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She’s fighting back tears, she’s fighting back years
Of the only life she’s ever known
There’s a future that’s bright in the dead of this night,
And all she’s gotta do is go

~Eli Young Band

"I am exhausted… day 3 of 3…day 7 out of the last 9 days" I whined to the nurse charting beside me.  I hadn’t done 7 straight but the days off had gone by far to quickly.  I stifled a yawn and looked down the hall.  A fresh post-op CABG was being wheeled into the unit.  I huddled behind my computer….

Maybe I can say I am watching the other patients… Maybe I can pretend I didn’t see him get admitted…Maybe  I can avoid helping this one time…

The thoughts circled in my mind.  Guilt settled over me as alarms started ringing in the room.  Unable to suppress my curiosity I walked to the doorway and hovered for a second before I grabbed gloves and jumped in to help.  Blood pressures alarmed as the patient grazed 45/20 and his heart rate jumped to 150. The tall surgeon shook his head and asked for fluids to be given and an epi push to handed to him.  I quickly settled into a chaotic camaraderie with the other nurses.  We pushed meds, flooded his body with fluid and blood and… made zero headway.  We worked with the surgeon, ICU doctor, and cardiologist as they scratched their heads while we drew labs, ran ABGs, titrated drips, and did everything short of compressions. Two hours rushed by in the seconds it felt like we spent at the bedside.  After 3 liters of fluid, 4 pressors, 3 units of blood, 3 amps of bicarb, 1 amp of calcium, 2 amps of epi….his pressure hit 90.  

The doctors shook their heads and rushed out of the unit exchanging high fives and acting as though the “stability” would last.

I glanced at the other nurses and laughed as the last of the white coats fled the scene.

"Goodness…they sure ran fast.  I hope they know he isn’t stable at all."

The charge nurse grinned and the primary nurse shook his head with a smile.  We lingered at the bedside to ensure we had done what we could.  The primary nurse was wide-eyed and nervous as we discussed different drips.  He was supposed to hang fentanyl to help with sedation.  I glanced at it and cringed… 

"That is going to make his pressure drop again… I would keep the dose low if you can…"

The charge nurse turned and looked at me with an appraising look. 

"You are really good.  It was like having one of us in here…"

The other nurse nodded and asked.

"You going to stay with us permanently?"  

I laughed and shook my head as they both looked at me expectantly.

"Thank you… I am glad I was able to help.. I don’t know what I am going to do…I am just a traveler…" I said averting my eyes.

The charge nurse shook her head.

"No.  You aren’t ‘just a traveler’.  We have had those… you are different,"

I blushed as I said thank you.

Relief flooded my body at their kind words. As I surveyed the destroyed room I realized… It was one of the few times that I had felt at ease in a month.  Discarded gloves littered the floor, syringes lay in disarray, empty medication vials cluttered the shelves and the trash cans overflowed with the relics of a disaster. The hiss of the ventilator and the beep of the monitor were soothing in a bizarre way.  

I had been feeling homesick but, I realized that the ICU is my home.

 No matter what state, what hospital or what occasion

Dream A little Dream

The screen lit up the dark room.  My only connection to the life I had left behind.  

"He got his heart"  the words said.  Simple.  No drama.  Yet- the impact resonated.

I jumped off my couch and threw my fist in the air.

I had been gone a week.  I had hugged him as I left the unit and told him confidently. 

"I can’t wait to hear about you getting your heart. I’ll do a victory dance in Texas for you."

He had laughed at me and wished me well.  

After months of waiting he had gotten the heart he so desperately needed. Goosebumps covered my arms as I recalled the dream I had the night before.  I never dream about patients, and yet I had dreamt of him. I had woken up with him on my mind.  It was mere hours later that the text had informed me that he had gotten his heart.

The reports trickled in over the next week…he was extubated…he was out of bed… he was eating well… he was walking the halls.

And then I heard the best report yet. 

He was being discharged…to home.  The home he hadn’t stepped foot into in almost 4 months… Home.

 As a nurse, it was the best going away gift I could have ever gotten.

New- Old

Afraid to lose control
And caught up in this world
I’ve wasted time, I’ve wasted breath
I think I’ve thought myself to death

- Kongos

The shuttle bumped across the gravel, my bag shifting in my lap.  I tightened my arm around it so it wouldn’t hit the lady sitting beside me.  I willed my grip on my phone to relax and my face to erase the feeling of panic.  I stared at the dark buildings we approached, the headlights cutting through the humid morning air. 

The herd of navy blue flowed into the building and I walked in unison, blending with the crowd.  I exited the elevator, my feet carrying me into the new portion of my life. I walked with all the confidence I could muster into the room where the nurses were gathered.  

The day quickly spiraled, report was fast and the charting archaic. I struggled.  For the first time in 3 years, I struggled.  I felt helpless and lost.  I went from being confident and prepared to confused and unsure.  I left that night with a knot in my stomach. I hadn’t felt so terrified in years.  I took a deep breath and curled up in my bed.  My head was filled with things I should have known, done, initiated but had been so bogged down in figuring out the charting that I hadn’t seen it.  I hated myself for it.

Day 2 was better but I was still feeling lost.  

I finally shook myself. I had to give myself a break-  I was in a new state, a new city, new apartment, new hospital, new unit, new charting system…with only 2 days orientation.  I realized then and there what is worse than being a new nurse.

