I was recently helping another nurse clean up an incontinent, elderly patient. She was so weak and deconditioned that she couldn’t help us turn herself even a little bit, and she wasn’t a small lady either. I stood straight and tall as I held her weight, trying to save my back, and my coworker grabbed washcloth after washcloth to mop up the liquid stool that had pooled underneath the woman. The aroma of diarrhea that can only be associated with a gastrointestinal bleed permeated the air, and we worked quickly since the patient’s lungs wouldn’t allow her to remain flat for long.

The patient’s daughter stood against the far wall. She exclaimed, “Gosh, Momma, that stinks!”

But to us she commented, “I don’t know how y’all do it, day in and day out. Y’all are better people than me!”

Nurses, she meant. And it was true; we did deal with poop on a daily basis. As an ICU nurse, and not having the assistance of auxiliary staff, I personally changed and cleaned all my incontinent patients. Then I helped my coworkers clean theirs too. Antibiotics made people sick to their stomachs, and yep, bleeding was common also. Then of course the Gastroenterologist would have us give them medicine to make them totally evacuate their bloody bowels! It could get pretty crazy. But that wasn’t the hard part of my job. Not even close.

So many times my patients would ask me how long I was there until, and when I responded, “oh, about 7:30,” they’d get wide-eyed.

“That’s a long day! 12 hour shifts, huh?!” They’d ask incredulously.

If you’ve followed me for any length of time then you’ve heard me talk about The Nurse Hangover. It’s that fog you find yourself in after a string of consecutive 12 hour shifts. It’s crazy. And yes, it’s hard. But it’s not the hardest thing I do. Not even close.

My poor husband gets to hear me vent about things like increased charting requirements, billing reimbursement and how that affects my job, or the dreaded white board. I’m still amazed people get paid just to check and make sure I keep that information board updated in the room of my sedated, ventilated patient who never has visitors. But I digress. The administrative duties of my job that prevent me from spending quality time at the bedside are aggravating, but they’re not the hardest part of my job. Close. But not really.

I can still recall what I consider one of my worst days. I have never been so emotionally and mentally exhausted than I was after watching my postpartum patient at risk for DIC hold her dead baby and cry. She dressed his 36 week old body in the blue, striped sleeper she was supposed to have him wear home, and she sang to him while she stroked his small, cold head. There was nothing I could do.

I still remember holding a homeless, nineteen year old daughter as she broke down against me. Her devastated tears soaked my hair, her flakes of skin from out of control psoriasis covered my dark scrubs, but I didn’t care. All I could do was hold her as she looked over my shoulder at her dead mother on the bed. The mother she didn’t even know was sick. She had no family or friends nearby, no home, no money, no food, and now no mother.

I still remember the day I coded a new admission 30 minutes after her arrival. It happened so quickly. As I began cleaning her up after the code was called and she was pronounced dead, all I could see was her grown son, scared, and kissing her on the cheek just a little while ago. “I love you, Mom,” he had said. He didn’t even know yet she was dead. I broke down crying. I had seen so many people die, had done so many codes, but that day I broke when I pictured a loving son’s last moments with his mom. Maybe I was thinking of my own mom who I never got to tell goodbye.

I can still remember standing with the doctor in the hall as he explained to a mother that her 25 year old son was brain dead, that there was no hope for recovery. She collapsed on the floor in hysterical tears. She just kept wailing, “no, no, not my baby!”

So many days I have stood at the bedside for hours, never leaving, changing the numbers up and down on multiple IV medications to make the numbers on the monitor stay in the realm of something compatible with life. I’ve walked in to assume care of a patient who was breathing like a fish out of water far too long, and then looked at his face and realized we graduated high school together. I’ve held a lot of hands after deciding to remove life support, and I’ve prayed with patients more times than I could possibly count. There’s a lot of things about Nursing that are difficult, perhaps even disgusting to some. Many days I get highly aggravated at documentation requirements or problems with supplies and the pharmacy. The days are long, and after a shift where I’ve fought tooth and nail to keep another human being on this side of heaven, haven’t eaten lunch, or barely had time to pee, I will think I need a huge pay raise! When we’re short-staffed, dealing with that family member you just cannot please, or getting swung at by an agitated patient, it’s tough work! But I tell you this… those things don’t even touch the surface of the hard parts about this job. You can think you know why it’s hard, but unless you’ve stood at the bedside and comforted a gentleman as he weeps for his wife of 56 years taking her last breath, you really have no idea. That’s the hard stuff. That’s the stuff we don’t talk about. That’s the stuff we try to leave at work, but when we pull into our driveway after a particularly trying day, where we faced the things we could not change, and we finally let the weight of it hit us, that’s what’s hard about Nursing.