It was a typical day in the ICU. I was wrestling with the numerous tasks I had yet to do, wondering how I would get them all done. I had three patients, I needed to draw blood gases and give my afternoon medications, and the charge nurse had just informed me that I needed to transfer one of the patients to the step-down unit-we were in a crunch for beds, and patients were waiting in the ED.
I still had a total bath and bed change to do, but the family members were in the room of the patient I needed to bathe. I had politely asked them to step out for a few minutes so I could finish my work. Now I gathered my supplies and went to the room, hoping they would take the hint.
I can't remember her name, but I can still see her face and the fear in her eyes-and in the eyes of her family every time her cough triggered the alarm or she grimaced in obvious respiratory distress. She was on the ventilator-and much too young to be dying of breast cancer. Her small children, clinging to her parents, stared at her in confusion and fright. Her husband was there too, along with her sister and her sister' husband.
I lingered at the bedside, feeling helpless to relieve her misery. I reassured her that the alarm was nothing to worry about. I watched her breathing, studied the monitor, confirmed that she was "okay," offered pain medication, and answered the questions of her husband and parents as well as I could.
I really needed to finish that bath, but I didn't feel comfortable insisting they leave. Instead, I transferred one of my other patients, completed the lab draw, and gave the afternoon medications-all the while trying not to look hurried or harassed each time the family called for me.
It was apparent I wasn't going to finish in time for report, although I had promised myself that I would this time. My daughter was going to miss another music lesson. And I could forget about my afternoon run.
I knew that supporting this patient and her family was the most important thing I could do. But leaving my patient neat and tidy for the oncoming shift was also important. I had faced the stern reproach of my peers before when the bath didn't get done. The bath was a job for "dayshift"; good nurses didn't "dump on" the next shift.
I finally insisted that the family step out for a moment. Assuring them I would only be a few minutes, I firmly suggested they take a coffee break. After they'd slowly filed out, I completed my tasks efficiently and quickly, making small talk with my patient despite her obvious depression, never really knowing how to comfort her.
Finally the bath was done and the bed changed. I'd be able to give report to the oncoming shift that all was neat and tidy-I was a good nurse. At last I could sit down, finish my charting, and maybe even get home in time to make dinner.
Paged to the phone at the desk just outside my patient's room, I picked up and heard my sister's voice: "Mom has been diagnosed with breast cancer."
I heard myself cry out, "Are they sure it's cancer? Could there be a mistake?" I don't remember what else I said, but I remember feeling as though the air had been knocked out of me as I stood there. Then suddenly I felt held up by my arms on either side-it was my patient's parents, with her husband and sister close behind to offer support.
I was never assigned to that young woman again before she died. However, I ran into her father in a parking lot a few weeks later. He asked me how my mother was doing. I asked him how his family was doing. I thanked him for his concern. He thanked me for taking good care of his daughter. We chatted briefly. That was the last time I saw any of them.
But looking back now, I wish that I had said more. I wish I had said, "I know what you are feeling. I understand now."