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What would you do if…?

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Attention: Nurse prompting introspection regarding touchy issues. Proceed with caution…

As nurses we are inundated with scenarios that demand emotional strength and unemotional fronts, mental stability, strong shoulders for others to lean on, the ability to look at a life or death situations from an unbiased vantage point, compassion and empathy. At the same time, we are the ones thankful that it is not our family members who we are caring for, and we are not the ones having to make these life-changing decisions, and we are able to return to our “normal” lives outside of the hospital come 7pm. We are merely placed in these difficult scenarios because it’s our job and we get paid to do it, right? Or do we secretly wonder what it would be like to be in their shoes, or if we could be as strong as they are as patients…

Have you ever wondered what is truly going through the mind of the mother that stares blankly at you when you tell her that her newborn is going back to the ICU again? Or what the teenage girl is thinking when she enters the gynecology clinic demanding an abortion? Or who the middle-aged mother of three thinks about when she is diagnosed with terminal brain cancer? Or how the grown siblings surrounding their elderly father can make the decision to turn off life support after weeks of waiting for a miracle? I have, granted the bulk of my curiosities stem from the pediatric realm and wondering how these incredible parents deal with the tremendous torment of watching their children suffer.

So I ask you, readers. What would you do if you were the patient, the family, the best friend? Some of you have probably been there, done that. But the nature of our work subjects us to these environments but at the same time protects us from the devastating emotional ties involved with being a primary party. Mind you, I’m in no way implying that nurses don’t get attached to their patients, form emotional connections and experience heartbreak in the process, but we are still the third party, the outside looking in.

What would you do if…?

You are 17 weeks pregnant and the ultrasound shows a suspicious looking heart. After a fetal echo, you find out that your baby has been diagnosed with Hypoplastic Left Heart Syndrome, one of the most severe of the congenital heart defects. The baby will most likely have to go through three different open heart surgeries before the age of two, and the average life expectancy isn’t much past early adulthood, let alone the complications that can arise. You live three hours driving distance from the hospital known for success in congenital heart defects, but your husband recently lost his job so your family is already strapped for money. What would you do?

You are a 37-year-old mother of three children all under the age of 10. After weeks of experiencing odd symptoms, you go through a slew of tests to find out that you have been diagnosed with stage four brain cancer. The options in front of you are immediate but risky surgery to resect the tumor located in a challenging part of your brain to get to, chemo and radiation to help shrink the tumor, or investing hope in an Eastern Medicine doctor that you have read rave reviews about and proceeding down the holistic path. What would you do?

Your stepfather who has been in your life for 20 years and with whom you’ve had a tumultuous relationship with has been put on dialysis awaiting a kidney transplant. He is getting sicker by the day and the doctors don’t know how much longer he will be able to live in such severe kidney failure. After doing some research, you realize that you are a match. Your stepdad has asked if you would be willing to donate one of your kidneys to him. What would you do?

You get a phone call one day with the devastating news that your husband has been in a terrible car accident and is on life support in the ICU. Weeks into his hospitalization, the prognosis is still poor and he is still in a medically-induced coma due to increasing ICP when they try to wean him off. There is minimal activity in the daily EEGs, but occasionally there are glimpses of hope. The doctors say it is time to start thinking about making end of life decisions. What would you do?

You give birth to a child with a terrible genetic prognosis, Trisomy 18. Because of all other co-morbidities associated with the diagnosis, the doctors encourage you to make the infant a DNR status. The hospital actively seeks a home hospice company so you can take your baby home to be comfortable but insurance denies the request. You are left with either living in the hospital for the unknown remainder of the child’s life or taking the baby home to be surrounded by family and friends, but not knowing when the last breath will happen or if you have adequate resources at home to keep him comfortable. What would you do?

Your three year old son with a congenital heart defect has just been deemed unrepairable by the surgeons at the hospital you’ve always been to, and where his previous surgeries have taken place. There is talk of a surgeon out west that specializes in the “irreparable” cases so you consult the surgeon to see if he will give your son a chance. Your son’s quality of life now is fantastic but it is a near guarantee that his heart will begin to fail in the next two years. The surgeon says he will operate and buy your son more years on his life but his time on bypass may be more than 10 hours which is a risk factor in itself let alone the possible complications that can be associated with open heart surgery. What would you do?

