The Little Things...

I crawled in to bed one morning after a long string of nights and hugged my husband. "You're not allowed to die" I often tell him when I come home from working in the ER, and he always gives me this strange look and says "I'm not going to die, stop saying things like that". But those life-changing scenarios and stories are what I witness all night long. What makes my life not in the percentage of spouses who have a heart attack or get in to a tragic accident while coming home from work? 

In one night there was a woman who frantically called 911 after realizing her husband was having a stroke with severe deficits in the middle of the night. Another woman got the call that her husband was flown to another state in critical condition after a terrible accident, and a third woman writhed in pain in the hospital bed while her husband paced the ER trying to figure out how he could take away her pain, too tired and nervous to head back to their new assisted living home alone. All three heartbreaking, and people just like you or me.

This particular night I was trying to be mindful of the fact that the ER is not people's place of choice at 0200 on any given early morning, which is easy to forget when you feel like you live there working nights. I communicated with the wife en route to her husband who had endured serious trauma. I was the first person she spoke to, the one to tell her he was still alive but critical, the one voice she heard between home and the hospital. As I gave her the facts my heart broke for her in her state of shock, simply wanting to know the extent of injury and what she was walking in to...I couldn't imagine being on the other end of that phone line, and it struck me that I was in a position to calm her immediate fear, that her husband was not dead, yet still had to deliver that he was critical. Not your average job duty...

Rounding around later that evening I encountered the flustered husband of the woman who had fallen and sustained a severe break. He came out to ask for pain medication three times in three minutes as the team worked to help make his wife comfortable. He paced the halls, appearing anxious as she was wheeled to and from radiology for multiple scans. Recognizing his frustration I brought him some coffee and went and sat with him to give him some company. His poor wife was shaking with anxiety and pain as the nurse pushed the IV medication. She looked miserable, as did he with no control and no way to help ease her pain.

This man and I chatted for some time. He explained how he couldn't get a hold of his children and they had just moved in to a new facility where he did not feel comfortable heading back alone. It was late, he was tired, frustrated, and completely out of control. I offered to look up his son's phone number and helped him leave some messages. It was no surprise there was no answer at the early hours of the morning that it was, and I assured him they would call back when they woke up for work in a few short hours. I saw a cup of coffee, some phone numbers, and a simple conversation turn his demeanor. This sweet man just needed someone to talk to, to acknowledge his fears, and to know his wife was going to be okay. 

This gave a whole new meaning to my leadership rounding question of "What has staff done to make you feel cared for as a person?" It's not a matter of asking someone if they need something, but looking them in the eye, caring, and your actions asking "Are you okay? I care about you and want to know if you need anything." I was drawn to put myself in this man's shoes thinking how I would feel on the other side, and he reminded me the importance of taking time to truly listen and be present and intentional in my words and actions. Sometimes it's the little things like looking up a phone number or a cup of coffee that can help someone regain control and feel human again. It's a privilege to have the time to sit and listen, and I will remember that gentleman, and remember to make the most of the time when I have it,  knowing it can make all the difference.

A Spirit of Compassion

If you ask my friends to describe me they would not use words like "less than pleasant", "sour", a "drill sergeant", "mean", or an expletive of choice. Amazing how in twelve hours at work I can be called all of these on any given day by patients. The verbal abuse that takes place from patients towards nurses on a daily basis is incredible and unacceptable. When you walk in to an ER you are asking providers to take care of an emergent medical condition and assist in your healing. The providers and nurses don't go in to healthcare to make people miserable, rather to make a difference and help others on a day to day basis. It is rewarding to soothe one's pain, hold his or her hand, and be present in difficult times of life. No one comes to work looking to pick a fight or make someone's life miserable.

