Brie Gowen

Savor the Essence of Life

3 Facts From the Nurse

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I was so excited when things started to get back to normal status post quarantine, and I know you agree. While the family time was great and it was awesome to slow down and reflect on life, in all reality I was tired of an isolation world. I missed going to restaurants and letting my children go out into the neighborhood to play with their friends. I wanted the public pool reopened, and I wanted to go into a store without worrying I might contract something. I wanted store shelves to be fully stocked, and more than anything I wanted people to see my smile that the face mask hid. I was ready for a return to normal.

As a critical care nurse, I talked with my peers about a resurgence of COVID-19 before restrictions even lifted. I mean, we intelligently hypothesized it would, but I guess there was that part of me, the starry-eyed dreamer, perhaps, who hoped that Coronavirus could just disappear. Yet despite my desires, I knew it had not, and that knowledge was nailed home this week. So, consider this a Public Service Announcement, friendly reminder, or simply some advice from your friend on the frontlines of healthcare.

1. COVID-19 did not disappear. I repeat, it did not magically go away. The numbers of active cases began to fall because, logically, the population had been self isolating at home for a month or more. The powers that be wanted to prevent a spike of infection that would overwhelm the healthcare system. Remember the term “flatten the curve?” Well, they did just that. We (pat yourself on the back) did just that. We kept contamination and disease spread at a minimum while stuck at home, and in that process saw infection rate numbers drop from their April highs to a nice May low. Good job.

As numbers dropped the noise became less. The news networks found new stories to report, and COVID took the backseat. But hear me now. Just because it’s not on every single news channel, that doesn’t mean we cured it. It’s still here.

2. COVID-19 pandemic was not a hoax! Listen, I love a conspiracy theory as much as the next guy, but trust me on this one. It is sadly and tragically very real. While working on the frontlines of COVID, in a critical care COVID isolation unit, in a large, multi-ethnic, highly populated area, I saw far too much of this pandemic. My area wasn’t as bad as NYC, but in the face of this disease, it doesn’t have to be. Outcomes were not great, and I had to be intentional in self care not to crumble under the stress and depression of far too much death from this disease. I wish to God it wasn’t real, but none of us can unsee the fear on our patients’ faces or soon forget the tearful prayers over the phone with family.

I know that when things improve it’s easier to say the problem was overstated. When you desire for life to return to normal it’s easier to convince yourself it was never that bad. I mean, you can go into public without fear if you tell yourself the government and media faked statistics to exert control. When you don’t know someone personally who has suffered with Coronavirus or who has worked around it, it’s easy to ignore. You can just pretend it was never a thing to begin with, and you can get back to life per usual. Gosh, I wish I had the privilege of thinking this way.

3. COVID-19 numbers are on the rise. I’m sorry, I’m sorry, I’m sorry. I don’t want to be the bearer of bad news. I don’t want to be a joy-kill. I want to go to the mall and take my kids to amusement parks. I want everything like it was before, but that time is not right now. I don’t honestly know if things will ever be the same, and in some ways, maybe they shouldn’t be. Remember the great stuff we learned through this all? Like, washing your hands? Yes, we should still be doing that.

Three weeks ago I saw the best COVID-19 positive numbers I’ve seen since this started. It was awesome!! The unit was almost empty, and it seemed a welcoming sight compared to the previous couple of months.

Two weeks ago I barely noticed that the numbers had doubled I think a part of my brain acknowledged the fact, but that hopeful gal inside tried to push it away.

This week the numbers doubled again. This week staffing is tight to care for these people, and the rooms are filling back up. When I saw the number of positive cases I knew this was it. This was the predicted spike/return/resurgence of cases after restrictions were lifted. Y’all, I’m not gonna lie; it kinda scared me.

Here’s the thing. We can beat this. We can be smart. We can do the things we know we need to do. Do you remember how soap, Lysol, Clorox, and hand sanitizer flew off the shelves in April? Well, that makes me wonder, were folks not being sanitary prior to this pandemic?

It’s ok. I’m not even mad. You can continue your newly found habits to keep this thing manageable. Wash your hands. Don’t stick your hands in your mouth or touch your face if you haven’t. Wear a face mask when you’re in large groups. If not to protect yourself, then to protect someone else. Clean surfaces, and maybe chill on the big group gatherings until we get a better handle on this. It’s ok to still social distance. You don’t need to be up in everybody’s grill anyway. That’s also how other (less deadly) viruses spread.

