1. Phipps, Marcy BSN, RN, CCRN, CFRN


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"His family knows this is not a survivable injury, right?"

Figure. Photo by Mar... - Click to enlarge in new window Photo by Marcy Phipps.

This question, posed to me in the doorway of my patient's room by a trauma surgeon I regard as brilliant, caught me off guard.


"No," I said. "They don't know that."


He frowned at me, mumbled something about false hopes, then moved away to continue his rounds. This wasn't the only physician who'd expressed a strong opinion regarding my patient's mortality-a consultant had deemed his injuries "not compatible with life." But I'd been caring for this man, as a 1:1 assignment because of his high acuity, for every shift for weeks. It seemed obvious to me that my patient's continued presence in the ICU-and his relative stability on that particular day-directly opposed the dire predictions. The man's family did not see his situation as hopeless, and neither did I.


And yet days after the surgeon uttered those words, my patient suffered a complication and became so unstable that for hours he teetered between life and death. The resuscitation effort was massive-and no one mentioned survivability. No one behaved like there was even a shred of futility in bringing to bear the full force of medical interventions. I never left his bedside, determined that if my patient were to die, it would not be for a lack of vigilance and intervention on the part of his nurse.


And now weeks have passed. The patient with the nonsurvivable injury is much improved and nearing transfer out of the ICU. He's impatient-tired of being in the hospital. He doesn't believe his mother when she tells him how sick he was. The other day, she called me over to his bedside and asked me to tell him about how I'd called her on the worst day, telling her she should come to the hospital, that I thought she should be here-just in case[horizontal ellipsis] and he rolled his eyes. He doesn't remember anything, thankfully.


The trauma surgeon's words continue to plague me. The blunt predictions of mortality, laid down as edicts, threw me off balance. I've seen people survive worse injuries; conversely, I've seen people die from far less. And although I have had the unsettling experience of caring for a person beyond saving-while waiting for a diagnosis of brain death, for example-those types of cases are generally the exception to the care I give, and not the rule.


It's been a while since that brief interaction I had with the physician, and I've spent more time ruminating about his comment than I'd like to admit, mulling over survivability and hope in the ICU, puzzling over exactly why I took offense. It's taken me some time to conclude that the heart of the matter is this:


The term 'false hope,' when used to describe survivability, is not compatible with nursing. For nursing, as I know it, is rooted in hope.