Part of that process for me includes re-certifying in Advanced Cardiac Life Support and finding a new job. I find myself a little anxious at the thought of working in an emergency department here again where patient complaints and attitudes were difficult prior to seeing what medical care in a developing country looks like. Now how can I respond to those same patients without expressing my frustration at the injustice.
This afternoon it hit me though. One of the many things that probably will hit me over the next weeks and maybe even months. Im sitting in a nice chair in a nice office with air conditioning, drinking my bottled water. I review familiar concepts and take tests to confirm I am able to effectively care for patients in life threatening situations. The final video about talking to families when lives are unable to be saved. A brief note prior to it starting says, “Viewer discretion advised. If you have recently experienced the death of a loved one, consider your ability to watch this video.” Or something like that. My heart sank. No recent close personal deaths but far too many notifications to parents of children, even babies. The first video a “bad” example of communicating to a family that their father has died. It made me angry. But angry was easier.
Then the words that have echoed in my mind since the moment they came out of the actors mouth . . . “we did everything we could but . . .” My vision tunnels and I choke back tears. Im here to show that I am knowledgeable and professional and I am only doing what I can to keep the emotions from flooding the room. So many times in my career I have said some version of those words and I meant it and although I wish we always “won” and brought people back from the grip of death. That simply is not reality. But then I find myself standing over a one month old baby. She is gasping for air. Each breath further and further from the last one. Her mother watching behind me from a few feet back. Hoping, expecting that the Mzungu could save her child's life. I know the things to do. Maybe its too late but maybe it isn’t. I am a nurse, a life saver so I don’t give up. I try everything. Especially on the babies. Its just too much to think that a child should die at such a young age. I find an Ambu bag. The tool that I had not seen in the two weeks prior. The tool that when placed on the baby’s face and squeezed could provide life saving breaths and oxygen. But I catch the ward nurses eyes and attention. He motions, communicating what I already knew. We don’t do that. I get it in the practical sense knowing what day to day life and death looks like there. But how? How do you stand there watching a baby die and not do anything to try? I said that day that despite being in powerless situations in the ED in the past there was no powerlessness like knowing there is something I could do and having my hands tied so that I could not do it. I was a guest and this was there culture.The breaths became more agonal and further and further apart. I stood there. I taught students about apnea and how to use an Ambu bag. But why? They don’t use them there. She took her last breath. And again with the tunnel vision. I tried my best to breathe for her but it wold never work. I held my breath. I placed my stethoscope in my ears to listen for a heart beat. The full minute went by. Then a little more. I knew the truth but I wasn’t ready to accept it.She wasn’t the first nor the last child that I pronounced in my time in Kenya. But what I knew was that I could never say “we did everything we could but . . .”
It is both a privilege and a horror to be the person in our situation at the end of life. The horror that there was nothing we could do to save them. That there might have been something we could do to stabilize them so someone else could take them and fix them. We feel we were inadequate. That it is so cruel that some of the most innocent of souls never get a chance to contribute to this world. The horror of the nightmares that follow us while trying to deal with the things that no person should ever have to see or do.
ReplyDeleteBut the honor that we have at a patient’s death is that we are there at a person’s final moments. That with all the limitations of the circumstances we find ourselves in at that moment, we sincerely have done our best. That we truly care, and that person’s final moments were spent with someone who honestly and truly wanted what was best for them. That their family finds closure in not just hearing our words, but in seeing our efforts and our sincerity.
For caregivers, we struggle to understand why. After 30+ years, i still have difficulty dealing with understanding why some lived and others died. Why there appears to be such inequity, not just at death, but in life as well. As I’ve grown older, i have realized that i will never know why. It is not for me to know. The life/death question is in God’s hands despite any human’s interventions. We are just the tools that he uses to perform his work.
Ultimately, I’ve realized that we struggle so hard to live when death is actually just the moment at which we earn our reward to be with him. Where there is no more pain, hunger, or injustice. It’s not the end. Life is our playing field, our time to deal with the struggles that are thrust upon us. Our chance to earn our ultimate reward.
We should find solace in that understanding for the patient. It’s now the family who is dying: the family who must deal with the huge hole in their life. In that critical moment when they are told that their loved one is forever gone, it is then that they need our lifesaving skills. In that moment, our delivery of that sad news is critical. They will remember that moment vividly, and will remember it forever.
That moment may determine how well they can cope with their loss. It is the moment that may lead them to a healthy way of dealing with their loss, or may be misunderstood and lead them into an angry and agonizing journey of denial and torture in regard to our having done “everything “ for their loved one. We owe it to them, despite our extreme discomfort in delivering such news, to ensure that they have the time to digest the information. That they have the time to process the moment and ask any questions that might linger unanswered if we don’t take the time to answer them. Families need to hear the words “we did everything...”: they need to believe that we did, indeed, do everything. Even if it seems trite and incomplete to us, it makes a difference in their ability to deal with this horrible moment in their life.
The skill to communicate in these Sita is often one that healthcare professionals do not work to acquire or improve over their career. It is critical that nurses learn how to expose themselves to interact with families in these situations. And i have found that of all the “skills” of nursing, it is the hardest. It makes you vulnerable. It hurts. There are gallons of tears. But ultimately, it benefits you as well. For it allows you to grow as a human, to develop the maturity to see life in a broader sense. To accept the otherwise unacceptable. To realize the dignity in every situation. in every person. In ourselves.