Dear ICU Nurse

When my dad returned home from the hospital after surgery, I felt that I needed to release all of the frustration and anxiety I experienced as a result of the care we received from a particular intensive care unit (ICU) nurse by writing a letter to her. I needed to respect my dad’s wishes and not confront her at the time, so the letter was put aside as I was consumed by the daily tasks of caring for him. But now that it has been 3 months since my father’s death, I feel compelled to share the experience to help others learn from his challenges and honor the memory of his incredible strength to overcome such difficult circumstances with a positive attitude and compassion for his nurse.

Dear ICU Nurse,

The blood that soaked through his bandages, gown, sheet, and blanket and dripped to the floor was not intended to cause you so much anguish. His attempt to help as you cleaned up the mess, by raising his arms while tethered to so many tubes, was met by your sharp reprimand, “Stop that!” He began apologizing for being so much trouble and I tried to soothe him by saying, “Dad, you aren’t doing anything wrong- you can’t will your blood to stop.” My anxiety about your attitude began to rise but admonishing you directly seemed dangerous considering my mom and I were completely dependent upon you to care for our loved one. My dad raised his finger and his eyebrows to say “stop” to me; he did not want me to confront you. I wanted to storm out of the room but I couldn’t leave because I needed to make sure my dad was okay.

When you explained how to use the call button, you did nothing to hide your exasperation after he told you his eyes could not distinguish the button to call you from the many others on the remote and his aged, anesthesia-soaked memory could not grasp the instructions for longer than a few minutes. He was accustomed to being the man of the family, the provider, the one others depended upon but now, he was completely dependent upon you.

When he was no longer catheterized but was still receiving IV fluids, I expressed concern to the nurse manager about his not being able to use the call button. I was reassured that you would check on him every hour. He had been stuck in a chair for four hours but he didn’t want to bother you to ask for help to move. You were never around and we didn’t know where to look for you. Other nurses kindly helped when we asked and we wished they were caring for our loved one instead. Dad wanted to be independent, to get up and walk, to release the discomfort of all of those hours of sitting. You attached an alarm to his hospital gown so that when he tried to get up it would alert you. You admonished him like a parent to a child, scolding, “Don’t try to get up without my help” which further reinforced his feeling that he was a problem and his frustration with being dependent upon you.

When you asked him whether he was in any pain, he said he was lucky that he didn’t feel pain. He didn’t talk about the mental anguish of being completely dependent upon you to meet all of his needs, of being made to feel that he was a problem, of the cancer that may still be lingering at the margins of the gaping wound in his neck or spreading through his lymph nodes. While tethered to all the tubes and wires, unable to move freely, he exclaimed that he was happy to be alive and had no complaints. He was determined to help you become the caregiver he needed you to be. Each time you performed a clinical skill, he thanked you. He continued to apologize for causing trouble, even though he was completely compliant. Whenever a doctor or therapist or case manager visited, he told them what a wonderful nurse you were. When he told them you had a great sense of humor, I almost choked because I had never seen you joke or even smile.

Each day, my mother and I were determined to wait out your twelve hour shift, making sure that our loved one’s needs were met. When we realized the night nurse would provide the nurturing care my dad deserved in our absence, we finally went home, exhausted and relieved. Slowly, you began to melt; I occasionally saw half-smiles. When I asked you a question about a side-effect of a medication, you seemed pleased to share your clinical expertise. I have no doubt that you know the clinical tasks of critical care well but I want you to understand that your role is so much more than that. You have the opportunity to not only provide clinical care but also to provide comfort and ensure dignity during the most difficult times of people’s lives.

Caring for my father at home by tube feeding him, giving him medicine, and attending to his needs, I realize what a privilege it is to nurture someone in this way. As I cared for him, I explained what I was doing and found ways that he could help. I used touch to comfort him and he used humor to comfort me. I anticipated his needs, knowing he didn’t want to bother me by asking for something. I had the luxury of only caring for one person at a time but my shift never ended. I was always on call, always worried about how to handle the next problem with the feeding pump or weeping sore that refused to stay covered by a bandage. I relied on my partnership with my dad’s hospice nurses to help me address his needs and I regret that you and I never had the opportunity to work together in that way.

Although the ICU is a completely different setting than home care, I wonder how we could have approached our roles differently. I hope that your time with my dad has helped you realize just how important this caregiving relationship is. Your patients need you to be not only a clinical expert, but also someone who sees them as people whose dignity and self-esteem are affected by your actions. Your patients are not an obstacle; they provide an opportunity for you to demonstrate both the depth of your skill and the depth of your heart. You can be the caregiver your patients need you to be.

I cannot mail this letter to the ICU nurse because my dad did not want us to confront her and I need to respect his wishes. As a family member, I am challenged to consider how I could have been more assertive with the nurse while honoring my father’s wishes to not confront her. As I saw her behavior change in response to my father’s actions and become more nurturing, I was reassured that his decision against confrontation worked out for the best in spite of the initial challenges. My father was my role model through encouraging the nurse to be the caregiver he needed her to be.

By sharing this letter with a community of caregivers through this journal, I can imagine people reading it and thinking how appalling the situation was but at the same time perhaps recognizing their own or their colleagues’ frustrations with patients. By reading, reflecting on, and sharing this article with others, I hope it helps caregivers get beyond denial (that’s not me) and defensiveness (I followed protocol) to focus on the heart of caregiving and always striving to be the caregivers their patients need them to be.