A few nights ago a co-worker and I were sitting at the nurses station charting and we both received alerts through the computerized charting system that we had pending notes needing to be signed. I clicked on the links and read through each note, there were three. I was stunned when I looked at the names….. I didn’t remember these patients at all.
All three had been discharged shortly after their time in the ICU and were at home, all three had uneventful hospitalizations with minimal critical care interventions (i.e. intubations, CPR, chest tubes, pressure ulcers, uncontrolled pain, and one never even had a foley- which of course is good for them.), and for all of them I had written very generic end of shift notes.
“Patient slept well overnight…..VS per flowsheet and WDL (within determined limits) ….. O2 weaned to keep sats >93%…..voided without difficulty, pain well controlled with PRN medication….family at home for the night.”
This could describe anyone…… I still, to this moment, cannot picture their faces.
When I began my career as a nurse, I would have bet an entire month’s pay that I would always remember every one of my patients. The work we do is so intimate and so personal. The conversations unique and patient’s situations individual. The stories that each person has about what happened to them, what brought them into the hospital, and even sometimes how they got to the hospital: are different. I never would have imagined nine years ago that the vast majority of my patients would begin to run together.
Of course there are patients I have cared for whom I can never forget. Each patient that has died in my care; either after the withdrawal of life support or an hour of CPR, I remember like it happened yesterday. I remember the names and faces of every one of my patients whose lives have been saved by CPR. I remember a few patients for their ability to make me laugh and the sense of humor they had, even when faced with tragedy. I remember the patients that opened up and talked about themselves. I remember the patients that brought us cookies and its impossible to forget the patients whose illnesses kept them in the hospital for months.
These notes pending, and waiting in my inbox to be signed, got me to think about other instances of not being able remember patients that were impacted, good or bad, by the care they received in the hospital.
The most common is when patients come back to the ICU to stop by, say hi, and update us on how they are doing. It always takes a minute to pause and look them in the eye before you can picture them as the patient in the ICU bed again. It’s always fantastic to be given the opportunity to forget what they looked like as patients and see them as people. As nurses, it’s invigorating to see them walking, talking, breathing on their own, smiling, and healing.
As I was sitting and staring at these pending notes, I suddenly realized that I had recently just been introduced to the idea that not remembering names and faces while hospitalized is a two-way street.
I was in a bar in Seattle watching football and a lady with gray hair and brown rectangular glasses walked up behind me and tapped me on the shoulder. I looked her in the eyes and immediately remembered last fall. A patient had come into the ICU after an accident, became immediately sick and went into a shock state with a severe and surprising inflammatory response. He began to stabilize after a few days and we never really figured out why he became so critically ill with the minor injuries he sustained. I took care of him for his first few nights in the hospital when he was really sick and then I went on vacation. When I got back to work he was moved out of the ICU and now I found myself looking his wife in the eyes.
As I sat and talked with them, I listened as they described how long and complicated his inpatient rehab stay was and how many months it took for him to get home. His wife and I were from the same state, nearly the same town, had gone to the same college, and were at the bar this evening to watch the same football game. We had hit it off right away and were catching up on our home state, almost right where we left off last year. I looked over at her husband. He was sitting and listening and it occurred to me that while he knew (from his wife) that I was the nurse that took care of him the first few nights he was the ICU, he didn’t remember me, and actually he had never met me. I took care of him, bathed him, turned him, monitored his vital signs, and intervened continuously to keep his heart function and tissue perfusion adequate and through all of this, him and I had never actually met.
Both situations are very surreal; not remembering patients that I interacted with and cared for intimately stings just as much as knowing patients don’t remember me after 3 consecutive, intensive 12 hour shifts.
After staring at the computer for a few minutes; I signed the notes and went on with my work. I still can’t remember the faces of these patients, but now I won’t forget their names.