love those surgeons, they just never give it up!), I went to the waiting room to talk to the family members, who I'd meant when he was admitted three nights ago. I knew he wasn't my patient anymore, but I felt the need to check on them. I brought tissues, and asked what additional questions they had at the moment. I explained what was going on at the moment. I only gave them the info they were ready to receive. I hugged the wife and then left. I hoped it made a small difference.

I also had a wife of a patient, who was a nurse, tell the other nurses that I was her favorite and a wonderful nurse. How sweet!

I'm moving to day shift, and I'm excited to have even more interaction with family members, and participate in rounds and plans of care in the morning. Oh, and finally having a normal sleeping schedule.