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You Can't Save Them All

By Miranda Dixon-Luinenburg

Last November, I went out for breakfast with a colleague after our last night shift. It had been an awful night for her–struggling to keep her patient alive till the morning, the inexperienced resident scared shitless, every nurse on the unit hanging around the room staring at the monitor.

The patient died at 7:45 am. My colleague finished charting, and we went out and ate a huge greasy diner breakfast and drank endless decaf coffee, and we told all our most horrific stories, and we laughed. Yeah. We laughed.

And one of the things that really makes it sink in, how many problems there are in the world, is that learning to laugh at the horror is one hundred percent necessary. It’s maybe one of the healthiest coping mechanisms, healthier than alcohol or even greasy diner breakfasts. It was the best way I knew to take what I saw at work, and somehow accept it and then move on.

So I gave up my day’s sleep to sit with my colleague and friend, and laugh so we could postpone the tears. Later I cried. And it was right, to feel sad for the person who just died, who was someone’s mother, someone’s sister, someone’s friend. I wanted to grieve, even if she wasn’t my family, even if I knew next to nothing aside from her name and age.

We stood outside the patient’s room at 7:45 am, exhausted after 12 hours, and watched her heart rate drop farther and farther until it was just an occasional ventricular beat. Watched the blood pressure go down to 30/10, which at that point is not really a blood pressure anymore, before we lost it entirely. She had a do-not-resuscitate order, and was already maxed on every vasopressor and we were running epinephrine at five times the supposed maximum dose, and we knew there was no winning this one–we had known it for days, really. You can’t save them all.

It’s been over a year, and I can still see that scene perfectly in my head. I don’t remember all of my patients, by any stretch of the imagination. But I remember the ones we couldn’t save.

I had a lady once for five 12-hour shifts. She had advanced chronic lung disease; she had been on home oxygen for years; and she was back in the ICU for the second time that year, on a ventilator, sedated. Her friend and maybe-lover came to see her every day, and sat by her bedside to talk to her, and asked me if I knew when she’d be coming back so he could get her room ready. It was one of the sweetest things I had ever seen.

She was my ‘boring’ patient that week. She got maybe a third of my time. I strained my back trying to turn her alone. Once I left her in a soiled bed for hours before I could find a second nurse to help me clean her. I put dressings on her inevitable bedsores, and I tried to make sure she wasn’t in pain.

Maybe three weeks later, I had two other patients and was run off my feet and stopped midafternoon at the nursing station, and I saw that her heart rate was 30. I glanced over, and knew immediately that she was palliative, that they were going to take her off the ventilator and switch her to comfort care only.

I didn’t have time to watch; she wasn’t my patient. But I did anyway, stood outside the room where she was alone, and watched her heart stop, and I wanted to say, I’m sorry. I’m sorry I called you my boring patient. I’m sorry I didn’t love you more. Fellow human, I want you to know that I know this is wrong, even though it’s the least wrong option. That for the last ten years you were slowly losing your strength, tethered to your oxygen, and the last three weeks of your life were spent helpless in a bed, surrounded by beeping machines, and that now there’s nothing more we can offer you except for a death without pain… We gave you our best, every step of the way, but that doesn’t make it right. I’m sorry that humans still have to get old and die. I’m sorry that I didn’t have the courage to go into the room with you and hold your hand, because you weren’t my patient and it would’ve looked weird and I didn’t have time.

The memory is hazy now. I’ve forgotten her name. I can’t even wrap my head around the tragedy of that one death. And we lose two more people every second. We’ve lost another sixty million since her. Gone, just like that. We can’t save them all. And we can’t take the time to grieve for them the way we ought to – so we laugh, and look away, and keep moving forward.

Because one thing I know is that we can’t afford to stop.