A Lesson in Failure

“Carry each other’s burdens, and in this way you will fulfill the law of Christ.” Galatians 6:2 (NIV)

Many of us look back in life and realize that we’ve failed in some way or another.  When I was a new RN, I worked at a hospital in St. Paul, MN, on the medical/surgical floor.  It was a great job.  There was so much variety in patients, so many new things to learn, and the other nurses were so supportive and helpful to me.  We had nurses on that floor who had been there twenty years, which is unusual.

I made my share of rookie mistakes.  More than once during my initial training, I took out a patient’s IV before he had his last dose of antibiotic, and the other nurses always helped me through that mistake.  Usually the charge nurse would call the doctor and say that the IV came out, and would he like to order oral antibiotics instead?  It was a great learning environment.  I learned how to handle six patients at a time, how to do lots of technical things, including feeding tubes, IVs, and tracheal suctioning, how to give so many medications–shots, IV, everything.  I learned how to clean up messes and bathe patients in bed.  But they never really taught us how to help someone through the dying process.  The hospital had a hospice floor; that was the floor for dying, not med/surg.

Yet there I was, a relatively new nurse, and my patient was dying.  She had an infection, and had become septic, so the infection was winding its way through her whole body.  Her husband said she didn’t want to be intubated, so she wasn’t sent to ICU.  Her oxygenation was low, and her blood pressure was low.  Without going to the ICU and being intubated, she was going to die.  And even if she did get intubated, I don’t think she would have made it.  She had a lot of other things wrong with her as well.

I called the doctor, and instead of showing up, he ordered albumin to try to raise her blood pressure, and he ordered that she be put on bipap to help her breathe (bipap uses pressure to help a person breathe in and out, but is not as invasive as intubation–though it is fairly invasive because it involves wearing a large mask).  The chance of these things working were a very long shot, but the doctor never came to tell the family that these things weren’t going to work.  It was a weekend. That, apparently, was up to me.  I sat her husband down, and said her oxygen was low and her blood pressure was low, and it didn’t look good.  Her husband seemed genuinely surprised that she was not going to make it.  He still wanted everything possible to be done, short of intubation, and we stayed the course. But that was my fault, because I didn’t have an alternative to offer him. It was a sad way to die.

My failure in this instance wasn’t necessarily an active failure; it was more of an ignorance.  If I had to do it over again, I would have gotten the hospice people up there to make some suggestions to me.  I would have been more assertive with the doctor.  Maybe I would have started morphine so that she was more comfortable in her breathing, able to take that mask off, and say goodbye to her family.  The morphine might have made her blood pressure drop more, so she might not have had much time, but she would have been more comfortable.  I would hope that I could have at least convinced them to move her to the hospice floor, where she could be in a nicer environment (and have more experienced staff) to die. But I didn’t.  Honestly, I didn’t know what to do.  I felt stuck between the family’s hope and the reality that her death was going to occur.  I couldn’t prevent her death, and yet I couldn’t take away that small glimmer of hope they were hanging onto.  She was still alive at the end of my shift, and I passed her along to the next nurse.  She died that night, and her family was there.  I don’t know how comfortable she was. I’ve thought about her many times since then.

It’s not always a bad thing to fail.  That’s been a hard lesson for me to learn in my life, because I always wanted to strive to be a “good” or maybe even a “great” nurse. I wanted to be a nurse that people would look up to, that people knew they could count on.  But we can’t learn what we need to learn until we know that we need to learn it.  Maybe this patient set me on the path that led me to hospice nursing, I don’t know. What I do know is that, even though I don’t remember her name, I have never forgotten her.

I know now that if you want to make a difference in people’s lives, sometimes you’re going to fail.  Sometimes you’re going to do the wrong thing, and you’re going to say the wrong thing. It matters that we do or say the wrong thing, very much so, and we should always try to learn.  However, I also know now that the worst thing to fail at would be to fail to care.  People forgive ignorant mistakes much more quickly than they forgive failing to care.

Caring seems easier once we realize how vulnerable we all are as human beings and how much our Lord loves us.  We don’t always have the right words or the right actions, but caring is always right.  Caring will lead us to do better.  Even though I failed to help my patient in her time of need, I do take comfort in three things: that I did not fail to care for her, that I did eventually learn how to take care of dying people, and that my Lord always forgives my daily sins and failures.  He is a merciful God, to my patient and to me.

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