Letter to a Young Nurse in Hope of Finding Solace

Recently, a friend of mine who has been a nurse less than a year, was involved in an unsuccessful resuscitation attempt. There is nothing so difficult in our profession as to feel that our efforts didn't make a difference. Below is a letter I wrote to this nurse after hearing that she was disturbed by the code. I realized after I wrote it that it says as much about nursing, in general, as it does about her specific quandary.

I was both happy and sad to hear that you experienced a code the other night. Happy because you need that experience (because it will happen again), and sad because codes aren't fun and can be emotionally trying and exhausting, especially when there are good reasons to save the patient other than the patient--I heard that a relative, a young boy, was present.

I hate to have a professional philosophy based upon a television show, but I remember an episode of M*A*S*H* in which Colonel Blake consoles one of the doctors after a soldier's death. I'll paraphrase. Blake says, there are two rules he's learned about the health care profession. Rule number one is, people die. Rule number two is, doctors and nurses can't change rule number one.

Despite the fatalism, remembering these rules can make the difference between despair and acceptance. People in pain, people with problems, come to us and ask for help. More often than not, we're able. Sometimes our help has positive outcomes, but not always, and sometimes not in predictable ways. There are some problems too complicated or too far gone for us to do much about. Recognizing this is not the same as failing to try.

And that's what you did, you tried. You tried against great odds. Unfortunately, this time the outcome wasn't what everyone hoped for and everybody lost. That's a real drag, but then, the rules are a drag.

As I heard somebody say recently, "We're living in a rented world," and saving lives is a game of odds. Sometimes you win (and your patient wins) and sometimes you don't. But no one lives forever, so for every patient, there has to be a time when you lose. It's a drag to be there when that time comes, but, because you never know when that will be, being there is the only opportunity you have to attempt to delay that time. You'll never eventually prevent it, but then, that isn't your job.

You (and nurses in general) are there when a lot of other people aren't. Between that and doing the best you can when you are there, that should make you feel good, and proud, and provide some solace. I'm sure the patient, his family, and your co-workers appreciated your presence.

That said, don't be afraid to talk about your experience and your feelings. Debriefing is a valuable process. Like with so many other strong, emotional experiences, talking about your feelings is a good way to exorcise the more damaging aspects of pent up emotions, frustrations, etc. We all have these after a code, successful or unsuccessful, and it never gets any easier. We just get a little thicker each time. That might not be something to look forward to but it'll happen, incipiently, sooner or later.

Emergency nursing is both a difficult physical and emotional occupation. Some events underscore this fact more than others.