I love two nurses. One of them is my son, and the other is someone very close to me. She’ll have her own article.
My son has just finished his seventh 12-hour ICU shift. He’s wiped out, devastated, and shell-shocked. Let me introduce him to you before sharing his pain.
The kid was always enthusiastic about medicine. He wanted to be a physician more than anything. Maybe it runs in the family; his sister followed the same path, and so did I. However, his dream of becoming a physician was derailed by excessive partying in college and choosing a university that prioritized a 100 percent medical school acceptance rate over students who would have made excellent doctors but lacked expertise in quantum physics. Nevertheless, his passion for caring was unstoppable, and he found another path. He became an EMT, volunteered for a small fire department, worked hard to become a paramedic, and eventually became a nurse. He started in the med/surg ICU, just as the COVID-19 pandemic struck. He became the nurse who held the hands of dying patients, often being the last face they saw in this world. He’s my son. Alongside his nursing duties, he continuously strives for self-improvement. He avidly reads in his profession and beyond, teaches, and shares his knowledge through podcasts and blog posts. He has pursued additional certifications to enhance his skills and expand his ability to help others. He’s a true Renaissance nurse.
Today, he works in a busy and prestigious ICU as a critical care nurse. However, all is far from well. He and his fellow nurses fight daily battles that have everything and nothing to do with health care. Let me share his perspective:
“It feels like it’s us against everyone else. Surgeons make false promises, only to backtrack and leave us to break the news to the family. Families expect miracles or hotel-like service. Patients complain and show little interest in getting better. Administrators keep piling more responsibilities on us, expecting us to do more with less. And if a patient complains, God help us. It’s all so incredibly exhausting.”
Exhausting is an understatement.
Today, as we do almost every day, we discussed the events of last night’s shift:
(All names and identifiers have been changed to protect patient and staff privacy.)
“Alright, here’s the next case.
Dorothy Smith. MRN 508291987. DOB 12/22/1962. Patient Type A-. Unit Type A-. Unit number T95218998711-K.
We finished checking the cooler filled with emergency release blood and waited. We knew that whatever came from the OR wouldn’t be pretty. An operation gone wrong, uncontrolled bleeding, hours on cardiopulmonary bypass. Liters and liters of blood products transfused, exploratory laparotomy performed to relieve the abdominal compartment syndrome caused by the massive amount of blood she received.
When the OR team finally brought Dorothy to us, I barely had time to comprehend the severity of her condition. Her face was so swollen with edema that I couldn’t open her eyes to check her pupils. Her tongue protruded from her mouth, posing a threat to her airway. A nasogastric tube stuck out from her small, adult-sized nose. In a different context, it might have been considered adorable. Frothy, pink pulmonary edema gurgled from her breathing tube as the respiratory therapist placed her on a ventilator. Her lungs were so severely injured that she received less than a tablespoon of air with each breath. Her chest and abdominal incisions revealed blue surgical towels and loops of bowel visible through transparent dressings. ECMO cannulas the size of my thumb drained blood from her femoral veins and returned it to her aorta.
There was no time to fully grasp the horror of the scene. Before we could even start the handoff process, the ECMO suction alarm broke the silence, indicating that she didn’t have enough blood in her veins to maintain proper flow. We administered two more units of blood and plasma, 250mL of albumin, and a gram of calcium chloride, just to get through the five-minute OR report.
Truthfully, I don’t recall much from the next five hours. We hung nearly 100 blood products (approximately 40 liters), emptied chest tubes until my hands hurt (her body was simultaneously clotting and hemorrhaging, indicating disseminated intravascular coagulopathy and a probable mortality risk), replaced chest tube collection containers as they filled with nearly half her blood volume per hour, troubleshooted ECMO and IV pumps, and dealt with a constant stream of beeps and alarms. A revolving door of nurses entered and left my room. At times, I felt like a failure, needing this many hands just to keep my patient alive.
Finally, it was 6:45 a.m., and my relief was ready for report. I hardly knew what to tell her. I went over the details of the surgery, reviewed the major systems, vascular access, devices, medications, and blood products. I said my goodbyes to Dorothy because I was convinced she wouldn’t be alive when I returned. I went home and slept fitfully, awoken several times by the sound of ECMO and IV pump alarms.
