Sunday, May 18, 2008

Opportunity Knocks

Since about January of this year, I've been contemplating a change in jobs. In the current economic environment that would seem crazy to most people; the rules however don't apply to nurses. We're a special group of people because we have a critical nursing shortage and can get a job just about anywhere doing all types of work. For me, I've been pondering this problem for months. What do I do now that I've lost the heart for working in an ICU?

It's routine to work anywhere in nursing and find yourself truly in over your head in terms of managing patient load. In a critical care environment, there is an emotional component as well. We are often in ethical conflict with the decisions families make for patients at the end of their lives. They want everything possible done to delay what we often know is the inevitable: death. Sometimes, we form amazing bonds with families who prior to this were complete strangers. People sometimes touch us deeply as though they are members of our own families. This can lead to often emotionally exhausting and seemingly never ending days. It's more common now for me to dread going in to work than to embrace it. This is so sad for me for I'd enjoyed this job for awhile and now, I don't.  

I've often said that if people didn't abuse their bodies and if we all did what we were told, we (the medical profession) would be out of jobs.  We are all guilty of abusing our bodies.  Still, I am bone weary of caring for people in alcohol withdrawal or drug overdose.  Patients in withdrawal will suck the very life force out of a nurse.  Just trying to keep these people safe can be physically, emotionally and intellectually taxing.   Imagine yourself at work and having someone say F**K  U B!tc# or suck my (you know) for 12 hours straight.  I will tell you from the bottom of my little nursing heart that it is an appalling way to make a living.  It doesn't make a difference to me that when once again sane, these patients often apologize.  I care not as the damage is done.

The other aspect of my work that has impacted me greatly is caring for people at what should be a peaceful ending to their lives.  They should be allowed to go with dignity but without proper prior planning, they end up in ICU with us trying to "save" them.  I don't think people that aren't in this business truly know what it means to be very critically ill. It can be awful. Endless tests requiring often invasive and painful procedures like central lines, arterial lines, dialysis lines, procedural CT Scans, chest tubes, surgeries (and sometimes more than once), blood tests and the dreadful hourly finger prick for a blood sugar (you can't tell me these don't hurt, I know they do.) If you didn't want this but chose not to direct your care, someone else will make decisions for you. You may need advanced life support and you will have a tube stuck down your airway (requiring pretty frequent suction), a tracheostomy tube when the one in your mouth has been in too long, a gastric tube in your stomach to feed you, a bladder catheter to drain and measure urine output, a rectal tube if necessary, someone cleaning your mouth every 2 hours, someone turning you every 2 hours or the endless rotating bed that must seem like a carnival ride to really sick patients.

People experience a loss of dignity, possibly their humanity and often their minds at times like this. If you're lucky enough to recover, you may have debilitating and long term sequelae to your critical illness. Issues with fancy names like Toxic Metabolic Encephalopathy (see, you did lose your mind) and you can read about one woman's journey through her personal hell here. Who in the world knew you could suffer PTSD-Post Traumatic Stress Disorder from being so sick? There are other physical issues that follow critical illness including (another fancy name) critical care polyneuropathy. This is caused by combining high dose steroids with neuromuscular blockade (medically induced paralysis) and may leave you with long term or permanent muscular and nerve damage.

I'm not writing this to scare people (dammit, get that advanced directive or health care power of attorney!) but to give you more or less a peek into my world. I simply find myself at a crossroad where I can't torture someone's 96 year old granny one more time. You can also be at death's door at a tender age too and although incredibly unfair, this, is life. I've experienced (one too many times) the nursing of the chronically critically ill who but for our intervention would be gone and perhaps, I don't mean this unkindly, should be allowed to die with dignity. I've seen families split themselves apart because they can't make decisions or they haven't made amends with loved ones and therefore, can't say goodbye. The time to make amends is right now. Be right with the people you care about because we all know it could end in the blink of an eye.

And so, I find myself looking. I promised my friend Sister Jeanne that I would wait until spring to see if I felt the same as I did at the start of the year about my line of work. I do. I think I could be a decent palliative care or hospice nurse. I want to work with people who are in need of comfort and not rescue. If all goes well this week, perhaps I will.


Rositta said...

You know Rudee, I'm not the most religious person in the world, but I believe all things happen for a reason. If it's mean to be, it will be...ciao

Rudee said...

Yes, they do Rositta. I believe that too. So, we'll see, come what may.

The Rotten Correspondent said...

Rudee -
Reading this I felt that sick flood of emotion running through me that forced me out of ICU. This probably won't surprise you, but I know exactly what you're talking about. You're a better person than I, because you've stuck it out for a good long time.
What is it about hospice that is so appealing after ICU? I love critical care - for now. I adored ICU - for then. But hospice? You're right. It's about the dignity and the peace and the not tubing someone's terminal 96 year old granny because someone in the family throws a fit and wants "to do everything".
I hope it happens for you. This week would be great. If not, I'm sure it will be soon.
All appendages are crossed.

Rudee said...

There are a lot of old ICU nurses doing hospice. Is it burnout RC? It could be. Or it could just be a finely honed skill at providing comfort for those at the end of life. If you do it enough (and we do), you either get good at it, or not. I'm good at it. Thanks for the good wishes. I've got everything crossed too.