You have a child who was diagnosed years ago with leukemia. She now needs a bone marrow transplant because her condition is deteriorating. Your oldest teenage daughter is a perfect match for her little sister but she expresses many concerns about going through such a painful procedure. She doesn’t want to be debilitated for her last summer before graduating high school. You want to respect your oldest daughter’s wishes but you want to do everything in your power to save your youngest daughter. What would you do?

You were an unfortunate victim of date rape, were impregnated, and thoughts of having the child bring back horrible memories of the experience. You just graduated college and are living in a city away from family and working in an entry level position making barely enough to sustain yourself. You never reported the guy because you did agree to go on a date with him in the first place, but you swear to never speak to him again. What would you do?

You are dating the man of your dreams and you two have been dating each other for almost two years. You love everything about him including his personality, his motivation, and his love of the outdoors and being active. You guys have been talking about getting married. While skiing, your boyfriend has a horrible accident and is suddenly paralyzed from the neck down. You never leave his side during his recovery but you realize the full extent of the injury and how it will change your lifestyle once he comes home. He hates relying on you for everything but says he has nothing to live for if you leave him. You didn’t picture your fairytale ending looking like this. What would you do?

Your father was diagnosed with Alzheimer’s disease years ago and in the past couple of months you notice that he has been getting progressively worse. Some days he is lucid but other days he doesn’t even remember who you are. He tells you that he never wants you to give up on him and he thinks people who turn off life support on their family members are selfish and unjust. Shortly thereafter, your dad suffers a massive stroke that leaves him ventilator dependent with a poor prognosis. After a week of no progress, then another, the family all gets together and decides that they want to withdraw care. You can’t help but voice what your dad’s feelings were on the issue, but your family is adamant that he has no quality of life. What would you do?

During your 25th week of pregnancy, you develop a serious condition that endangers the life of both you and your baby if the pregnancy continues. Strict bedrest is the only option to salvage the pregnancy but you know that will be entirely difficult in light of the fact that you have a three year-old and an 18 month-old at home. And going on bedrest does not eliminate the severe risk of sudden hemorrhage which could be deadly since you live thirty minutes from the nearest medical facility. You have two girls, this one is a boy, and he was to be the last of the bloodline of your husband’s last name. You are too old to go through another pregnancy but you know a premature baby born at 25 weeks is bound to have a plethora of complications. What would you do?

Although some of these are fabricated stories and some of them real accounts, all of them have the potential to be real, and all of them are situations that people in the hospital setting face from day to day. My job can be a difficult one, but I am thankful each day I come home that I am not spending the night at the hospital and facing these harsh realities that families and patients go through. Leave your comments if you like, or just reflect on these scenarios and discuss them with your close friends. Because putting yourself in the shoes of those you care for in the hospital can bring out great depths of empathy and make you a better nurse.

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Nicole Lehr

Nicole Lehr is a pediatric nurse. She can be described in three adjectives: content, thankful and fortunate. All credit for the aforementioned description can be given to the love she has for her profession as an RN. She graduated from University of Florida with her Bachelor’s in Nursing and moved to Atlanta to work at the Cardiac Stepdown Unit at Children’s — her dream job.
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3 Responses to What would you do if…?

  1. kate

    I think this list puts situations in our heads where we hope that the ‘right’ choice would be made. It unfairly imposes a self-importance that we nurses possess. The reverence for hum life is often seen as saving it, but not preserving dying with dignity. To out forth these questions provides us, as healthcare workers, with the tools to effectively create a god-complex. Thank you for allowing me to come to a sound decision to stop reading this blog and others like it.

  2. Melissa

    I have no idea what Kate is talking about. It is not applying to us having a god complex but putting ourselves in these patients’ and families shoes and have more compassion for them. These situations are seen by nurses on a daily basis and after awhile the compassion can wear thin cause of burnout. This is only meant to remind us to have that empathy and compassion. That is what makes a great nurse …..

  3. kate

    You do know. It’s every time you tell someone that a dying patient should get palliative care, every time you say that a premature baby should live, and every time a lactation specialist makes a new mother feel like a failure by not getting the baby to latch. We have all done it, and thing that our training makes us know better. If doesn’t. It makes us failures in light of our calling to care for people at their worst moments.

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