As I walked into work the next day, a commotion down the hall caught my attention. It naturally came from the same room I had left that morning. The report was brief.
They took her back to the OR. She’s bleeding uncontrollably. Surgeons and family are optimistic. We’re continuously transfusing blood because she crashes if it stops. ECMO support is increased, but its flow is decreasing due to abdominal pressure. Dialysis is running through the ECMO circuit. Good luck.
And so, I was back in the chaos of transfusions, administering medications, and continuously emptying chest tubes. The blood bank called to inform us that they were running out of platelets in the hospital. Her husband held her hand, tears in his eyes, asking when he should stop us from doing anything more for her.
By 10:00 p.m., the surgical team conveyed their decision that, after a multidisciplinary meeting, the situation was futile. The family came in and took turns kissing her swollen face, embracing her shattered, bloodied body. By 10:45 p.m., they informed me that they were ready for us to stop. With the precision and coordination known only to ballerinas and fighter pilots, my respiratory therapist and I simultaneously shut down her life support. She was gone before we had finished. The time was 10:54 p.m.
One by one, her family members left the room. Her husband, a tall, sturdy man, cried on my shoulder. Her sons and daughters joined in. I choked back tears but couldn’t cry. Not here, not now. There were still others to care for. Perhaps I will allow myself to grieve later, as I write this. But not while Dorothy still lies in that bed. The same team helped me bathe her, removing what we could. Yet, Dorothy carried a breathing tube, three ECMO cannulas, two central lines — including the one she used to administer medication during her walks to prepare for surgery — and two IVs into the afterlife.
We placed her in a body bag and zipped it up. I despise the smell of body bags. They smell like beach balls, but with a more chemical scent. I wonder if surgeons have ever had to endure that smell. The tech assisting me shrugged. That would mean getting their hands dirty. It’s our job.”
How can my son begin to process all of this? How can I, his ever-loving Dad, comfort him? I have never witnessed these horrors in my sterile and pristine corner of medicine. I’ve never been there. I’ve never been covered in the blood of my patient. I’ve never had to inform a family member that their loved one has passed away. How can I make this right for my beloved son?
I tried my best. I resorted to every platitude in the book. You alleviated their pain. You provided comfort to the family. You did everything anyone could have done. And then I stepped right into a pile of sh*t … I offered them hope.
In his anguish, my son let out a hoarse laugh.
“Hope? Are you kidding me? Surgeons offer hope, alright. FALSE hope. These patients are nearly dead by the time they arrive, and everyone knows it except the patient, who’s usually unconscious, and the surgeon, who thinks he’s a god and refuses to acknowledge the truth. Hope? What a fucking joke. Yeah, they offer hope when they operate on a case that’s impossible to save. And then they offer even more goddamn hope when something goes wrong, and they decide that another trip to the OR will fix it. ‘To cut is to cure,’ right, Dad? You once told me that as a joke, but it’s not funny when they actually act that way.
So here I am, left with this bloated mass of humanity from the revolving doors of the OR, and it’s my responsibility to keep her alive. Even though I’m not the one who killed her. I’m not the one who insisted on another operation. But I’m the one who has to try to preserve her life. To hold onto that HOPE for one more minute, one more hour, maybe even one more day. Yet, I wouldn’t wish what I’m doing to her on my worst enemy. And it’s already been done.
And you know what the most awful part is? Those fucking surgeons actually believe the garbage they spew. They think they can bring the dead back to life. Because they’re gods, didn’t you know that? And gods can raise the dead. They never lose. Except when they do. Like today. But then it’s our fault, or at least not theirs. It’s never their fault.”
My son fell silent for a moment, and after a while, I asked if he had any ideas to improve the situation.
“Sure. Add more staff. And make the doctors understand that they are NOT gods. Good luck with that.”
Backtracking, I said, “Look, you did the best you could. Allow yourself to acknowledge that.”
Another laugh escaped his lips.
“You sound like a therapist. I think I’m going to order some ice cream from Uber Eats for dinner.”
That’s a good idea, Son. Sometimes, it’s good to start with dessert. I love you.
“Love you too, Dad.”
The author is an anonymous physician.