Breaking Elizabeth: Part 1

Death as a Nurse

I have seen many people die in the hospital. It is a safe, controlled environment. People pass with little fanfare, sometimes with family, sometimes alone. We nurses follow our process, console the family if we can, ship the remains off to the morgue and refocus on the living. As a nurse, it becomes almost second nature to be unaffected by death. I remember the transition, from being heartbroken for my patients to focusing on the process and maintaining efficiency.

I learned to deal with horrible, gut-wrenchingly painful situations on a daily basis. I became invulnerable to the pain of my patients. Plenty of sympathy, and focus on doing the best I could, but keeping the empathy in check. I was able to leave the pain at the door when I left and found humor in morbid situations to process them. Too much, empathy is simply unsustainable in the hospital environment.

As a nurse, there is a wall you create to keep distance from your patients. Patients aren’t people, not really. We care for them, but keep our emotional distance so that if things go badly we can easily walk away unscathed. Certain situations can and will hit you unexpectedly, you will connect with a patient or a family member and experience that loss and pain as a regular person might, but it is rare. It should be rare, because those walls are built for your protection and are required to maintain your sanity. Wall maintenance is a constant, mostly unconscious effort. Sometimes your wall is too much of a barrier and has to be opened up, other times it isn’t built high enough and you sustain damage. It’s a delicate balance, that you must attain for sanity to be maintained.

Trying to meld the experience of the death of my mother with the previous closed off experiences of my patient’s deaths has been very difficult. I tried desperately to balance the concept of my mother as a patient, with the reality of my mother being my mother, and I failed miserably. I knew all too well, the dangers of the hospital, things get missed and people slip through the cracks. I was on guard as a nurse and a daughter. So afraid as a daughter, but seeing things from a removed nurses perspective and trying not to be too paranoid because of the extreme cases I’d seen. Visions of all the possible bad outcomes danced in my head and I did my best to balance that knowledge with the very real likelihood that the treatment would work fine and she would recover. It was a simple diverticulitis rupture in my relatively healthy 60 year old mother. There was no reason it should not have been a successful recovery. It’s a fairly standard treatment of surgery and antibiotics. We just had the worst possible luck and every time she should have recovered she didn’t. Abdominal infection that would not respond to treatment, cultures weren’t growing the bacteria we were fighting, her organs started shutting down one by one. Five weeks of hell for my mother, my family and myself before her body was giving out and we decided to take her off the life support and let her pass.

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The process left me broken in ways I didn’t think I could break.  I maintained so well while at the hospital, while fighting, planning and leading my family through the process. Recognizing when the time had come to stop fighting, and assuring that her death was as comfortable as possible.  But, watching her die, dealing with the loss and guilt that I felt was so painful. I was in over my head. I failed her, and it broke me. Broke my faith in medicine, my confidence in my abilities as a nurse, my confidence in my own strength. I had this perception of how I would handle the loss of someone I loved, I thought I would be strong and valiantly move forward, instead I was broken and weak and grieving. Obsessively reviewing the situation, staying awake at night cycling the lab values through my head, frantically trying to solve the situation, trying to find answers that would make no difference but unable to let it drop. I would see patients in situations similar to my mother’s and have momentary visual and audio flashbacks. I saw a patient with dusky skin, and flashed back to her face as it grayed, her lips and tongue as they turned black, heard her rasping, gasping, final breaths. I held myself together and didn’t let my coworkers see how bad it was. Even though I was having multiple flashbacks a day, I was seen as strong and doing well and didn’t want to lose that perception. Wouldn’t let people see my weakness.

Her death, my failure, tore my carefully maintained walls down, turned them into rubble. Working as a nurse became a daily onslaught of pain and suffering that I couldn’t seem to block out. I still had to do my job, but my soul was so vulnerable. I had to rebuild my walls from scratch, and over a year later, they are stronger but still vulnerable.

I’ve thought often over the last year over what it takes to break a person. I assume that anyone can be broken given the right set of events. Abdominal Sepsis was high on my list of ways I didn’t want to see someone I loved pass. It is a truly horrific way to go, and the pain and guilt I felt were tremendous and overwhelming for a while. This horrible experience broke pieces of me and affected my nurse side in ways I didn’t anticipate, but didn’t quite break me. I had my husband, family and friends for support… or so I thought.

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