Last week a question was posed to me on Quora : Can you tell me about the most stressful incident that happened in your nursing career? It got me thinking about the worst day and best day in my nursing experience. Although I don’t dwell on the bad times, I never forget them (as I mentioned in Running into My Labor Patients in Public and Working as a Labor and Delivery Nurse).
The Worst Day of My Nursing Career
I admitted a woman to the labor and delivery unit. She said she was 26 weeks pregnant and didn’t feel the baby move. At 26 weeks gestation (a picture, not for the faint of heart) the mother should feel the baby move often. Though it is too early for formal fetal kick counts, most moms know the patterns of their baby’s movement.
I turned on the fetal monitor and attempted to find the fetal heart rate. My own heart sank as I palpated her belly, looking for a likely spot to place the monitor. Her belly wasn’t firm and rounded, but soft and without tone. I couldn’t locate fetal heart sounds. The patient was becoming more distraught with each passing second.
I summoned one of our obstetrical residents and he came in right away with an ultrasound machine to look at the baby’s heart. I held the patient’s hand while he performed the ultrasound. The heart was still – an intrauterine fetal demise. It would be stillborn. We can use whatever medical terms we want, but in the eyes of the mom, her baby was dead. It was heartbreaking.
She cried. I stayed with her. She called her husband and family to come. I stayed with her, and also with her family, while the patient and her family grieved over the news.
When the initial shock eased somewhat, her physician explained what had to be done: induction of labor. She’d give birth, as usual, but there was nothing usual about it. The baby was dead. And she had to deliver that dead baby. The doctor explained what would happen, but it was the nurse’s job to carry it out (me). Draw blood, start an IV, give medication through the IV to bring on labor, see that her pain was controlled, push with the patient until delivery was imminent, receive the baby at delivery, and do post-mortem care. And, of course, provide emotional support for her and her family.
Meanwhile, I needed to ask the patient many emotionally difficult questions required by the State for filing the fetal death certificate. I also had to explain the “disposal” options, the autopsy options, and ask whether she (and her family) wanted to hold the baby. After the birth, I would need to try to make the baby presentable – clean it, take footprints, pictures, get a lock of hair, weigh and measure the baby, and swaddle it for mom to hold (and somehow prop up the chin, which invariably hangs slack). And the saddest part for me: later taking the baby to the morgue and placing it in the refrigerator.
The patient and her family (there were six or eight sisters and aunts present in addition to her husband) understood the baby was dead, and by the data obtained from the ultrasound measurements, it was likely the baby died a week or so ago.
Her labor was mercifully quick for a first-time mom. Her extended family remained present for support of their loved one (I never left the room except to obtain medication or supplies). She pushed a few times, and her baby boy slipped out. It was obvious to me, by the condition of the skin, that it wasn’t a recent death. Otherwise, the baby was perfect. They all cried. So did I.
I received the baby and put him in an infant crib. The patient previously requested I do all of the post-mortem care in the presence of her and the family.
And then …
What Made it the Worst Day in My Nursing Career
The patient screamed. I expect a patient in this situation to cry, and maybe scream in grief. Then the whole family screamed. They screamed at me:
“Why aren’t you doing CPR?”
“Get one of those breathing bags!”
“You’re not trying to save my baby!”
“Oh my God, she’s letting the baby die!”
“Why aren’t you calling a pediatrician if you don’t know what to do?”
It was mass chaos. They were screaming all at once. I was frozen. There was no saving to be done, and I couldn’t abuse that little body with pretending. They expressed understanding beforehand – the baby was dead, probably for quite some time. I guess they were not able to process in their hearts what their minds heard.
I have never felt so useless, so helpless, so inadequate as a nurse in all my life.
It was nearly the end of my shift. I functioned like a robot, doing the post-mortem care and handing the swaddled baby to the mom. Her family gathered around and took turns saying hello and goodbye to their family member. At some point the screaming stopped. I don’t remember when, or what I said to them. Traumatized by my inadequacy as their nurse, I cried the rest of the night at home.
Their grief was greater than mine, I know that. They not only lost a baby, but the hopes and dreams of the man he would become and how their lives would play out. I’d only lost the notion and confidence that I was a good nurse, able to care for families in a way they need and make a positive difference in their lives.
The next morning, I dreaded getting up and going to work. But then something beautiful happened…
The Best Day of My Nursing Career
When the charge nurse gave out the assignments to start the day, she said the patient I had yesterday requested me as their nurse. It must be a mistake, I thought. So with a heavy heart and zero confidence, I went down the hall to the patient’s room.
The family was still there – they’d stayed all night with the mom. When they saw me they crowded around me, hugging me. Tightly. The patient thanked me for my care during labor and delivery, and said she would not have been able to get through it without me. Her family members each in turn thanked me for the caring and support I showed them during the ordeal. They said having me as their nurse made all the difference in their ability to get through the day and their thankfulness and appreciation knew no bounds. They couldn’t have done it without me. I made a difference in their lives, they said, and though they were grieving together they also had joy in their hearts for what they thought was the best care in a bad situation. And the mom said if it never happened, they would never have met me, and known how kind and caring a soul could be.
And those few words made my day, and made that day the best day of my nursing career, ever.
*Details were changed to protect privacy (no HIPAA violations).