Nursestories

Posted on March 09 , 2010

What to say rss

Dear Professor,

I was a student in your Interviewing Methods class this past January. Although the course is over, I wish to share with you a situation that happened to me at work lately, in which I think could be related with the class you’ve been teaching us.

As you may recall, I’m an emergency department nurse in a downtown hospital. A few days ago, I triaged an 80 year old woman who was brought by her husband for not feeling well. Just before entering the triage booth, she started becoming symptomatic and was placed on a stretcher. She had right side paralysis with facial droop and slurred speach. She presented herself with multiple ecchymosis throughout her body. She was on coumadin for a history of pulmonary embolism. I immediately thought of a brain aneurysm and brought her to the acute care area. I then returned to my post and continued triaging other patients. Throughout the day I stayed informed on that woman’s condition. I learned that she was rapidly intubated because she was choking on her own saliva making it unable for her to keep her upper airway patent. A ct-scan of her brain confirmed a massive bleed and a blood test showed her platelets to be at 3. Throughout the day I saw the nurses transfusing the patient with all sorts of fluid to slow down the bleed. Watching the whole staff working on that patient made me feel there was hope.

After my 8 hours in triage I was sent to a different section to continue my remaining 4 hours of my shift. The same section where the female patient was brought to pass away. I wasn’t expecting that outcome for her. She was extubated and with her family around her bed, everybody was waiting for the final moment.

In the 5 years of my profession I’ve accompanied many palliative patients. But never have I felt as affected as this particular case. Because of the sudden appearence of the event, the family was stunned and speachless. One family member kept on asking me questions about the reasons why it happened. Although I was able to give her the medical information she requested, I knew it wasn’t enough. No matter what I told her, she kept on asking ... but why? And for me to answer ... because unfortunately that’s how it is, we just don’t know the reason ... These answers could never be satisfactory enough, especially when you’re watching your godmother pass away.

I felt very helpless and simply didn’t know what to answer anymore. That’s when I started thinking about your class and instead of finding something to say I kept quiet to give that person the opportunity to express herself. Although it did work somewhat, I noticed that during these moments of silence, I was the one being uncomfortable and had to leave the room and attend to my other patients.

It’s only later when I started thinking back, that I realized I should’ve reflected her questions more. Her: « Dou you think she understands what’s going on? », Me: « Well, do you think it’s important for her to know? », Her: « Her breathing seems so laborious, do you think she’s in pain? », Me « Would that put you unease if you thought she was in pain? » And so on.

I think I was also affected by the situation because I was there from the beginning to the almost end. It’s different when you’re caring for someone who still has a few weeks or months to live. There are things you can still say or do with this person. But that case was too sudden. It took everybody by surprise.

When my shift ended, the patient was still holding on and the grandchild thanked me for my help. I guess I wasn’t a complete loser, but I do wish I was more sharp about it so I could establish a more therapeutic connection with the family. I’m being hard on myself I know, but thinking about it prepares me for future similar cases. And your class has definately brought me the tools to deal with that kind of situation. So thank you.

Posted by: RN13 0 comments