Today I left feeling a little defeated for no good reason. I enjoy my  role in leadership, and one of my jobs in this role is to deescalate difficult patients and enforce boundaries that are made to keep staff safe and keep the department running. It's hard to enter an argument seeing in the patient's eyes you will not win, and they will do everything in their power to emotionally break you in the process. Reasonable people can be reasoned with and a compromise can typically be reached. Mentally unwell patients do not have this ability. It's like trying to reason with a drunk person...you can't. There is no capacity for reason. Therefore, no matter how hard I tried, I managed to anger two patients in one shift. One wanted to sleep all morning and was refusing to leave while the other prolonged a workup from 30 minutes to four hours by falling asleep, demanding a hot meal, and refusing to provide a urine sample in hopes of spending the night. The first was in tears and told me I was rude and inconsiderate for making her leave after she had been cleared and discharged thirty minutes prior. She avoided eye contact, teared up, and passive-aggressively fired back comments about how she didn't feel cared for. I knew she would not be satisfied even though I tried for 15 minutes to re-explain her situation, medications, and how there was nothing more the ER could do for her at that time. I'm sure she felt alone and just wanted to feel secure in one aspect of her life. She accused me of being mean and basically heartless. I wished there was something more that could have been done to ease her mind and her pain, but there was no medical reason to keep her in the ER and she had all the tools she needed to be comfortable at home.

The other patient was flat out mean. He was prolonging his stay on purpose, manipulating staff to see how much food he could gather, and then yelled and threatened when he realized he was not able to board in the ER overnight. I went in to set boundaries and lay out a time frame for discharge to stop his abuse of the system and of staff. Recognizing this, the patient became even more upset. He yelled, tried to leave, and then was finally escorted out by security for his aggression towards staff, but not before he chose to leave the urine sample, which he swore he couldn't give, all over his room floor.

I asked for a coworker to walk to my car with me that evening actually fearful of what he might do if I ran in to him on my way to my car. I should not be afraid after work, nor should I feel defeated. I knew there was nothing I could have done different to make those patients happy, but it made me sad that they felt the need to take out their aggression on people who were simply trying to help. I wish I could let every homeless person sleep and have shelter each day, but this is not an appropriate use of the ER, and without boundaries we would have no rooms for the critical patients we need to treat.

I can't imagine what it's like to feel like your mind is overwhelmed by something else. I can't imagine what it's like to not know where you're going to sleep each night. My heart hurts for these people, but that doesn't give them the right to take out their anger on me. It is exhausting to be verbally shot down throughout the day and to encounter someone who refuses to acknowledge that you genuinely care. This is balanced by those who are appreciative and those who recognize that you are doing your best to help them feel better, but some days those tough cases overwhelm the compassion you are trying to give.  

So I go home, breathe, and wake up with tomorrow as a new day. I will remember that these people are not in a place to be kind. They don't have the capacity to see beyond themselves. This doesn't make it right, but it is the reality of broken people and a broken mental health system. I challenge myself each day to find the good in these people, to grant them every compassion possible, and to walk away knowing I will not win every battle, but in the process will be kind. There is no patient that should walk away with the victory of breaking my spirit of compassion.

Resolving to Care

I started off my New Year at work determined to start new habits. The glorious New Year's resolution plan. I even made a poster to encourage the thought process of self care as a goal for a resolution. What did I do today? Naturally didn't follow through with the promises I had made to myself, and they were little things like to put something in my mouth as a snack at least every three hours and fill up/drink my water bottle just as often. Self care is a hard concept to grasp and be okay with in a profession that specializes in putting others first. In my current state it carries much more weight when I realize I am not just caring for myself, but also the little human I am growing inside me. Then it feels selfish to not practice good habits. 

But why does it take having a baby to influence how I care for myself? I should be prioritizing basic human needs like food and water and bathroom breaks on the regular, and as nurses I think these little things are the first to give when we are focused on caring for everything our patient's need all day long. I'm not talking about long breaks, just simply the respect to myself to prioritize those needs as I prioritize everything else in a shift. 

