The Art of Dying

There's a strange haze over the city tonight. The kind of haze where you’re not quite sure whether it’s cloud cover or night creeping in. The pathetic fallacy that’s synonymous with my mood… unsure if it’s one feeling or the other. Darkness vs distortion.

I had an interesting conversation with a former colleague this evening. The topic surrounded the withdrawal of life support/care on 17-21 year old patients. Zoe left the ICU to go work in a clinic. When she first left I was astounded; flabbergasted as to how you could ever leave the ICU to work in a boring clinic. But a couple of recent experiences enlightened me to how one could leave intensive care and nursing entirely.

A couple weeks ago I took care of a 17 year old victim of a gunshot wound to the face. The ambulance attendants found him Vital Signs Absent (VSA) at the scene… they performed CPR for 10 minutes and brought him back with the knowledge that he would probably have a severe anoxic brain injury. Essentially he was a vegetable with little to no brain activity. Without the ventilator he would be dead since the bullet went right through his spinal cord and severed it… annihilating the brain’s pathway to initiate vital respiration. For two days I took care of him… turned him, bathed him, assessed him to see if there were any signs of brain activity. Vacant stares turned into eyes that closed and would never open again. The mother sobbed at the bedside and begged for more time with her son… praying for a miracle to bring him back to her.

Zoe left a week before that which came as a surprise. The week before she left she admitted a 20 year old boy who thought it was a good idea to jump from roof top to roof top while intoxicated. He ended up herniating his brain into the space where his spinal cord was because there was so much swelling in his head. Zoe kept him comfortable while he passed away. To her, that was the last straw.

As ICU nurses I think there’s this expectation to be strong and distanced and stoic about the people we palliate. Life and death… that is our job. But this doesn’t come without consequence. Underneath we still are humans who feel and hurt and suffer. The things that we do become “normal” to us. Something that is just “part of what we do”. Something that just comes with the territory of being a nurse who works in intensive care. Sometimes we help people live… and sometimes we help people die. I don’t think anybody realizes (even ourselves) how much of an effect that has on our hearts, our minds and our souls. The devastation and the helplessness does NOT pass us by. Outwardly we are expected to keep ourselves together… maintain composure… avoid getting emotionally involved. But how… I ask you… do you do that when you’re watching a 20-year-old boy take his last breaths. How do you tell his mother that everything will be ok? Trying to convince her that her only son is in a better place. How the hell do you do that without falling apart?

That’s why Zoe left. And that will probably be the reason I’ll leave one day. The emotional toll that this job takes is unforgiveable and irrevocable. I’ve cried more over the last 3 weeks than I have over the last year. Some days it makes me sick to my stomach and other days it makes me want to do something completely different than nursing. Something that doesn't make me hurt the way I do.