How am I Supposed to Feel?

Our Father, who art in heaven, hallowed by Thy name. Thy kingdom come, Thy will be done, on earth as it is in heaven. Give us this day our daily bread...

This was the prayer my coworker whispered into my ear as she embraced me in my tears. I thought I had it together. I thought it didn't bother me. I thought I could just swallow it and move on. As I exited the room after time of death was called, all I could hear was the loud sobs of the family members present. I thought that patient wasn't supposed to die...the tears began to fall and I was overcome by the emotion I thought for sure I wasn't burying deep inside. 

I felt emotionally numb. There was nothing more than could have been done, yet I wanted nothing more than to see that patient breathe or cry out. The team was excellent, the interventions on point, and yet we still couldn't change the outcome. We still couldn't mend the grief of the family. What more can you do than be present, and ask if they need anything, or say, I'm so sorry...? 

After some chocolate, a long run and bike ride, venting to my best friend, and some writing, I developed some perspective on the event. I know some days will hurt and I know my job is emotionally, physically, and spiritually challenging. I know there are days when I'll feel like I want to cry and days I can't save people. There will be days I fail, and days I exceed expectations. Every day is different. I wake up and come to work every day because I have the privilege to be the hands and feet of Christ and touch people in a way many cannot. I have the ability to help save someone's life. I have the ability to educate those in the community about how to care for themselves. I have the ability to intervene, assess, and make a difference. 

In the ER we fight over the big cases, we live for the traumas and the high acuity patients, and we rejoice when we help them pull through and stabilize to continue their care as an inpatient...and then we are struck hard by the ones that don't make it. Those cases we try not to think about because they hit home and rock us to the core. Those cases humble us, are difficult to process, and leave us asking how am I supposed to feel? I have come to the conclusion that no matter what I do feel, it is important to feel it. Am I allowed to smile and move on? It is disrespectful to not mourn the loss I just witnessed? 

The charge nurse commended the teamwork and commented on how lucky the family was to have me as their nurse. I shook my head thinking, I don't know how to help them. I feel like I didn't do much for them. She smiled back reassuringly and said but they know that you did your very best and their family member had the absolute best care.

I honor that patient by feeling whatever feelings are aroused within me. I honor that patient by leaving everything I have in that room and knowing I gave my whole heart and soul. I honor that patient by saying a prayer for them and their family and processing the event the night after it happened. I honor that patient by putting my scrubs back on the next day, showing up with a smile, and once again giving 100% to every patient that walks through my ER doors. 

To my patient, 

I pray for you and I pray for those you left behind. I pray for all involved in your care and I pray your presence lives on in my heart as a reminder to always give my best. In your honor I will hold my head high, smile, and I will remember you. I pray that God is holding you tight tonight in a place better than the imagination can fathom. Thank you for letting me care for you today. 

Practice What You Preach

When you teach something it helps reinforce it in your brain. I tell my students this all the time:

Dictate your care to process what you're doing.
Talk about medications and side effects as you give them to educate your patient and help reinforce medication knowledge for yourself.
Sit down and discuss a patient's diagnosis with them. Print off guides and learn together about how they can better understand concepts and take control of their own care.

If you've never tried it, try it! I find when I study something and break it down to teach, I know the concepts 50% better than before, and I tend to retain that information.

Practice what you preach.

In educating about nursing practice and how to be a nurse I like to help students look beyond the diagnosis and at the whole person. Not the patient, but the person. This involves what my Jesuit schooling would define as cura personalis, or, care for the whole person: mind body and soul.

I was reflecting this week on how much I enforce quality time and connection with patients- Really getting to know them and understand something about who they are and where they come from. 5 minutes sitting and listening is all it takes. In addition, ask the patient what one thing you could realistically accomplish to make their day better and so they feel their needs were met. Integrating this in to a plan of care can be difficult with a large patient load, but intentionality and true care and compassion are recognized by a patient.