"You can't care for others well until you have taken time to care for yourself". There is so much truth to the wise words of my mother. As long as no one is actively dying, taking 5 minutes to eat a snack to avoid being hangry is in my best interest in addition to the interest of those around me. Even such small acts of self care take practice. It's not something one can be good at unless you practice it regularly. It's like working out. You don't stay in good shape unless you keep up with your weekly regiment...and we all know the crazy crowds at the gym die down by the end of January when the New Year's pledge of consistent workouts tends to wear off...

So how do I resolve to care for myself? This year I resolve to listen to my body, to acknowledge how I'm feeling physically and mentally and process my days and learn from them. This is packing snacks so I don't hit a "hangry"low and take it out on those around me. This is checking in with myself and acknowledging my feelings so my emotional well-being is also assessed. This is acknowledging the feelings and basic needs of those around me and encouraging my coworkers to also advocate for themselves. 

I resolve to prioritize my health as part of a daily practice that strives for resilience. I resolve to care for myself so I that I know when I have hit my limits and can then take a step back and catch fatigue and burnout before they take over. I resolve to smile and take each day one at a time. I resolve to reconnect to my purpose and remember why I nurse and remember the privilege it is to care for those around me. 

I will not be perfect, but this year I resolve to continually strive for these things. Here's to a resilient year.

In New Shoes

As nurses we see, feel, think, hear, and smell things the average person does not in his or her daily work. The crazy thing is that after a while it doesn’t phase us. Thus, why we can discuss bodily fluids at the dinner table without realizing that it may not be quite so appealing to the rest of the normal world. That being said, I think perspective of circumstances changes as life changes. Cases that made me feel one way now may be different three months from now based on life events.

Now that I am expecting a child, I see cases surrounding miscarriage, pregnant patients, and children in a whole different light. For kids I want to soak in every ounce of knowledge so I can assess my own sick child in the year to come and know when I should be concerned as a nurse verses just being a mom. Will there be a difference?

I triaged a woman with the same due date as myself and sent her back to a room to see a doctor for abdominal discomfort. Immediately I felt connected to her. Something about the solidarity between pregnant women...that understanding of discomfort, change, and vulnerability that comes in the first few months that makes your heart feel for that other woman no matter who she is or where she comes from. I didn’t reveal this commonality to her, nor did my baggy jacket, but worried simply because any new or uncomfortable symptoms in a pregnancy are scary. After she went back to a room I checked my baby app as I do daily to learn what fruit my baby was comparable to that week. A small peach. Wow, I thought. We were both carrying human life the size of a peach!

Later that shift I reached out to help a coworker with an IV and ended up in this same woman’s room, where she was indeed miscarrying. The sadness and pain in her eyes and the father’s eyes struck me. Why her? I thought. Why is that fair that her baby couldn’t make it? Why do they have to feel this pain? Why isn’t it me in her shoes? I looked down to see the beautiful baby, too young to be saved, curled up and attached to the umbilical cord, the size of a small peach.

I have seen miscarriages before and cried silently for the baby and family, but this one pulled my heart strings in a different way. I silently prayed for this baby and mom and dad and held back my tears. The first miscarriage I witnessed I cried out of pure shock and sadness for the family, trying to process the sight in front of me. This time I knew what to expect, but I was struck by the beauty of the baby, how in his developing state, he looked so perfect and human. I was confused with feelings of sadness and wonder as I realized that was what was inside of me. That is what my baby looked like.

A selfish part of me wanted to be a part of her care, to help however I could simply to feel like I could do something...because what can you do or say at a time like this? I simply could not imagine being in her shoes...and I felt vulnerable knowing her shoes were walking my same path only hours before.

I am continually grateful for what I have and where I am, particularly in a job that sees tragedy most every day. I pray for the grace to be present to others and humility to be grateful for each day I am not in the shoes of patients I treat.

