If you ask nurses what they love about their jobs, they won’t talk about high-tech equipment, complicated procedures or newly discovered cures. They talk about their patients—and not just those they saved. While they do celebrate medical successes, the names and faces of the patients they lost are etched into nurses’ hearts. Perhaps that’s because nurses perform the often intimate parts of bedside care and form instant bonds with patients in their hours of need.
Heather Haddock is no exception. As Nanticoke Memorial Hospital’s clinical educator for maternal and child health, she has helped deliver thousands of healthy babies to happy parents. “I love every patient, but the names and faces I remember are related to losses,” she says. One of them belongs to a woman whom Haddock cared for when she was a registered nurse in Nanticoke’s maternity ward.
Her pregnancy full term, the woman was concerned that her baby had stopped moving. Decreased fetal movement is a common complaint. Typically, Haddock would put women on fetal monitors and find their babies’ heartbeats. Not this time. An ultrasound confirmed the fetal death. Haddock’s patient elected to be induced and to deliver her baby immediately. It wasn’t the first time that Haddock dealt with this situation. “It’s very tough every time, but this time was tougher because I was pregnant with my first child,” Haddock says.
At Nanticoke, pregnant nurses are not assigned to patients who have stillborn babies. The patient doesn’t want a nurse with a belly, and the experience takes a toll on the nurse. But Haddock was so early into her pregnancy that she hadn’t yet told her coworkers.
Haddock cared for the patient and consoled her through the sudden and enormous loss. But Haddock couldn’t answer her basic question: Why did it happen? There was no obvious trauma, nor was there a knot in the umbilical cord or any other typical sign of fetal death. “That added to the heartache,” Haddock says. “This woman carried to term and thought everything was OK. She saw the fragility of babies, and so did I—not just as a nurse but as a soon-to-be mother.”
Karen Nestor cares for medically fragile children every day. A pediatric clinical nurse specialist at Nemours/Alfred I. duPont Hospital for Children, Nestor works in inpatient units with kids who have a variety of illnesses. Many of those conditions are chronic, so Nestor often cares for patients for years, even decades. “But the great thing about children is that they want to get better,” she says. “They want to play and laugh and be well.”
That doesn’t always happen. Nestor recalls a 13-year-old patient with a terminal illness. “It was one of the most amazing and heartbreaking things of my career to see this child come to terms with his situation, then talk his mom into letting him go,” Nestor says. Losses take a toll on the medical team. They often have debriefings after patient deaths, child abuse cases and other difficult situations. “I’m not sure if it’s the right way to do it, but I tell new nurses that it’s OK to cry and let it out,” Nestor says. “It’s a healthy way to cope with those emotions.”
Crying, talking and hugging are essential coping techniques, says Carolee Polek. “And sometimes, we need doughnuts,” she adds. Now an associate professor in the University of Delaware’s College of Health Sciences, Polek spent many years working as an oncology nurse at Jefferson, Hahnemann and the University of Pennsylvania hospitals. A self-described “cancer nurse,” Polek grew attached to her patients. “They become part of our lives and vice versa,” she says. “Now, I take my students to the Christiana oncology unit and show them a card. It’s so old that it is taped together. It says: ‘To the nurses on 6B – From the bottom of our hearts, thank you for giving us more days with our daddy. Love, Bob and Sam.’”
Cards like that aren’t unusual. Patients and their families know that nurses help them fight those battles, even if they eventually lose. Cancer nurses read the obituaries every day, Polek says. “We post them in the kitchen area of the floor,” she says with tears in her voice. “You may have three people dying a week. That’s a rough week for nurses. Families will send us notes thanking us for the care we gave their loved one. It’s incredibly touching.”
Though losses take a toll, there are plenty of successes to celebrate. Nestor was walking through the Ronald McDonald House in Wilmington when she heard someone calling her name. It was the mother of a child she had cared for years prior. Then an infant, the child traveled to duPont Hospital from another country to have a surgery. The mother remembered the role Nestor played in saving her daughter’s life. “But the child had no idea who I was because she was a baby at the time,” Nestor says. “It was amazing to see her healthy and doing well after all those years.”
Jennifer Graber is a professor of nursing at the University of Delaware. // Photo by Leslie Barbaro
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Jennifer Graber had a similar experience. Now a professor of nursing at the University of Delaware, Graber spent many years working as a clinical nurse specialist in psychiatric units. One patient, a man in his early 20s, was a member of Graber’s psychoeducational therapy group. When discharged, he told Graber how helpful she’d been. “A few months later, he spotted me out in the world,” she says. “I didn’t recognize him because he was so healthy. He had a job and was doing well.”
Graber often made similar connections with patients, despite the chronic mental illnesses that necessitated their hospitalizations. “If you show patients that you respect them and are there to help, they will accept you,” Graber says. “That’s the biggest piece, and it allows us to make a difference in their lives.”
Lauri Littleton makes meaningful connections with her patients, even though they are groggy when they meet her. Littleton, a nurse manager for Christiana Care Health System, works in a surgical unit that specializes in gynecological and urological procedures. She treats patients who are emerging from anesthesia. Opioids have become a hot topic when discussing patients’ recovery. Most operations require the temporary use of opioids to relieve surgical trauma which, while ultimately curative, can create temporary pain. “Because opioids have been in the news so much, patients and their loved ones are concerned about becoming addicted,” Littleton says. “Other people have trouble with pain because they are already taking opioids for other issues. We’re doing a lot of educating about pain management.”
That’s one of Greg Parr’s main responsibilities. At Nanticoke Memorial Hospital, Parr works with patients who are in the end stages of many illnesses, including congestive heart failure, pulmonary disease and renal disease. Caring for terminal patients may seem emotionally grueling and medically unrewarding, but Parr doesn’t see it that way. “Palliative care helps manage symptoms to give patients the best quality of life when they have a disease we can’t fix,” he says. “A tough nursing job for me is pediatrics. I’m not cut out to do that.”
Where others see rigors, Parr sees rewards. He recently cared for a 90-year-old woman who had surgery, radiation and chemotherapy for her pancreatic cancer. Treatment proved effective until another mass grew. At that point, she declined aggressive medical intervention. Parr’s job was to make sure she was free of pain and breathing comfortably with minimal fatigue. “She had a remarkable life in rural Delaware’s farming community,” Parr says. “She told me that she had a good life and wasn’t bothered that it was coming to an end. She said, ‘If my heart stops beating, hold my hand and wish me well.’ I was honored to spend an hour with such an engaging, funny and thoughtful woman.”
Polek says cancer nurses think much the same way. “I may not be able to cure you and save your life,” she says. “But while you are in my care, you will not be in pain. You will not be cold. You will be clean and dry. If the lights bother you, I’ll turn them off. If you want your bandanna fixed to hide your thinning hair, I will do it. If you need earphones, I’ll find them for you. I am your advocate. I will take care of you. That’s my job as a nurse.”