patient stories

The Necessity of Suffering

The other day at work, I had an elderly woman named Iris.  Her veins were fragile, frail, twisted, much like her general figure. Her skin fell off of her bones like a curtain. Her bright blue eyes were full of life, but her mind was clouded by a mild dementia.

“I’m giving you a medication through your IV, Iris,” I stated routinely as I programmed the IV pump. “Were giving you potassium because your potassium is low.”

Intravenous potassium chloride stings, to say it nicely. Because potassium is an intracellular ion (meaning, the majority of potassium in the body is inside the cells of the body), potassium given intravenously instantly wants to go from the blood stream (extracellular) to inside the cells (intracellular). It’s caustic, burning the vein as it goes in, intolerable for a number of patients.

“Oh, ow,” Iris quipped as the first drops of potassium chloride entered her veins. “Ow. Ow! OWWWWWWW!”

“Potassium can sting, Iris,” I said comfortingly. “That’s normal.”

Her eyes began to water. “What are you doing to me? Why are you hurting me?”

My heart ached for her. “You need this medication.” It doesn’t have to hurt quite this badly, I thought. I re-programmed the IV pump, dropping the rate in half, reducing how quickly it would enter her vein.

“Ow! Ow!” she continued as she rubbed her arm near the IV site. “What are you doing to me?” she asked, pleading, her blue eyes brimming with tears as she looked right at me.

“Just give it a minute, Iris,” I said as walked out of the room and called the resident. “Ow!” I heard her yell as I walked to the computer.

“It’s Neil,” he answered.

“Hey, can we add some lidocaine to the IV potassium for bed 40, the old lady? She’s not tolerating it well.” Lidocaine is commonly used as a local anesthetic, utilized to numb an area. Though medial literature goes back and forth as to the usefulness of lidocaine mixed with caustic IV potassium, I have found it if nothing else has a placebo effect for patients.

“Yeah, I’ll put it in. ”

I tried to see another patient as I waited for the order, the necessary legal documentation, but her staccato “ow”s filled the hallway. “Ok, Iris,” I said as I rushed to her IV pump. “I’ll stop it. We’ll get something to help with it.” The pump powered down.

“Where are you going?” she pleaded as I went to leave.

“I have other patients to see,” I said. Other patients included a new patient brought back from the waiting room with chest pain. Chest pain meant a variety of testing needing to be done rapidly. I did not have time to comfort her. “I’ll be back.”

I drew labs and settled my patient with chest pain, passed a medication for my abdominal pain, saw my knee pain off to Xray, and circled back Iris. I mixed the potassium with lidocaine, even mixing the potassium within the IV tubing with lidocaine. I restarted the pump, hopeful.

“Ow! Ow!” she cried as the pump pushed in the first drops. “What are you doing to me?” I shook my head and left the room. “Where you going?” she called after me.

“Ow!” I made a beeline for the cluster of providers: attending physician, resident, medical students, and midlevels crowding around a computer looking at a scan. “Neil,” I said to the resident. “Can you please come into 40 for a second? I added the lidocaine, and she’s not tolerating it.”

“Ow!” We came in. Iris was crying, rubbing her arm. “Why are you doing this to me?” she pleaded with us.

Neil thought for a spilt second. “We gave her the oral dose, yeah?” I nodded. I had given her a horse pill of potassium a hour ago. “It’s OK, dear,” he comforted her. “We’ll stop it.” I turned the pump off. “It’s all done,” he emphasized.

“It’s finished,” I repeated as I flushed the last milliliters in. “Just water with some salt going in now.”

“Don’t leave me alone,” she begged as I typed in the computer.

“I have to, dear,” I said pumped for a drop of hand sanitizer. “You’ll be OK.”

“Where are you going?” she called after me. “Don’t leave me!” My heart dropped as I rubbed the last bits of hand sanitizer out of my fingers and headed to another room.

