“He just fell! He just fell out of that tree!" One of the people inside the house said with concern.
I was facing away from the window chatting about something benign. I was at a friend’s family party, 90% of the guests didn’t know I was a nurse. I was perfectly OK with that, I try to not be a pushy nurse when I am around strangers. If they need me, OK. If they don’t… I leave them be and don’t mention my occupation.
Seconds after he fell, his mother had him scooped up and ran him into the house. As she burst past us, I cringed. He was sobbing, the mom looked panicked.
My friend’s dad looked at me expectantly. I set my drink down quietly, straightened my shirt and walked to the room where they were.
Her eyes were desperate and as I knelt beside her, she was already scooping him back up.
“He said his belly hurt! I’m taking him to the hospital!!” She said in a shrill voice.
I backed off. She knew her kid better than me. I hadn’t even seen him fall.
The kid’s face changed at the mention of the hospital and he stopped crying. I walked back out on to the porch as she ran back through the house.
She finally settled on the couch to regroup and see what they should do. I looked around and then sat beside her and spoke to them quietly. I wanted to reassure her and assess what was actually wrong. I was 99% sure the belly pain was from the wind being knocked out of them and he was scared. He was moving everything so a back injury was unlikely. He had two small scratches on his back from the rocks he had fallen on. He wanted to keep playing and ended up going back with the other kids before long. They decided to not take him to the hospital and we all went back to the party.
My friend laughed at me as I resumed my seat.
“Was that your calming nurse voice?” She asked grinning.
“Ha! It was! Did you hear it?” I said with a laugh.
“Yup. Nicely done.” She said.
I laughed as the conversation resumed its steady flow all around us. I hadn’t even realized that I had used that voice when talking to the mom. It was instinctive.
The same way it was instinctive for me to assess, clean and bandage my friend’s cut on her foot hours earlier. The same way it was to listen to stories about medicine or medical issues. The same way it was to diagnose people as they talked diet, exercise, and genetics. The same way it was to glance outside to assess the kid, who fell out of the tree, every couple minutes as he walked around.
It was instinctive.
It always is.
-1 Thess. 5:16
When a solider takes a bullet or lives through a battle, the medical community rightfully looks at his resulting anxiety and calls it post-traumatic stress disorder. When a nurse works on a unit with high acuity, gives herself to each and every patient, and watches those patients die, what do you call the resulting anxiety and depression that follow her throughout her job?
Only now are we…
I have compassion burnout.
"We need to bring her over now. They can do report when they get here.” the manager of the other unit said a look of taut worry on her face. We nodded and quickly got our room ready.
You could hear the moans of pain as they pushed the stretcher down the hall. As they aligned the stretcher to the bed, my stomach clenched. A tech was holding pressure on the biggest hematoma I had ever seen. I glanced at the patient and my heart ached for her.
Her eyes were clenched shut as a steady trail of tears slid down her weathered cheeks. Her lip was quivering and a continuous verbalization of how much pain she was in tripped from her mouth. She was elderly, her short curly hair was matted down and her glasses askew as she sobbed. We pulled her into our bed and I quickly applied pressure above the hematoma in an attempt to stop the blood from accumulating. The tech continued to express the hematoma as I crushed my hand into her groin. Blood coated our gloves. Her blood pressure was low and her cries of pain heart wrenching.
The cardiologist walked in and I asked for pain meds.
"Uh… her blood pressure… I just don’t feel comfortable. She got something earlier." He said brushing me off.
"Well, She doesn’t feel comfortable either. This is torture. We already have her on fluids and pressors- we can turn them up… give her something." I said firmly, staring him down.
The patient whimpered under my hand and began a mantra that no nurse ever wants to hear.
"Oh please… PLEASE… just let me die. It hurts too much. I can’t do this. Please let me die." Her voice silenced us in the room. I glanced at the other nurses.
"No Ma’am. I know this is agony. We are going to get you something for pain…and we are going to try and get you better, OK?" I said softly and looked pointedly at the doctor hovering at the doorway. He nodded assent and a nurse scurried off to get morphine.
I continued to speak softly to her. As the minutes ticked by, the vascular surgeon walked in and out, restlessly awaiting the OR teams arrival. The groin started softening up, the hematoma stopped spreading and her blood pressure started creeping up. The morphine calmed her and though she was still hurting, she felt better.
She was in no way stable but between the tech and I, we had her groin under control. I held pressure until my hand lost all feeling and it was no longer safe for me to hold pressure. I turned her over to her primary nurse. I stripped my bloody gloves off and ran my hands under water to restore feeling. Not long after I relinquished control, her bp slipped again and the hematoma started growing. I felt a profound frustration and despite my hand still tingling I helped hold pressure again on the growing hematoma. As the vascular surgeon went to put in an arterial line, our little patient started gasping and couldn’t breath. Her heart started slowing and I started bagging her as they called a code overhead. The room was soon flooded with doctors of every genre. I spoke to the patient and her eyes flickered and she nodded. I held the ambu mask over her and gave her extra oxygen by blow by. A doctor started preparing to intubate her and I tried to stop him.
"She is awake!" I told him as the patient blinked.
"What?" He said as he tried to take the ambu from me.
"She is awake…Hey… Can you hear me?" I said looking at the patient.
She blinked at me and said in a tiny little voice.
"I am alright."
I looked at the doctor and he hesitated and then shrugged.
"I am alright" She said again.
The OR team arrived and in a whirlwind of white coats, green scrubs and anxious faces she was pushed towards the door.
"Thank you… for saving me." She said weakly as they pushed her down the hall.
The cluster of navy blue clad nurses stood and watched the procession from the doorway of the now eeriely quiet room. The pause felt heavy and each gathered their thoughts until a voice broke through.
"Hey… I need some help in here." Said another nurse.
In unison we moved into the next room, into the next crisis, into the next moment.
I can’t be alone in this. I can’t be the only nurse who wonders sometimes what makes a good nurse. I can’t be the only one who wonders why you can take an excellent ICU nurse to a step-down unit and see them fall apart. I can’t be the only one who wonders why you see the panic on the face of a step-down nurse when they start on an ICU floor. I can’t be the only one who is baffled at the resiliency of med-surg nurses who deal with so many patients with such patience.
I have been contemplating a change and yet, when I do, I feel almost panicked when I think about not being in the ICU. I don’t really consider myself a great nurse, but I work hard and I am good at my job. I was thinking about why I thrive in the ICU as I drove home from work the other day. Patient after patient had gone bad that shift and I could so vividly see the deterioration as it was starting.
I realized as I thought through the day…ICU appeals to me because I am a worst-case-scenario person. I look at sick patients and imagine the absolute worst and work to avoid it. I think about the worst complications and issues that are related to the symptoms and jump to that conclusion and work my way back.
Your patient is hypotensive?
I assume a bleed.
Your patient is acutely confused?
I assume a stroke.
Your patient is short of breath?
I assume a PE.
Your patient has a hematoma from a line pull?
I assume they will visit the OR.
Your patient is ‘just not acting right’?
I assume they will code.
It’s pessimistic. It’s negative. It’s dark.
And, it has saved countless lives.
In everyday life… no one wants to be around someone like me.
People want sparkles and cheer.
I am not completely negative all the time but, it’s interesting that a part of my personality that I never really liked… is the part that makes me very good at my job.
thewinged asked: Hi! I was particularly interested in your career as a nurse and as a nursing student myself for my school project I am conducting some questionairre interviews. Would you be interested in filling one out? Thanks in advance!
Absolutely. I am sorry if this is a delayed response, it didn’t show up that I had a new message, silly tumblr.
Let me know how I can help.