December 29, 2017

Coping With Bad Outcomes


We are nurses. It is in our nature to want to help and save people. But sadly, the human body can only compensate for so long. As a graduate nurse, I had this thought that everyone could be saved under the right circumstances. As time went on and I gained more and more life experience, I concluded that concept was inaccurate. When I was a graduate nurse, nursing was conceptual. It was an idea. When I started working as a nurse, many of my theories and concepts about healthcare changed. Regardless of lifestyle or choices, the body is made up of tissues and bones. Yes, there is much more to being a human. But to our core, we are varying body systems. We become ill, we bleed, we recover, and we heal. Humans can achieve incredible feats, and I do believe in miracles. But I also believe in the human condition and its limitations. There will be moments in your nursing career where you perform every intervention available, and it still ends badly. This post is about how to cope with that event.

I was told I couldn’t naturally conceive children. It was infertility due to unknown origin or defect (by me). It took my husband and me 10 years to conceive our son after many medications and procedures. I would check my ovulation and temperature daily. I would not allow myself to give up on this goal. Every night I dreamed of our son. And, for about 9 years, it was just that, a dream, an unattainable goal, a fantasy. I was that patient who wouldn’t give up and wanted our next available option. I was stubborn and borderline pushy. And if I weren’t, we wouldn't have our amazing son today. The doctors didn't say, “It wasn't likely.” The doctors told us, “It was impossible. It wasn't going to happen, regardless of what medications and tests were completed.” We would cry after every appointment - we were heartbroken. And, it was that experience that turned me into someone who believes in miracles despite reasoning, because we were told so many times something wasn’t possible, and yet it was. Yes, I’m a nurse. I understand pathophysiology, biology, and anatomy, but I’ve seen some unexplainable things. I will never lose my wide-eyed optimism, and I hope I never do.

I believe in miracles and medicine all in the same breath. But, as a nurse, I often find these two concepts conflicting with each other. I’m that nurse who believes in the positive outcome all the way up until the patient passes away. I will never stop believing, and I will never stop being positive. But, at some point, I had to understand the human condition in its entirety. The body can only go so far, and it can only recover so much after certain milestones have occurred. Medications and procedures can only improve a prognosis so much. There are some disease processes and events that we, as humans, can’t recover from. It’s unfortunate, but as nurses, we must understand this concept and process these feelings. It’s okay to get upset, but it’s not okay to blame yourself. Healthcare is emotional, and we must cope with these emotions in some fashion. Whether you chose meditation, therapy, crying, or other means, processing is essential. Processing and acceptance will keep you emotionally healthy. You are not in control here. You are not in control of a person's body and its ability to compensate. You can’t make a family understand the limitations of medicine, nor can you make a family respect the wishes of a loved one by respecting their DNR status. All you can do is provide care and educate when appropriate.

It’s okay to want the best outcome yet accept the worse under evidence-based measurements. Healthcare will break your heart sometimes, and in those moments, you must process what is happening. Care for the patient and the family members, but when you clock-out or get a break, it’s time for you to take care of yourself. The patient might not be personally known to you, but you did lose someone. You were there. You fought your hardest. Now you’re expected just to walk away unphased? No, life doesn’t work that way. I can care for a patient for one hour and cry for their loss while doing postmortem care. I was there. I experienced a loss too. Gather your emotions and process them when the time is right, but don’t underestimate how much losing someone, in general, will affect you as a nurse. Unchecked, the emotional weight of working in healthcare can bleed into your personal life and have adverse effects. Find your outlet. Find a way to cope with what has occurred. I tried to be that one nurse, the one who is numb to things. I made a conscious effort not to allow people or events to touch me emotionally at work. At the time, I thought that invisible armor would help me cope. Well, eventually, those very emotions did reach out and touch me, hell, they reached out and choked me. That's the thing about things you ignore. They always come back in one way or another. Don’t pretend you don’t feel, and don’t ignore your feelings. When the time is right, embrace, accept, process, and heal from within.