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Every month More Voices invites readers to contribute short nonfiction prose pieces of 40 to 400 words on a healthcare theme.

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Amy Eileen Hiscock

I cannot take my eyes from his face.

It has been destroyed in the wreck, along with the rest of his body. His head is misshapen, bloodied. Someone has tried to staple together one of the larger lacerations--extending diagonally across his face and under his chin--but there was little point. They gave up partway through.

I have never seen a dead body. I am twenty-five and in the second of five terms of nursing school. 

Before the calm of his final resting, the CPR was violent. Even as his stretcher came barreling through the emergency-room door on its way to the trauma room, someone was pumping his chest. It was hard to see between the scrambling bodies, all in green scrubs and yellow gowns. But the ones doing the compressions were obvious, kneeling on the mattress, their shoulders heaving at once chaotically and rhythmically; I could almost imagine they were fighting wolverines in there, not trying to save a life.

There was only so much that could be done. The carnage was too great. 

His eyes are still, cold--very nearly swollen shut. I remember hearing someone yell amid the chaos: "Pupils are fixed and dilated!" 

Now that it's over, there are doctors and nurses (many students) learning from him. As an observer and nursing student, I'm told to come into the trauma room and don gloves. To touch his body. His broken chest. It's hard to look away from his face, though. The left side of his chest sits about an inch lower than the right; someone tells me there was a moment when his heart was beating visibly from the outside. I think of his crushed chest pulsating like a creature breaking free from its egg. But that is a birth, and this is a death.

And there's my hand, on his chest. The sternum is soft and pliable where it shouldn't be. He's already cold. I am gentle when I touch him. I don't know why; I can't hurt him. 

Stupidly, I ask: "This isn't from CPR, it's from the crash, right?" 

"Yes, CPR would never cause that much damage," someone answers. "Broken ribs, yes, but it would never crush someone's chest like that."

Of course it was the crash. All of his limbs look broken, too. 

People begin to file out, but not before cleaning his blood off their shoes.Why do doctors and nurses wear white shoes? I wonder.

A doctor takes an ultrasound of the lower abdomen "to see if it's full of fluid." He seems curious about the extent of the internal bleeding. 

I nod, looking at the young man's body. So many people are touching him. He does not flinch or shy away; maybe that's the most shocking part. 

I'm new to nursing, but I've grown accustomed to examining people's bodies, touching them. People are guarded, self-conscious. Maybe they use the gown to cover every inch of skin except the one I'm looking at, or they tense their muscles or blush or go very quiet or talk too much. 

Dead people do nothing. It's nearly too much to take, the strangeness of this. 

Someone explains that the breathing tube and catheters and electrodes will stay on the body for the coroner's report. 

Yes, I nod, looking at bloody-pink frothy bubbles in the endotracheal tube protruding from his mouth. 

"Should we clean his face for the family?" I ask. 

"The nurses will do that if the family comes to see him, but we'll try to discourage them from coming," someone answers. The wreck caused too much damage. 

I look around the room. Bags of unused blood hang at the bedside. I clean the young man's blood from my own white shoes and leave the room. Wash my hands. 

It's been maybe thirty minutes since he came through the door, but it feels like hours. 

Look normal, I tell myself, but I'm already starting to break down. 

"It's okay," a colleague says reassuringly. "Not everyone is meant to work in this area of nursing."

Can I really be a nurse at all? I wonder. 

I am shaken in multiple ways. I feel betrayed by my physical reaction to the young man's death: constricted throat; trembling hands; tunnel vision. The tears that followed. This leaves me with a gnawing unease that I won't be able to function during emergencies or emotionally charged situations.Will I let my patients down? Will I let my team down? What if I can't help a patient in need? What if I hurt a patient--or, worse, let him die? 

For weeks, I check the newspapers for news of the young man. "Industrial worker dies in on-site traffic accident," the headlines read. "Man airlifted to hospital following work accident dies...Safety investigation following employee death." 

Blurbs only. Blurbs do not convey a tragedy. There's no photo, no name. No sense of what was lost. 

It's been more than three years since then. I have seen more tragedy--seldom on the same scale, but tragic nonetheless--since becoming a registered nurse. The young man's face occasionally surfaces in my mind. Though I knew so little about him, he's become an integral part of the way I practice. 

When I recall his face, I remember my fear that I would never become a nurse. I know now that nursing didn't require that I become callous to others' suffering; it required that I learn to balance my emotions and my technical skills, that I achieve an artful blend of caring and calculation. 

For me, nursing is tricky: it is so inseparable from caring that it's easy to slip from a stance of empathy into one of overwhelming sympathy--to allow sadness and pity to wash over my senses like a tsunami. When I meet patients who strike a chord in me, maybe because they remind me of a loved one or share familiar stories, I find it especially challenging to keep my balance. 

