There is absolutely nothing more frustrating than being unable to ease the woes of an inconsolable patient. Especially hard is the moment in which I, as a nurse, have to stand at the end of a patient’s bed, my head hanging low, voice soft and defeated, and say, “I’m sorry, there’s just nothing more we can do. We’ve tried everything.”
In this case, the culprit was restless leg syndrome.
Symptoms of Restless Legs Syndrome
People with RLS have strange sensations in their legs (and sometimes arms) and an irresistible urge to move their legs to relieve the sensations. The sensations are difficult to describe: they are not painful, but an uncomfortable, “itchy,” “pins and needles,” or “creepy crawly” feeling deep in the legs. The sensations are usually worse at rest, especially when lying in bed. The sensations lead to walking discomfort, sleep deprivation, and stress.
From WebMD: Read more
This gentleman was on incredible doses of many drugs. His cocktail would easily have depressed my respirations enough to leave me comatose and most likely dead. By 04:00 I had given him the following: 0.125mg Mirapex, 15mg Zopiclone, 4mg Ativane, 5mg Buspirone, Olanzapine, and 30mg morphine.
He was still screaming though. His moans could be heard throughout our unit which should have been completely silent–except for the quite drone of the radio, the hum of the idle computers, and the scratches of our pens on our charts.
His screams were always followed by the BANG BANG BANG BANG BANG of his legs slamming against his bed as he despiritely tried to relieve the sensations in his traitorous legs.
Then the call bell would ring, “please PLEASE….somebody help me….I can’t do this anymore…please!”
“I’ll get you some more ativan and morphine.” Is all I could ever say.
Every time I would pump him full of medications through his peg tube, I couldn’t help but notice his sunken eyes and desperate expression. He had lost a lot of weight over the last several days. He had been assigned to me for three nights in a row and in that time he’d fallen asleep for thirty minutes: and day shift reported that he hadn’t slept a wink for them. You could see the sleep deprivation in the dullness of his eyes.
Compounding the issue was his cognitive abilities. He had the coping skills of, I would guess, a five-year-old. He didn’t have the ability to calm himself. He was unable to develop strategies for himself to work through the pain and suffering of his never-still legs. He looked outward to us, his nurses, as the sole group of people that could help him…but we couldn’t.
I kept wishing I could consult an anesthesiologist for the sole purpose of completely sedating and paralyzing him; perhaps even for a few days (wishful thinking, I know). I wanted to walk into his room and see him sound asleep and at peace. I would have given anything to hear him say, “I slept so well last night.”
As for now (I have a few days off–he’s in another nurse’s hands), the plan is to keep increasing his medications. The idea is that there must be a dose/cocktail of narcotics and neuro/psych meds that will get him some relief and perhaps even some sleep. Or, maybe, I will witness the dangerous reality that sleep deprivation really can kill you.
It’s hard to reach a point where you admit that you are entirely helpless. After all, when we can’t help people, doesn’t that signify our failure as a health provider? Are we not here to ease people’s suffering? I have solutions for most issues: can’t pee then foley, emesis then NG tube, pain then narcotics, no pulse then CPR. But this situation completely defeated me.
Every time I would walk away from him I could hear his cries, “please please PLEASE” BANG BANG BANG “Help me! Please! I can’t do this!” BANG BANG BANG. I could feel his frustrations throughout my body; I felt ragged and raw; my emotional barriers were worn out.
It burdened me that I could not console the inconsolable.