I love to see this put into action and was amazed by the kindness and creative ways each student helped their patients feel acknowledged and cared for. It's the little things. It's prune juice with butter, it's lotion to the feet, a shower, teeth brushed, a visit from the therapy dog, a warm dry shampoo cap...
What's beautiful, in addition to seeing and hearing appreciation and joy from these patients, is hearing how their joy invigorates these students and encourages them to make intentional care a core part of their practice. They acknowledge nursing is not tasks to be completed, but entering in to a person's health  journey and inspiring their healing through individualized care.

After days of enforcing intentional time and self care I found myself tired and working on my normal shift in the ER.

It's the little things...my lesson came ringing through my ears. This is something I strive to incorporate always in my practice, but I made it a goal to practice this more intentionally this day. I made it a goal to pay close attention to the little things. A chocolate chip cookie for the sweet patient waiting for a ride, warm blankets and water for family members. Extra timely and thorough updates while talking to patients. Finding one thing in common with them to recognize their humanity- (person, not just patient). These little things felt good, but even more they made the patients and their families extra responsive and grateful, which in turn made my day enjoyable with smiles all around. It reminded me why I love what I do.

Even the little things need reminders from day to day or they get lost in the hustle and bustle.

Practicing is an art and skills are lost when they are not practiced. As an educator I strive to continually learn so as to be a better resource to my students, but it is often the students themselves who teach me in addition to reminding me why I do what I do.

Not My Place to Judge

Working in the ER one encounters many types of people. Young, old, middle-aged, kids, black, white, male, female, Asian, Caucasian, Hispanic, Vietnamese...and the list goes on. Then you encounter all kinds of chief complaints: belly pain, sore throat, back pain, chest pain, headache, weakness, fatigue, nausea, vomiting, lacerations, broken bones, etc...again the list goes on. One encounters different attitudes in people: kind, angry, calm, anxious, expectant, worried, scared, mean, delusional, egotistic, respectful, rude, polite, etc...

All these and many more combined to bring in every type of patient imaginable from every type of background you could picture. There's no rhyme or reason to what bring any person in on any given day, but as a nurse I expect diversity. I expect to care for different types of people who come from different walks of life. This doesn't bother me. Rather, it is exciting to learn about different people and it is a challenge to meet each person where they are, help them understand their course of treatment, gain their trust, and assist in their healing. 

Who they are and where they come from doesn't really matter. What matters is caring for them to the best of my ability and knowing enough about where they come from to care for them with cultural competence and respect.

Then there are the patients who comes from jail, who caused the accident, who drank too much before getting behind the wheel, and who comes with a story. A story that is relevant to the mechanism of injury, a story that explains why police are there holding a ticket, a story that sometimes makes the providers shutter and judge. 

I had a patient with a story. This story was similar to many I had heard before and I didn't think twice about it. Injuries were significant and I diligently managed pain, comforted, and reassured. Police showed up hours later with a different story. A story that painted a new picture of the patient, a story that better explained the injuries as well as how the decision impacted others. 

My heart broke.  It didn't change my care for this patient, but boy was it a struggle in my brain not to judge. And it is so very easy to judge when in my line of work we see the impact of decisions every day. 

How would this had played out if I never knew that story? Probably in my mind a complicated case I had the privilege of being a part of...and what was it now? In that moment I judged and I struggled with the facts of the event. And now reflecting on it...

Still a complicated case, and still one I feel privileged to be a part of. Why? Because I had the opportunity to treat this patient the same as I would treat any other patient. I had the opportunity to show compassion and grace in a time where it would have been easy to tell that patient to deal with the consequences. We all make mistakes in life. Some that affect the lives of others and some that stay hidden behind the doors of our homes. At the end of the day is there a difference? We all struggle with different things, but not all those result in physical damage. 

If I made a mistake that landed me in the ER with a story, I hope I would receive compassion and the benefit of the doubt. Maybe I would deserve it, maybe I wouldn't...but whose place is it to judge?

Not mine, I remind myself each day, not mine. 
 

What is Your Expertise?

I take my car to the mechanic when it's not working because that is their specialty. I have full confidence in the shop to change and rotate my tires and diagnose the reason my blue tooth won't connect or why my heater doesn't want to blow heat when it's less than 20 degrees outside. While I could open up a book about cars,  my car's make and model specifically, and follow the YouTube video about how to check out the engine and heating systems, I choose to go to an expert. Why not put trust in someone who works with cars day in and day out? Lazy? I prefer to think of it as a wise use of resources. I could learn to change my own oil, but when it comes to the engine function I'm leaving that to the people who know what they are doing.