A New Baseline

I stopped, took a deep breath, and thought to myself You’re being ridiculous. You can do this. It will all get done. I felt overwhelmed and quite honestly just wanted to sit down and cry, yet at the same time realized this was irrational and I was overreacting. Conversing in my head I realized I was flat out exhausted. I called for help and was granted extra hands, yet I still just wanted to throw in the towel and cry.

Yes, I work 12 hours shifts and run around on my feet all day, but usually the exhaustion hits at the end of day 3. When fatigue takes hold before day 1/3 even begins it can be a rough day. The last three months have been rough and recently took a turn for the better (thus my lack of posting). It is hard to find a positive spin to life when it takes every aspect of your being just to get out of bed in the morning. This is not me, this is not who I am. What is worse is when your coworkers notice. I looked tired, my energy was low, and faking it days on in addition to days off was flat out exhausting! Turns out I am pregnant, which explained the utter exhaustion, constant nausea, and irrational mood swings. A beautiful thing, yet really hard if you’re keeping it a secret through the first trimester and visibly not yourself. It’s hard to just “be sick” for 2 months.

In this time, I reflected a lot about what it meant to be out of my element. No, I wasn’t myself and no, I couldn’t run around the ER with my same gusto. What is more, my patients often annoyed me and I found myself thinking What happened to my compassion? Why is it so hard to fake it and not get annoyed?

Trying to come to work and fake my normal level 10 energy needed to end. It was too much. The first step was accepting this. I acknowledged that I had a new baseline. I didn’t need to skip everywhere, I could slow down my pace and still get everything done well. I hoped it would end soon, but in the meantime, took lots of deep breaths, and gave whatever my best was for that day.

Life throws us waves and we must learn to roll with the tide. As nurses we’re good at that. Flexibility is key. But we’re the ones caring and don’t do well being cared for. This was humbling as I was forced to slow down and let my coworkers help me and my husband care for me and take stress away at home. It reminded me what it is like to be the patient…So the patients who were annoying were simply annoyed because they had to be in the care of others, not because they wanted to be rude. I could at least relate to this.

It’s critical to leave personal problems at the door. My physical symptoms were still present, but my mental strength could acknowledge I was not doing well, leave “me” at the door, and move through my day one step at a time. 

Gratitude

It’s the most wonderful time of the year, right? I like to think so. The excitement, giving, and spirit of the holiday season typically fills my life with joy. There is nothing like Amy Grant’s Christmas album playing with a kitchen full of baking goods and friends and family. I think in a way I have always taken this for granted. I thoroughly enjoy holidays with my family where we spend countless hours laughing and competing in board games, treasuring the time we have together. That time is precious and I wouldn’t trade it for the world.

This week at work made me grateful for my reality. For many it’s the most stressful time of the year. Finances are tight, family problems arise, deadlines get harder, and as Thanksgiving and Christmas loom closer the stress builds. For others, it’s the loneliest time of the year. My suicidal patient this week told me I (as in the hospital system) was only making her life worse by locking her away on a holiday away from family and friends. I felt for her as this was a difficult time and the fact of the matter was that she was safer in a facility than at home. Yet she made a valid claim…aren’t we all better when we feel surrounded by those we love?

Then there was my stroke patient who was no longer capable of ambulating independently and was admitted the day before Thanksgiving. He was grumpy and I stopped myself before saying “Happy Thanksgiving” and changed my language, recognizing that this Thanksgiving for him was not going to be so happy, rather potentially life changing. He had made it very clear that he was not happy about the situation. I held his hand and wished him well.

No one comes to the ER because they think it will be a fun experience for the day. They come seeking help, and on the holidays, most often because the matter is urgent. It is always hard to see a family member in the hospital, but that weight is felt more around holidays.