But I know that when I succumb to my deepest feelings, it's a disservice to my patients. I can't think or act effectively, and they need me to do that, too, as well as to feel for them.

I've learned that some tragedies demand that I take an emotional step backward, and others that I take a step closer. It's a complex, endless dance--one that I keep practicing and refining, one whose steps I first began to learn in the trauma room.


About the author:

Amy Hiscock is a registered nurse in neuropsychiatry at the University of British Columbia Hospital. Prior to completing a nursing degree, she earned a bachelor of journalism and was a health writer and editor in the private sector. "Self-reflection is tantamount to good nursing practice. For me, the surest way to do this is on a page."

Story editor:

Diane Guernsey

Comments   

# Toni Koch RN, BSN, W 2014-08-04 16:57
Wonderful painted, pointed, slow-motion recall. Thank you for your words, your story. Self-reflection . We are changed with each uncomfortable experience, trying to fine-tune what we think, and how to do what helps most. As a GN what I had feared most actually evolved into the most natural care. Scared stiff, I had to admit a frightened, exhausted woman in the same hospital room my sister died in three years earlier. I recall my patient's cold hands, her hollowed face, her desperate expression. Her relief when I held her and gave the calm and compassion she so needed. I helped her family. My family had been there, literally. With all her family nearby, my sister, Jo Ann was dying; unable to speak. In that my first semester of nursing school, I felt I knew too little, too late; for so long. I went on to become a Hospice nurse. I can't help but feel God's plan is just out of reach like a butterfly. Keep reaching for the beauty, the meaning of that which He means for us to share.
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# Peter de Schweinitz 2014-08-04 12:46
The description in this article--and the reactions to the scene--were vivid. Many articles about empathy and sympathy offer a narrow view of the relationship of feeling to care. This article is real. I appreciate the idea of dancing between closeness and distance based on the circumstance.
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# Mary Martin 2014-08-04 11:09
Such a beautiful piece of writing. My brother lived for 5-1/2 years after receiving a lung transplant. When he passed away from complications, and all six of his siblings and his parents turned to go after an 8-hour bedside vigil, it was his nurse who hugged us all as tears streamed down her face. It's been 18 years since that day, but I will never forget the compassion she showed us. Thank you, Amy, and all the other medical personnel who combine competence and care in their life's work.
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# Pam Mitchell 2014-08-02 18:37
Thank you Amy. I am so grateful you continued on in nursing. It is a great comfort to know that wise and compassionate nurses are choosing to learn the dance. I hope you continue to lay hands on your patients, always. Blessings on your journey.
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# Bill McLaughlin 2014-08-02 11:52
I was very touched by this story - beautifully written with remarkable restraint, and a very touching analogy at the end. The "complex, endless dance" between the callous and the hypersensitive response to human suffering in health care is a career long challenge.
I also liked the notion that the faces of our patients "haunt" us in a profoundly moving and inspiring way years after we witness their tragedy.
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# Josephine Ensign 2014-08-02 14:33
A lovely essay. I was especially taken with the phrase "artful blend of caring and calculation" since 'calculation' is a surprising word choice that has interesting layers of meaning--especi ally for nurses.
Thanks for writing and sharing this piece. I plan to use it this week in a narrative medicine course I teach. I'm always on the lookout for strong writing by nurses and this fits that description.
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# Dale Ann Micalizzi 2014-08-02 09:15
Thank you, Amy. Beautifully written article. I'm sure the experience will continue to follow you in your career and that you will still see his face on occasion and remember. I often think of the nurses who were with my son during and after his death. Did they feel what you felt? Did they care that much to touch his face or chest or arm (for me) to say goodbye...thank you for your compassion and for the lesson the young man taught you in life. May you continue on to teach others as his mom would want you to..
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# Ginna Crowe 2014-08-02 08:58
Lovely ... thank you for this view into nursing that I find so often minimized. And thank you for reminding me of my faces.
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# Ck399 2014-08-02 03:47
Agree, very moving. Had a big impact on me. Brought back memories of my own similar experience. Especially people's reaction (or in this case lack thereof) to being touched.

I wonder should empathy and sympathy be switched around in the final paragraphs? I've gotten them confused before. Thanks
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# Lisette Bolduc 2014-08-02 02:14
Wow. Thank you.
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# Pris Campbell 2014-08-01 20:41
Very moving account. Thank you for sharing this. As a former clinical psychologist there are faces that will remain in my mind and heart forever, too, so I can really relate to this story.
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# Lisette Bolduc 2014-08-02 02:15
I work with this amazing young lady. I absolutely relate and am so grateful to her for sharing her thoughts and feelings around this very pivotal event.
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# Cortney Davis 2014-08-01 19:53
Beautifully written, moving account of the many emotions nurses and caregivers experience in the course of their days. Nursing is such an embodied practice; how fortunate we are to be engaged in this human and transcendent work. Essays like this help bring others into our world.
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