Code Blue

Here’s this week’s reflection. I hope it resonates with you and ask that, if you enjoyed, please comment and share on your social media. Heartfelt thanks for all your support!

Keeping the light on for you,

Carol

Lifeless flesh undulates to the rhythm of external chest compressions. A crowd of providers streams in from a variety of departments as invasive lines are placed, medication timing recited, and respiration commandeered by a surrogate. Several minutes of continued effort offer little reward. A last-ditch invasive emergency procedure proves ineffective in reversing what we now realize is the unavoidable outcome. One tired heart has adamantly refused to oblige everyone’s best intentions. The lengthy code ends due to medical futility. 

The group thins and nursing staff transitions to post-mortem care: bereaved families are consoled, a funeral home is notified for a pick-up, and the ICU’s phone rings with another request for the just departed’s bed. The ability for staff to shift seamlessly between these states of compassion and emergency readiness is required in the critical care arena.

During a typical day in the ICU, we nurses carry out our specific duties in this well-practiced gig to preserve both mortality and dignity. Making peace with the ever-palpable stress, and becoming desensitized to it, is vital. Tending to the continual viscous swirl of life and death is intellectual and noble, for sure: it is also mentally and physically exhausting. While many patients “improve,” there are those who relinquish their earthly presence to a greater power. The never-ending need for efficiency – in both saving lives and providing room for those in need – creates a perilous dichotomy that surreptitiously fuels mounting unresolved grief. Providers are fine, until they are not.

My burnout moment happened during the above cardiac arrest. 

Involuntarily, I vividly stepped outside myself to float above the controlled fray while still going through life-saving motions on the ground. Having always been an adrenaline junkie — necessary for such work — I suddenly felt profoundly, poignantly drained. My focus shifted from the narrow lens of renascence algorithms to the wide-angle of the importance of death in the circle of human existence. My task-oriented checklist vaporized. I now saw the crisis in full depth: the life under our care was tired, and it was time to stop the insanity and let respect and dignity have its due. 

When I returned home, I casually told my husband that a change of scenery was in order. Years of repetitive crises had taken their toll. While defibrillation is necessary to skirt death, it can also provide a jolt for the living on many levels. Like that tired soul receiving CPR, I had also become lifeless, allowing myself to have been dragged through an arduous routine far too long. I felt that I had mentally expired.

Despite being a young nurse at the time, with hopes for a long career ahead of me, I began to question my personal trepidation of death as well as my vocational choice. My faith and profession had sown the seeds of empathy and urgency that I shared generously with others. But it was time to view my existence more holistically. I furthered my education, changed venues to continue to care for others, and eventually left intensive care for a perioperative role. Now, as a mature nurse and anesthetist, I am grateful to have seen the light on that dark day. 

With elderly parents on both sides, my husband and I embarked on long conversations about end-of-life care. The cardiac arrest scenario etched forever in my mind, I felt more compelled than ever to protect my complexly ill kin from the rigors of a full resuscitation effort. Their bodies frail, I wanted them to simply slip into God’s hands without a fuss. While lengthy lives are not in the cards for some (with a very different set of circumstances validating heroic measures), my parents considered themselves “blessed with a good run.” Simpler health issues were addressed, but all-out, poked and prodded, aggressive endings were, decidedly, not an option. Family dynamics can often be all over the map: ours were, gratefully, all on the same page.

Recently, at my father-in-law’s bedside, I had the pleasure of speaking with hospice personnel at a variety of stages in their nursing career – from nursing assistant to ICU RN. They all shared similar sentiments to one ICU RN in particular: We spend so much time on just one part of the journey and hospice care provides real balance; it’s a privilege to respectfully ease suffering at the end of a life and meet family who often add a rich and beautiful context. I was warmed and intrigued by that. Hospice is much quieter work for obvious reasons and, while outcomes are always predictable, it is certainly not “easy.” 

For a critical care provider to actively seek this work was refreshing to me. She struck a chord when she added that, in contrast to her typical work, it was wonderful to finally have the time to allow a death in its own time, and with dignity. We had several lovely chats over the course of that day commiserating on the highs and lows of our respective careers. And I applauded her willingness and courage to do a clinical one-eighty. 

Observing — and then rejoining — myself around that bedside long ago was crucial to my personal and professional growth. Epiphanies can range from subtle to florid. Regardless, they are always life sustaining. Such was mine on that day I opened my tired heart to the fragile beauty of the human condition in its entirety.