Nursing, it's arts and crafts

- forgets to introduce themselves - does not identify their role - you can’t see their name badge because its turned the wrong way - wears a white coat, and doesn’t wash their hands - says something about being on the “team”

I’ve been thinking about death. Death in a hospital is so strange. Death to a nurse is even stranger.

We recently discharge a patient who had spent 116 days on our unit. She was crazy and hated everyone. Refused cares, assessments, vitals, everything. Called every morning at 3am on the dot for coffee. She was famous for hoarding anything and everything we took into her room. From boxes of gloves to mouth wash bottles to spoiled food.

We couldn’t wait until she was gone.

A few nights ago we found out that she had been readmitted to a different unit in our hospital. A telemetry unit. We all laughed and couldn’t believe she was back. She had only been gone for two weeks.

Then, a couple nights ago, we heard the call overhead. Code blue. Her room. Myself and the nurse I was working with stared at each other, dumbstruck. We couldn’t believe that the old, stubborn bat that had spent 116 days with us was dying two floors down.

She passed that night. And we did what nurses do. We joked. From the outside I’m sure we all sounded macabre and sadistic, the way we talked about all her outbursts and how she would be hoarding in heaven now. We joked about death like it was a friend. I guess it kind of is.

See, to us nurses Death is a friend. We walk the halls with him, joke with him. We have an agreement. He doesn’t get in our way and we don’t get in his. We let those who have made the decision to do so go peacefully. We stand vigil with Death. He waits patiently as we make sure they aren’t in pain. Drip after drip we fill their bodies with the poison that allows them to meet Death peacefully.

Then there are the other ones. The ones where Death has gotten a little antsy. He hasn’t stuck to our agreement. And we do what we are trained to do. We fight. Violently. We fight for the life that this patient wasn’t ready to give up yet. We yell and we scream at our friend, Death. We break ribs with our compressions. We burn veins with our drugs. And if we are lucky that patient lives and we go on with our friendship, our agreement, with death.

I feel the need to bring your attention to the purpose of this post. The OP can correct me if I am wrong, but as I read it, I found the purpose was to bring attention to the various experiences of death for people who see it frequently. That sometimes death is welcome, or dreaded, or somewhere in-between, where you walk away feeling bitter and tired and guilty and lost.

For OP and those of us who have reblogged to contribute things like “this is beautiful” I would like to clarify. We are not defending it. We are not glorifying it. We are not saying it was the “right” way to handle the situation. We are presenting it as-is, bringing an emotional, well-articulated light to a relationship many of us wish we didn’t have.

When I saw this, I remembered a similar experience when I was an aide, as I’m sure many of us did. Where I recognized that a patient in my care was lonely and needed attention, but that to give her what she needed meant neglecting 3 or 5 or 15 other people who needed my time and energy as well. Making this decision day after day - do I partially neglect 1 or neglect 15?- hurts. It burns, and the only way you can justify it without dying inside sometimes is humor. She was a flaming racist, homophobe, screamed and threatened people- we made fun of that. We justified our humor because we took her abuse.

I remember how I felt when I was told she passed on an alternate shift. How guilty I felt, how angry, and tired, and sad, and confused.

It’s important to recognize and air this. It’s important to make this known. It’s important to share this pain, learn from it, and find ways to make it better for ourselves and those patients. We need places where its safe to talk about patients and the frustrations they bring, so that we can work through that and bring our best the next shift. We are human, and we cope how we can. When you don’t have an acceptable outlet, the outlet is gallows humor, and if you can’t have that humor, that outlet becomes depression, burnout, substance abuse, or suicide.

Making fun of patients isn’t right- its a warning.

Gallows humor is a canary in the coal mine. Ignoring it or saying we shouldn’t use it does not make things better for patients, or ourselves. To change it, we need to make it known and use that knowledge to change the environment of healthcare.

In conclusion, I think this video sums the situation up well: