Professional Distance

One of my favorite bloggers, New nurse, in the hood (NNITH) has a really touching post, Haunted up over at her blog. I immediately wanted to comment, but as I started composing my thoughts I realized there was so much more to be said than should be left in a comment box.

I'm coming up on a year of work experience in an ICU, and I've made my way through all the clinicals associated with nursing school. All of that, though hard-won experience, isn't terribly impressive, and really I'm still just a baby as far as my nursing career goes. But, I have been around long enough to know that sometimes, certain patients just stick with you long after shift's end.

In school we were counseled on getting too close to our patients. We were told to maintain a professional demeanor, a professional distance, a certain detachment from our patients. This was necessary to protect the patients, and to protect ourselves. You see, we need to remain objective so as not to miss some critical sign or symptom. So as not to be blinded as to what is truly best for the patient. So that we can continue to function in highly stressful situations, and deliver the same standard of care to all whether through good news or bad.

Admirable advice really.

And I think it's a load of crap.

I work in an ICU. People come through our unit on a regular basis, and when you're a patient in the ICU it's generally for a reason. We don't typically see a lot of stubbed toes or sunburns--our patients are sick. Nearly all of them. Some are sicker than others, but everyone has the potential to backslide right down to death's door. Others claw their way back towards health, and I think it's our job to give them a hand up. Or sometimes let them know it's ok to just let go. I see so many gravely ill people that their faces and cases have already started to blend together a bit. The rooms in an ICU are witness to life-altering scenes, and when the patients are gone, the room gets cleaned--a set of fresh linens, and a liberal dose of CHG to wash away the tears and pain. Then, a new patient arrives, and we begin it all again.

I treat every patient with the same standard of care. I am equally conscientious, engaged, and caring, regardless. But the memory of some of them slips away to join my collective experience of the unit. Not individual anymore to me, but part of the background ambiance, or aura, if you will.

But others remain with me, their faces clear as day, dancing just at the edge of my vision in that moment between sleep and wakefulness. Their whispers still echo in my ears in the quiet moments, and I've come to realize their stories are firmly entwined in my heart--a part of my life experience.

I believe that patients like these are put in our path to teach us lessons. Sure, we may be the one to provide the patient care, to serve them, to fight for their well-being on their behalf when they simply cannot. But the true service comes from the lessons we learn about ourselves from them.

The emotions from losing the older gentleman patient that NNITH has written about haunt her in a very real, very painful way. But I guarantee she went home and told the people she cares for that she loves them.

It seems a terrible price to pay for life's lessons; to be haunted in a such a way. But are any of life's lessons worth knowing any less expensive?

We risk being hurt when we care. It's the price of admission of letting yourself be vulnerable. Opening ourselves to experience joy and love leaves us unguarded to pain and suffering as well.

As nurses we routinely intersect people's lives at times when they are in full-on crisis. They are frightened and angry. When we put ourselves in the path of these times and places, it's not unforeseen that they will begin to affect us.

So NNITH, please don't stop caring. I respect you because of the compassion you show for your patients. I respect you for your intolerance to bullshit when people come into your ED to waste everyone's time, and to steal attention and resources away from those that actually need it. I respect you for being affected when life happens in front of you, and you allow yourself to be a part of it, and to ultimately allow your soul to be touched.

I think you're an amazing nurse.