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Journal of Nursing

True Suffering In An ICU

Carlton R. Smith, Professional Therapeutic Counselor, Author, The Ignorant Grandfather, 2014. [email protected]


True Suffering In an Intensive Care Unit 31 July 2013

People who work in intensive care know there are worse things than death.

Mark Rosen, Mount Sinai Medical Center, New York
NOTE: I have talked with a number of I.C.U. nurses and doctors who confirm this with both sadness and rage. Carl Anonym.

The Habitat of an Intensive Care Unit is formidable, foreboding and chills visitors. It seems a holy place of transcendence from life and the struggle to keep its' inmates confined to our comforting knowable four dimensions. Struggles there are heroic in nature by Doctors, nurses and other helping technicians from the lowly phlebotomist, scorned by many in this realm of ceaseless toil and struggle to X-Ray Techs, breathing therapist and so many others who are un-sung.

Though the suffering of the patients is not to be dismissed nor diminished, every effort is made by the staff, at all levels and times, to mitigate, soothe and as nearly as is humanly possible eliminate pain at all levels. The patients are the focus of all involved including the demoralized, terrified, confused, and emotional family. Quite frankly I am sure that the patients, no matter their condition, prognosis and outcome, have the easiest transition either back from the verge of the eternal or passage to their own vision of the elysian fields.

But in another stream of one's consciousness, in this drama in the twilight between two existences, they are antagonist and all surrounding them, the supporting actors, are protagonists in this theater. When looked at in this way the patients are really minor actors participating in the play for a limited time who leave the how either stage right or stage left as directed by the moving finger of the eternal G-d! Others remain in the play to redux their parts nuanced anew in each daily appearance by new protagonistic themes.

Let us now consider the aspect of suffering from the perspectives of those who remain in this battlefield of loss and salvation.

Part the first—is that of physician. The physician is the alchemist who transmutes hopelessness into hope and a withered blossom back into a scintillating life— as God directs. He studies, he trains, he performs mightily and his salvation of patient brings great glory to him and his platoon of fellow warriors for life. But then there are the failures. The physician knows that for each successful revitalization there will be many failures. In time even his meager successes will become failures. If not this day then the next or the nest. He knows his victories are ephemeral and his failures eternal. So what must he do to retain his persistence, drive, and sanity; where is his hope? When finished he must face the family: wife, children, mother, father. All these plead and desire reprieve for their agony. The end is nigh, say your goodbyes. For the physician anhedonia—the inability to feel is a blessing. Is it any wonder that your physician develops a distant relationship with you? He knows that he will lose you if he gets close and he will have to feel. In order to put on his white coat and do battle with entropy, pain, suffering and fear; each day he must be "above the fray; cool calm and restrained." Yet he is still bound by his humanity to feel, empathize and… to suffer. Despite how beautifully he smiles represses and suppresses his feeling they still have a roiling and boiling existence deep inside. Suffering is with him always. It is with him in the most intimate to the most casual situations. Sometimes he gets to rejoice at a reprieve and give solace to the family of the patient. And still his knowledge of future failure lingers, and he is constantly feeling the pressure of others waiting his ministrations in the ICU behind him. After comforting the family he turns to the beds behind him— a modern Sisyphus appointed a task he can never complete.

Now part the second—Nurses. While the doctor is in charge the nurses play a different role in this ongoing play with its' variation on a theme. Nurses are the first line troops in the war for life and the contact with the patients family and friends. They are the people who face others struggle for life " vis-a-vis death" "up close and personal" as we used to say in the army. To be up to your arms in the fight and all in emotionally. They are also torn between allegiance to the patients, family, doctors, and patient friends and the swirling ,maelstrom of emotional anguish over lost opportunity. Guilt, shame, hanging on, pity and so many other emotions. Pandora's box was never fuller than the ICU as faced by nurses. Nurse do not control the hand of G-d which closes the box on hope, usually ever so slowly until the final irreversible collapse of life into the Black Hole of eternity. Straining to pull all who are around into its' unknowable Here After. The inner void cries out in pain within these nurses for surcease from caring. Nurses are trapped in this caring and anguish because they do care and are up close and personal—that is they are empathic humans. Dealing with the family after is as grueling emotionally as it is dealing with the patient. The family has needs too, they often cause great suffering when trying to keep loved ones alive to suage their own emotional terrors. They grasp the dying and often control the patients passing. To save self by keeping the dying in limbo between heaven and the hell of torture by loved ones for Great Aunt Bessie or Grandfather Alfred without knowing what they do is the ultimate torture for our battlefield Nighting Gales in this endless parade of insensitivity. This may be the very worst affront to these nurses who must watch mutely while multiple family members unnecessarily and often unwittingly fight each other to be the last "hold out" thus showing their "loss, love, and compassion" to all assembled; for after all, no-one loves and hopes for life like me. The nurses must of course, calmly and tactfully try to help these competing elements resolve their issues and allow Aunt Bessie to "pass"—without ever saying that you are torturing her, and the nurses, doctors, and other staff with your petty, rank selfishness—though they are too well trained to say so!

Part the third has all ready been mentioned; perhaps, I'm sure, much too harshly. I know these are another set of feelings concerning guilt and judgmentalism that make all concerned feel guilt and perhaps shame for thinking thus and so. The family feels uniquely helpless and often suspicious. Paranoia flourishes within the family; suspicious that "not everything that could be done is(was) being done to preserve the most precious life in the ICU bed. Strangely the more a physician or nurse tries to explain everything to the family the more the group paranoia may flourish! The family talks and shares what nurse and doctor say and become fixated more and more on suspicion if the caring parties do not share amongst all people within the family all that they know in exactly the same way. I have counseled with a neighbor and his wife concerning their mother's death after a very lengthy illness. No matter my efforts they will go to their graves believing that the hospital, doctors and nurses conspired to kill their loved one, in spite of all logic, reason, common-sense, and facts. The mysteries concerning their individual "horribilizing", as Albert Ellis named it, are incredibly magnified, amplified, and energized because they play off each other in a mathematically astounding manner. The permutations creating their anguish may be astronomical in number. Is it any surprise that the family members are often quite irrational and emotionally disturbed for they each and severally are in a crisis mode. Confusion and emotional suffering are two of three hall marks of crisis, the third is inability to make sound, or in fact any decisions. Pity the pettiness of families in such situations, they are dying inside as well and remember we are also family and if we haven't been through this we will go through it. I can assure you, you won't be prepared either—at least the first time.

So now you have a little bit of understanding and perspective from multiple participants in this drama and struggle for our humanity in the face of great threats to it.

G-d of all wisdom, mercy and kindness. How you must weep at our suffering. If only we could see the glory for thy the fallen that you have prepared INTRA MURAS [note 1] how comforted and re-leasing of the loved ones we would be. Ease our struggles help us to trust and know your love will provide for those in your care, both living and transformed—if we but trust.

Note 1: A book about what people encounter in Heaven after death.

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