I often forget that is how the world sees us as healthcare providers. Doctor or nurse, I hear frequently:

But you've seen this before? 
And you know it works?
And your confident he/she will be ok?
Did others make the same decision? Are we making the right decision? 
What would you do if you were us?

I encountered two different families last week asking these very questions. They were asking about quality of life for their loved one and if they were making the right decision. I humbly listened to each group feeling honored that they asked for my professional opinion and advice while I felt somewhat naive to the emotional weight of such decisions, seeing as these people were old enough to be my parents! And yet, young or not, they trusted my expertise as a nurse, and as a person who understood the circumstances and cared.

Knowledge is a privilege and one that should not be taken lightly. I am blessed to be in such a position each day at work, and moments like this remind me to use the gifts and experience I have. I cannot tell someone what they should do, but I can offer pros and cons to each side and help them understand the options and fill in the knowledge gaps to make the picture a little clearer.

Sometimes we forget that others look to us for advice on the things we're used to seeing and doing every day. Embrace your gifts and talents in what you do, no matter what that may be. It takes all kinds to make this world go round, and if we all knew the same things it wouldn't get us much of anywhere.

Recognize your daily value and share it with the world.

Quality/Quantity

Living his life without a care in the world and out for a ride on his bike. One minute the breeze blowing through his hair and the next thing he knows there's a car, he's on the ground, and he can no longer feel his legs.


He has been playing his instrument since he was a little boy, this talent marking his career path. He lives for the rhythms and sounds he plays from church to church. Then, in an instant, the physical ability is gone. He cannot move his left arm and is left to listen to the sounds of the music he once played.


Nothing makes you appreciate the little things in life more than losing them for a period of time. You cut your finger and forget how much you actually use that finger in your day to day activities. You have knee surgery and forget what a blessing it is to be able to run around for a 12 hour shift until it hurts to walk 20 feet.


Every day at work I encounter people with a significant diagnosis that changed their life forever, and I am reminded to count my blessings. While my functionality is crucial in my line of work, I wonder what would happen if I lost the ability to work? Does my work define me, or am I defined simply by who I am?


I encountered two souls whose lives were altered by life circumstance out of their control. One struck me with his kindness, openness, humbleness, and strength. It wasn't about what he couldn't do or feel, but about what he could still do. It was about the love and commitment he shared with his wife. It was about the life he still had left to live as opposed to the function he had lost. The glass was half full and he was delightful to be around.

How did this man see himself? While I know little of the path that led to our encounter that day, I do know there was a peace and contentment that radiated from him and a comfort he had about himself. This man did not measure the value of his life by what he was able to do, but by who he could be. How beautiful. Isn't that how it should be? What if we stopped focusing our societal value on what we can do, earn, and cost, and valued people for being their authentic selves?

This man made me stop and think. If I lost the ability to move my legs I could not function as a nurse in the capacity I do now. This thought devastates me, but while my work is a part of who I am, does it define who I am? Or am I defined by how I carry out this work from day to day? Am I defined by how I treat others and the intention and meaning behind my words and actions? I hope it is the latter. 

Life is about the quality of how you live it, not the quantity of things you do, and every day is a gift and an opportunity to live to the fullest.

Live intentionally.

From the Penalty Box

The last three weeks I have been in recovery from my meniscus surgery with orders for limited mobility and movement. Luckily I have been able to work in the front of the ER triaging patients as they walk through the door. I register them and assess their condition and then appropriately place them in a room behind the swinging doors to the ER. 

I love to be constantly on the move at all times, and recovering from knee surgery is anything BUT running around. Confined to my chair in the front of the ER with minimal walking has helped me heal, and is fondly referred to as my "penalty box", as it separates me from full patient care and "playing" with my coworkers.