Every given day at work, I hurt someone. I initiate IV therapy, which starts with a poke in the arm (if you’re lucky) and more often than not numerous needle sticks and some digging around in the sensitive skin of the hand. I give injections, which involves a needle in the thigh or arm. I educate on various health topics, which usually involves a patient needing to make a significant change in his or her life. I deliver bad, unexpected, unwanted news. I leave patients alone when they desperately want someone to be with them. Emotionally or physically, I hurt someone every day at work.

Most of the time when I asked how to mentally handle hurting people, I am told to mentally escape. I am told to not think about it. I am told to disconnect.

I’ve tried disconnecting. I’ve tried not thinking about it. I’ve tried mentally escaping.  It left me burnout, bitter, unhappy, and seriously considering changing careers. As a nurse, I cannot escape the reality that at every given day at work, I hurt someone.

I’ve learned the mind cannot forget the select images of people we’ve hurt, however much we try. Iris’ bright blue eyes, brimming with tears, is burned into my mind like potassium burned in her vein. The image of her in pain mentally hurts me as I allowed the potassium to physically hurt her.

I allowed her suffering to happen, and I could have prevented it. But for however much I’ve second-guessed my decision to administer that potassium to Iris and reflected on the circumstances to improve my care for the future, I knew she needed the medication. However painful the momentary suffering, I had a greater good in mind for Iris. Low potassium leads to cardiac arrhythmias leads to organ dysfunction leads to organ death leads to bodily death. She needed potassium, however painful.

I could never intentionally hurt her or any patient, with needles or information, if I did not know it was for a greater good. Our Lord acts in an infinitely more merciful and wise fashion than I, and He allows even greater suffering than IV potassium.

The Lord allows war to happen. The Lord allows death. The Lord allows isolation, pain, despair, misunderstanding, and seemingly every kind of evil to happen in the world. Why why, does an all-loving, all-powerful, all-knowing God allow such suffering?

St. Augustine answers it beautifully and humbly, as it is quoted in the Catechism of the Catholic Church (311):

For Almighty God…, because He is supremely good, would never allow any evil whatsoever to exist in His works if He were not so all-powerful and good as to cause good to emerge from evil itself.

My patient, hurting and writhing in pain, is never what I want for another person. We reject suffering, we question suffering, we despise suffering because we implicitly understand that suffering is not what the Lord desires for us. But yet He allows it to happen, orchestrating a greater good.

What would the Resurrection be without the suffering of the cross? The glory of the resurrection is made all the more glorious because of the juxtaposition of the suffering of the cross. Without the pain, the anxiety, the unknowing, the suffering, the joy of the Lord would not be as full.

As Venerable Archbishop Fulton Sheen wrote:

“Unless there is a Good Friday in your life, there can be no Easter Sunday. Unless there is a crown of thorns, there will never be the halo of light. And unless there is a cross, there will never be the empty tomb.”

– Fulton Sheen,Lift Up Your Heart: A Guide to Spiritual Peace

Suffering is a part of healing, a part of life, a necessary part of closer unity to our Lord, a constant mystery in our lives.

When we reject suffering, when we reject the crosses that the Lord has intentionally allowed to be present in our lives, we reject the will of God. Jesus never said life would be without suffering. From the beginning, God has never hid the fact that suffering is a necessary part of life. If He willed it for Himself to bring His glory, why would He not will it for us?

Suffering is necessary for our redemption, but we never have to bear our crosses alone. Our infinitely compassionate Lord knows, knows from experience, suffering. He was rejected. He was abandoned. He was beaten. He was suffered more than we can imagine. He knows suffering, and through our suffering, He will redeem us. 

He can handle the weight of our suffering, our crosses. He can carry it with us when it is too heavy. He can pick us up when we fall down. He will stand at the foot of our cross as we bend our will to His and nail ourselves to the cross He has made for us. And even more, He can handle our anger, our frustration, our jeers, our incessant questions of “why?”

The cross is not end of the story. Suffering and death is not the end of our story. There is life after death, and just so, there is joy after (and even during) suffering. 

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