One of my favorite parts about being a nurse is how much you never stop learning. I can honestly say I learn something new (more often like ten new things) every night and it's exciting to me that no shift is the same. No patient is the same. No disease is the same. And most certainly, no twelve hours are the same. While this is the most exciting aspects of my job, at times, it is also the scariest. I have spent the last three years desperately seeking all the knowledge I can in order to make the most informed decisions when advocating for my patients. I spent the first two of those years learning an overwhelming amount of information that felt like was spoken in a foreign language. Once I became fluent and started being in a practical setting where I can apply all that I have learned, I realized I wasn't taught anything that I use on a daily basis and honestly do not apply any what I learned in nursing school. Neonatal nursing is so specialized, we didn't learn much of anything that is applicable on my unit and unfortunately, I feel like I have forgotten so much of it already -hypertension, diabetes, etc. It would be impossible to have a Guide to Nursing for Dummies containing everything you need to know because you just cannot be taught it all in a classroom and I have learned to be conscious of the fact that I don't know what all that I don't know and still frequently ask questions just to triple check; I have a tiny life in my hands and the smallest mistake could mean life or death in a neonate.
As a nurse, you strive to do everything in your power to heal your patient. It's that innate drive to want to rid someone of their pain, to help them to heal and grow stronger... but what do you do when you are ordered not to? What questions do you ask when your patient is too sick and any intervention would just be causing more pain? Delaying the inevitable? When there is nothing else we can do. When no medical intervention would serve any purpose but to prolong death. When treatment would only cause more harm than good. This is the ethical dilemma that is becoming more familiar to me ... to allow natural death. By setting aside all the life-saving skills I have been taught. By watching a mother stand over her child helplessly crying at the bedside. By watching a patient slowly deteriorate until finally they are at peace.
It's a strange phenomenon that it appears as though certain defects or diseases come in waves on my unit. Trisomy 18, gastroschisis, TAPVR... and the current theme: Allow Natural Death. As I sit here for the fourth night in two weeks watching a baby gasp as he takes his final breaths, I try to look at it from a medical prospective. The baby is better off. He is no longer in pain. He is no longer suffering but there is a part of me that cannot disengage. Cannot let go of the fact that this is not just a disease; it's somebody's child. A baby with a name, two eyes, one nose, ten fingers, ten toes...
As I watched a family be informed that there was nothing else we could do to save their baby for the first time back in December, the chaplain that was called to the bedside told me "The day you stop crying is the day you should quit your job". Fearing I might drown in my own tears tonight, I have a feeling I will be a nurse for a long time.