I recognized yesterday that many whom I treated were in for a rough Thanksgiving with their families. One family so relieved to have help for their dad, yet sitting by his intubated side in critical condition on this Thanksgiving, and another who buried their mother the morning of only to have their father pass suddenly that very evening. As time of death was called shortly after arrival I began the process of the death paperwork and stopped. The patient was dead on arrival and we only did CPR for a few short minutes. Typically, these cases have little emotion attached simply because we know there was nothing that could be done; however, when everyone left the room I paused and reflected over this man’s case and felt a pain in my heart. This family lost not one but two people in a short span, and their joyful holiday was clouded by the sadness of loss. This man was celebrating the life of his wife just hours before…it would be a Thanksgiving without her…did he die of a broken heart? Usually this case wouldn’t strike a chord, but sadness and tribulation feels greater in this most wonderful time.

Life brings its ups and downs and it is amazing to witness and an honor to be a part of many people’s holiday experience. It is times like these you almost feel more needed than ever as a looming holiday adds more stress and sadness to a situation. I hugged a daughter before leaving last night who said “You really love your job. We need more people like you”… a small reminder of why I do what I do. I love caring for others. While holidays are tough they present a beautiful opportunity as a nurse to make a huge impact in someone’s life. It is an honor to be in a position to bring stability and peace to the chaos. For that I am grateful.

To my nurses working today, thank you for working and remember you have the ability to make an extra special difference for someone today. Happy Thanksgiving.

I'm Your Advocate

Recently I've been educating about distracted driving in the high schools to fulfill hours for my practicum course. One of the classes I was fortunate to speak in was focused on careers and future aspirations. The teacher asked me to speak a bit at the end about nursing and what it is like to be a nurse. As I started to speak I became excited. I was so proud to talk about my job that I love so much and kept coming back to the idea of being an advocate for others. I find this to be one of the most beautiful pieces of the nursing profession. 

Advocacy in nursing comes in so many different forms. On someone's worst day I have the ability to be their voice and advocate for best practice and excellent care. As an educator I have the ability to advocate for my students and support their growth and development. As a relief charge I get to advocate for my nurses in the craziness of our daily work.

When I first began to transition into a relief charge position I was curious as to if I would like not having my own load of patients. Would I miss that patient connection? Would I lose a par of that patient advocacy? Surprisingly I found quite the opposite.

Every shift as leadership we are asked to round on patients in the department. How has your care been? How have we made you feel cared for as person? I was running around trying to check tasks off my daily list when I found myself rounding on a tearful young woman. She was the daughter of a patient who had been living with her for an extended period of time. She had become his caregiver. I sat down to ask my questions starting with “how has your care been today?” This sweet woman broke in to tears as she explained the disease process that took over her father and her fear that she could no longer handle his medical needs. She voiced her internal struggle and how she swore she would never put him in a nursing home, but was realizing right now things were just too much. She wept and I had the honor of listening and allowing her to express the pent up frustration and sadness she had been harboring. I was struck by her honestly and her devotion to family. She was such a strong, kind, and selfless woman, and her father, too weak to speak much for himself, simply looked towards her and smiled. He loved her and the connection these two shared was just beautiful. As he went off for a scan I discussed options with the daughter. I applauded her dedication and the love she possessed and reminded her that she was only one person. She was only one person and her superhuman strength and love could only take her so far. I connected her with our case manager and wished her luck. By the time I walked out of the room we had spent a solid 20 minutes together.
On a busy day as a nurse there is no way I would have been able to sit for that long without being called away to another room. This was a type of patient and family interaction I had not anticipated being in leadership. This was the ability to advocate for the awesome care my nurses provide in addition to giving someone who needs it the space to talk during a life changing event. This advocacy is my favorite part of nursing. Advocating for my staff, for my patients, and for their families. While a charge shift poses different challenges and responsibilities throughout the day, it still provides fulfilling interactions that help reach and care for people in a way I didn’t anticipate. Perspective change is always valuable and this new leadership opportunity has allowed me to open my eyes and see emergency care through a different lens that ultimately broadens my perspective.