It’s being a new-old nurse that has to backtrack and unlearn and relearn everything you thought you knew.  

That

"Can I bribe you into writing orders with some cake?" I joked with the cardiologist as he wandered through the unit.  He laughed and proceeded to chat for awhile as we swapped stories of triumphs and failures. 

That is what I’ll miss.

The sunshine blinded our eyes as we walked outside.  He had been in our unit for a few months and the walks outside were his only break from the four walls of his room.  He was feeling sad, not smiling or joking like usual, after the doctors talked to him about limited options regarding his heart.  I talked and chatted to him about life and my new boyfriend until I was able to sneak a smile out of him.  Pretty soon we were laughing and joking like we always do.  He is a bright spot in my day- the 1A’s always are. 

That is what I’ll miss.

The hallway’s bright light and poorly buffed floors contrasted as I helped guide the patient’s bed to CT.  The entourage of wires and tubes spilling out into everyone’s personal space took effort and considerable time to control.  I smiled and waved as people I recognized passed.  A few doctors grinned and jokingly said, “You lost?  Far from home aren’t you.”  I smiled back and nodded. 

That is what I’ll miss.

"Code Blue 5th floor" The eerily calm operator stated overhead.  I jumped up and speed walked upstairs to respond.  The PA handed me a contact gown as I strode into the room, my eyes taking in the scene.  I talked to the nurse briefly, jumped into the code and  helped stabilize the patient.  I joked with the doctors and a few unshaken nurses afterwards as we pushed the bed down to the ICU.

That is what I’ll miss.

The grouping of navy huddled around the charge desk.  We all giggled and whispered as we exchanged horror stories of the previous shifts.”Remember 8204?”  Someone said and I laughed and told the story.  A new nurse smiled without knowing and had a look of bafflement as we talked of patients in the past and that have passed.  

That is what I’ll miss.

The familiarity.  The camaraderie. The expectations.  The comfort.

The feeling of knowing and being known.  The feeling of belonging and readiness. The feeling of respect and openness.  The history, the moments, the memories.

THAT….is what I’ll miss.

That last connection

And I will swallow my pride
You’re the one that I love
And I’m saying goodbye

~ A Great Big World

The tears were threatening.

I have heard that phrase so many times but it took my job to help me understand it.  

He walked in with such courage, his pace steady.  He started out so strong and then faltered.  His hands.  The  strong hands that once grasped her hands, shook as he set the donuts on the table.  He smiled.  A ghost of the one he would flash at her. 

He cleared his voice and shakily said, “These are for you all…”  His hand absently patting the box.

There was a pause.  A long one.  We all stood there numbly.  I wanted so much to tell him how much she had meant and how much we had all loved her… I knew it would mean nothing to him right then.  I stayed silent and hugged him.  

His blue eyes sparkled.  Not with the jokes and mischievous looks that he used to share with her, but with the tears threatening to fall. 

He cleared his throat again and nodded, whisking the tears away with a calloused finger.  With a nod of his head and a small farewell wave, he walked away. 

My heart ached for him as I watched his retreating form leave.  His shoulders hunched with raw emotion.  His beloved wife had died with us mere days ago and he had come back to thank us personally.  She had been a patient off and on with us so long that he had come back partially, I believe, because he didn’t know where else to go.

He wanted that familiarity, that last connection.  

I couldn’t say goodbye

The wind outside the window swirled violently.  The storm we were promised was way less dramatic than we had thought but still whipped the trees into a frenzy.

It was eerily quiet in your room. A stark contrast to the day outside. People whispered and furtively glanced at you to ensure you stayed asleep.  They congregated in the hall and lingered by your door.  They all gathered for one reason.  Their eyes watery, their words tinged with a forced brightness. 

One by one they sidled off after whispering the words they came to say. 

"I love you.  Goodbye"

You were aware but unaware.  We had you comfortable but teetering on incoherent.  You saw hallucinations in the corner and on ceiling thanks to the concoction of anti-emetics and pain medicine. 

I got texts from co-workers throughout the day asking if you were ok and how you felt.  I replied generally.

I didn’t want to admit that I couldn’t go in your room.  I could barely look your husband in the eye.  I couldn’t help but swallow tears when I went to your room and helped reposition you.  I had refused to take care of you.  I couldn’t watch you die.  

I watch many people die.  I watch death happen over and over.  

But, with you… I was watching a friend suffer. You had been around when I first started in that unit.  You were someone I talked about music to and showed pictures of my art work.  We joked about doctors and you laughed at my impersonations of their antics.  Your husband brought us chocolates and taught me the right way to cook a soft shell crab.  You are a frequent flyer, a known entity.  We love you.  You are always smiling and upbeat.  You know us on sight and are always interested in our lives. You see us as humans.

You told your husband, when given the chance to transfer, that you wanted to stay with us.  You loved us, too.  

Today I left my unit and couldn’t say good bye.  I couldn’t see you like that.  I couldn’t see the pain and hurt.  I want to remember you smiling at me and waving hello.  I want to remember the time you told me that you liked Pit Bull as a singer and thought Snoop Dogg was “neat”.  I want to remember that beautiful human that we all loved so dearly.  

I walked away and know I’ll never see you again. I am crushed and devastated.  

But, your memory, your sweet spirit will always be present. And that, is how I’ll make it through another shift.