While not the most exciting part of the ER, I have been able to draw great insight from the last weeks up front and had a little time to take a "time-out" and reflect. I recognize that every day presents an opportunity for growth. Being new to this role in the department it was an opportunity to really learn my strengths and weaknesses, reassess, and try again the next day. There was something to take away each day even if it wasn't taking the most critical patient in the department. 

The second was the value of a first impression. 

When you walk into the doors of the ER you typically don't feel well. You're scared, you're nauseous, your head hurts...etc. You pass through the metal detector and have to be cleared by security to then approach the nurse's desk for assessment and admittance to a room. This can be a scary passage for the patient, and at times an overwhelming position for the nurse when there are no beds available and the waiting room is filling up with multiple patients waiting to be checked in. 

I am the first healthcare provider you meet. You are uneasy and uncomfortable and the least I can do is give you a smile and assurance that I see you, I care, and I am going to help you. It doesn't do you any good if I appear annoyed, angry, or frustrated, or if I don't treat you with respect and kindness. While it can be a high tension position with lots of emotions in the waiting room, it helps you if I remain calm and listen to your concerns. 

Perspective is everything. 

From the eyes of the nurse I want to make sure no one needs immediate life-saving intervention; however, if I had my loved one in the waiting room, I too would be anxious to have them seen first and ensure the nurse didn't forget I was sitting there. Fear not, I see you, but only have so much control over the accessibility of beds and higher acuity patients are seen first. 

You sometimes yell, you sometimes lash out, you can be rude, you may have left the emesis bag behind, you may pace angrily, you may even choose to leave, but I promise I will be kind to you. I promise not to yell at you, I promise to give you a fresh emesis bag, I promise to respect you, and I promise to listen. I will watch you and assess you and intervene when necessary. I will advocate for you and I will get you a room as soon as possible. I will smile and I will remember that no one ever really wants to come to the ER. 

In the front or in the back I promise to remember the last three weeks. I will smile, and make it a point to make sure you are informed, aware, heard, and cared for.

I promise to treat you like I would want to be treated if I walked through those doors. 

In Your Shoes

I am the nurse, you are the patient. That is normal, that is how it is supposed to be every day I walk in to work. This normalcy can sometimes numb me to what it feels like to be on the other side. To feel tied down, needy, a little scared, and out of control. 

This week you were the nurse and I was the patient. First you asked me to exchange my comfortable sweats for a gown, complete with non-skid socks and a fall risk bracelet. I felt vulnerable and uncomfortable. I was a little snippy and recoiled immediately, realizing it was my vulnerability speaking and you were being nothing but nice to me.

Then you had to start an IV and it took three times. This was my fault for being dehydrated and having been NPO since the night before, but I wished you had just poked first at the vein I showed you. I smiled because I've been there and a nurse hates not being able to successfully get that first stick. I felt the vein blow and realized how much it actually hurts. 

You, the doctor, and the anesthesiologist approached me separately and confirmed that I understood the procedure and that all my questions were answered. This was nice. I felt as comfortable as a pre-op patient could and safe knowing my identity and surgery site had been confirmed multiple times. You knew I was cold and automatically draped with with a warm blanket. That also helped me feel better.

We wheeled into the frigid OR and I again felt uncomfortable as the nasal cannula was placed in my nose. The smell and taste of the oxygen made me queasy. I began to talk to the anesthesiologist and begged him not to over-sedate me. How much propofol are you using? I'm really trying not to be an obnoxious patient...they all laughed. All of a sudden the room became blurred and began to spin. 

What did you just give me???!!!

 That was some Fentanyl, he responded. I didn't want that! I hate you I moaned. I had never felt so dizzy. I also was miffed that he had administered the drug without warning me first. At least he had the courtesy to give me Zofran first. Again, feeling vulnerable and completely out of control. Then I was asleep. 

I look back and I think of you, the patient. I forget how scary and vulnerable it can feel to be tin your shoes. I forget to listen when you tell me which vein always works when you come in. I forget to bring you that warm blanket I promised you 20 minutes ago. Do I always explain all medications thoroughly enough before administration? Do I give you the benefit of the doubt when you lash out because you are afraid and don't know how else to respond? 

This week I was put in your shoes and I will take these lessons with me and remember next time what it's like to be you.