Breaking Elizabeth: Part 2

Breathe with me

They had left her on the ventilator overnight after her third surgery and it was time to take the breathing tube out. She was doing well for while and I had left to get a snack in the cafeteria. My brother called me as I was paying and said that mom was having a hard time breathing and should get back up there. I got there as fast as I could and as I was buzzed into the ICU I could sense that something was really wrong. I opened the curtain and saw Mom breathing fast and hard with her eyes wide. I could see she was well on her way to respiratory distress. The doctor thought she might just be anxious and that she would ease into breathing without the tube with some intravenous anti-anxiety medication.

After 20 minutes she was breathing harder and her oxygen sats were dropping. My gut had been right and she was going into respiratory failure. They decided to put her on the bipap machine, which is a mask that fits over your face, is strapped tightly to your head and blows air against your nose and mouth. It made her feel even more out of breath and I could see the anxiety on her face, brows furrowed, eyes tight shut as she gripped the bedrails and her knuckles turned white. I was standing at her side, putting on my calm nurse face, trying and failing to sooth her. I was trying to keep her, my family, and myself calm, but I was scared. This wasn’t normal and we couldn’t figure out why she wasn’t breathing.  

She was “air-hungry,” anxious, terrified, but still trusted me. I could see it. She wanted to rip that mask off of her face and tried multiple times. I could see the desperation to breath in her eyes I could see her Sats dropping lower as they prepared to reinsert the breathing tube. It felt like years, though I’m sure it was only moments. Her eyes looked up at me pleading as she started feeling even more desperate for air and reached up for the mask, again trying to rip it off, her oxygen hungry body believing that the mask was keeping her from breathing.  I had to hold her hands down as I continued trying to sooth her. I knew as I looked into those desperate eyes, that even if she lived through this, these moments would haunt me.

My face was close to hers as we waited. There was increasing desperation in her eyes, frustration and terror, but even worse there was trust. She trusted me, she was trying so hard to listen to me. Trying so hard not to fight my grip on her wrists. Fighting that instinct a drowning person has to attack the person trying to save them. She was fighting the urge to fight me. I saw the conflict and the pain and would have done anything to make it stop. Those moments lasted an eternity and are forever burned into my mind. That wide eyed look of terror, half-crazed mixed with the trust of her daughter the nurse. They came in to intubate her and sedated her so they could do it.

When she was unconscious, I walked out passed the curtain because I couldn’t watch anymore. I had seen hundreds of intubations, had kept patients from pulling tubes and removing masks before, but this was different, this was my mother. One of the closest people in my life. I had kept my cool, remained calm, and held her down but then I went to the bathroom and sobbed. I will never forget that. Those were some of the hardest moments of my life and some of the few conscious moments she had left. It turned out that a cyst had swollen up on her vocal chord, which had been irritated when the breathing tube was removed. I had spent 20 minutes explaining to my mother that it was just anxiety, that she really could breathe as we waited for the anti-anxiety meds to kick in, as the cyst swelled and made it harder and harder for her to breathe. I was wrong, she trusted me, and I was wrong.

Advertisements

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.

6r7kcxbeee

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.