“What You Do Matters” is the essence of why many of us become nurses, doctors, healthcare workers. Rarely do we work shifts, and go through all we do in order to make lots of money (though that would be nice too…)
Rather for most of us it is the knowledge that we DO make a difference to our patients that keeps us going. Unfortunately with the acuity of our patients and the attendant alarms, pumps, and other equipment as well as everything else we deal with in life it is sometimes difficult to remember that this is what motivated us in the first place…
Sometimes we don't realise the difference we make to our patients or their loved ones. Often we'll have absolutely no idea, as the healthcare systems in which we do our human-to-human work simply fail to provide the mechanisms required for adequately expressing the depth of involvement and investment we have with the critically ill and they have in us.
In sum, while a thank you card and chocolate is nice, they don't always give us the whole picture. We can easily fall into the thought that whilst each nurse has nearly identical training and access to the same policies we are all interchangeable. And from a clinical skills perspective, that might be a fair assumption. But on that human level, nothing could be further from the truth…
Several years ago I was learning how to manage Renal Replacement Therapy (or dialysis machines). I was in the transitional learning stage of being confident with access, changing bags and setting up circuits and was in the process of integrating theories of currents, counter-currents, solutes and filtration. My patient allocations were starting to reflect this, with sicker patients (they actually came sicker than I was already getting???) and more technology.
I arrived on a night shift to find that my patient for the night was undergoing dialysis but was using a Hudson mask and not on a ventilator.
Non-ventilated patients were unusual for me at that point – I wasn't the junior nurse I had been, so I could manage with patients who were quite sick and that usually meant my patients were ventilated. There were newer staff in the slow wean patient phase, so I didn't see as many as I had.
(Of course I now realise that this is a huge responsibility on junior staff as our non-ventilated patients can be some our most unstable patients…)
She was sleepy, and it was late, so I used my neuro torch and the reflected light from the bed space examination light to do my assessment and safety checks and let her sleep. I noticed her yellow, jaundiced complexion, registered that that pale white of her eyes had turned egg yolk. She had a big day tomorrow: handover from my late shift colleague had indicated the dialysis would cease in the morning and she would be a ward transfer. We talked a bit, but mostly she slept. I studied my workbook on the dialysis machine and occaisionally changed a diasylate or replacement bag and that was the night.
Bold, golden light flooded the room in the morning. A truly astounding sunrise streaming through the window
We have huge windows, and this bed space has the best view of sunrise at certain times of the year (almost worth working nights for). I had forgotten to close the louvres but it wouldn't have mattered – the golden glow of the full sun would have burned straight through all but thick black plastic. It was glorious.
Without thinking too hard (I was going to bed soon) I asked her if she wanted to see it. She said yes, so I raised the back of the bed as high as it would go.
I noticed that my bare arms had taken on the same yellow glow from the sun as had everything else it touched.
Including, as she sat there watching wordlessly looking out the window, my patients' previously jaundiced skin.
Of course she was still jaundiced, but when everything else is changes to that golden yellow the mind automatically adjusts its expectations of what colour things really are. Again without thought (and probably tactlessly, under other circumstances) I said “see, in this light we've both got the same complexion and everything is normal again, just for a bit.”
My patient smiled at me, and nodded, both of us thinking if only her life were that simple.
I stood next to the bed, and we just looked out the window together for about ten minutes.
Then the wardies came, I moved her off her back, finished my work, wished her well and thanked her for her company during that magical sunrise.
Later that day, my girlfriend (now my wife, and a wonderful RN on another ward) woke me after she had finished her work as an Assistant in Nursing in the same ICU. We had a discussion about her day and a catch up as we do when we are on different shifts. She said she had been involved in cleaning a bed space after a patient death and the AIN team were perplexed by a message on the small whiteboard on the wall. No-one writes messages there. It is used for patient names and ACCESS nurse contact numbers.
None of the staff on day shift had understood it.
It said simply “thanks for the sunlight and see you in the sunrise.”
I explained my night shift and my experiences with the patient. She had hepato-renal syndrome on top of her end stage liver disease. The night I looked after her she was waiting for some family members to travel from interstate. She wasn't expected to last long after the dialysis ceased, and she hadn't. My girlfriend and I both cried for her and I was grateful for her message. I hadn't realised the difference I had made.
Remember, ALL the things you do make a difference. And you may never know the difference that you DO make.
So to all those who wonder what difference they make, I give you a reminder:
With thanks to @EM_educator who presented the above reminder to all at the Social Media and Critical Care conference, Gold Coast, Australia, 2014.