In the return of COVID I’ve seen people advised as an outpatient to self-quarantine, ignore those doctor orders and infect their whole family. And while a young person may feel just fine, an aging parent or grandparent won’t fair as well.

I’ve seen people come to the hospital to get tested (and test positive) after leaving their shift at a restaurant. SMH. If you are symptomatic, stay home! I know we all need a paycheck, but this is life and death. I’m not exaggerating. I only wish I was.

Bottom line. Although COVID-19 left the news networks, it hasn’t left the hospital bedside. It hasn’t left your neighborhood. I’m not trying to scare you, but I am trying to educate you. Be smart and practice the previous guidelines. Just because life seems like it’s returning to “normal,” that doesn’t mean we have to. We can be better than before.

Check On Your Nurse Friends. We Are Not Ok.

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I took a survey from my employer today, and as I went through the questions I was surprised by how easily I could answer one way or another. It was a survey for how the pandemic, COVID-19 was affecting us, and as I clicked each bubble I understood even more just how much things had changed. One question that stood out to me asked if I thought about work more when at home. The fact was I had always been proud of my ability to leave work at work. I am an extremely compassionate person, but after twenty years in healthcare I had learned that to keep my sanity intact, patient care needed to stay at the bedside. It would be there waiting when I returned. But today, as I pondered the question on the survey, I realized that had changed. Everything had changed.

It had really started to hit me, the weight of it all, a few nights ago. I sat in bed the night before work and I prayed. I felt so down, and the fact was I had for weeks. There was nothing wrong going on in my life. I wasn’t financially stressed. My marriage was amazing, my children healthy and adorable. I had absolutely nothing to be upset about, yet I was. The only out of place factor I could pinpoint? COVID-19.

Years ago I had come to a place in my nursing career where I absolutely loved my job. I considered patient care to be a privilege, and even on tough days I considered it a wonderful vocation. It was a calling, and I carried the task with a smile. This past week I noticed an unwelcome feeling coming over me. It was a feeling I hadn’t experienced in many years. It was dread. I was dreading the return to the critical care bedside. How could I dread something I loved so much? I cried out to God to bring back my joy for the field.

When I sat in bed praying to feel better I realized that all this was hitting me harder than I thought. I realized that even though I thought I was doing ok, I really wasn’t. Even though I thought I could handle stress well, I don’t guess I had ever experienced stress like this.

Typically, nursing is about healing. A patient comes in sick, and we make them better. That’s not COVID-19.

And yes, I had experienced lots of death and dying. It was part of the job. So it wasn’t the people dying that got me. It was the fact that most of them seemed to be dying. The ones that were in Critical Care, anyway. The prognosis of these people was horrible, and when you have to break that to a daughter who can’t talk to her mom, or even see her, it’s depressing.

I was used to elderly and debilitated patients dying, but this was different. I was seeing people my age, younger, or just a few years older, and they were not doing well at all.

Nursing had always been a career where I had to be careful with infectious disease. I frequently encountered illnesses I could pick up and take home if I didn’t use proper protection or hygiene, but this was different. It was so new, and I watched the information available change day by day. One minute it’s airborne, the next droplet. One day the CDC says one thing, the next day, something else. The suggested PPE (personal protective equipment) changed faster than I could keep up, and it became this constantly evolving situation. I sadly knew that each time I came to work things would be different than when I left.

Do I need to shower and change clothes at work? Is it in my hair? The questions I had to ask myself. Is a Level 1 mask good enough, or is a Level 3 safer? Wait, now you’re saying it’s aerosolized and I should definitely wear googles? Why didn’t anyone tell me that yesterday?

Am I bringing bad stuff home to my children? They’re so little still. The fact that our government and healthcare system was treating the response to this unlike anything I had ever encountered only added to my thoughts. I mean, your president says everyone needs to stay home. Except you. You need to run into it head on! Unless your patient’s heart stops. Then, don’t run; put on your PPE first. It was going against everything we had ever done as lifesavers!

Everyone was watching us. People whose sole job was to make sure we were protecting ourselves properly. And while I appreciated the effort, it also made you feel pretty odd. I mean, what kind of crazy crap makes hoards of upper management and administration watch your every move? What exactly were we dealing with? The answer to that seemed to change every day!

I never felt so helpless. Everything we tried seemed to be in vain. They typically weren’t getting better. One week this was the go-to drug of choice, the next week something else, and the next week the surprising news that none of it would improve outcomes. In fact, it might make it worse.

It didn’t matter that the mask or respirator hurt my face, left bruises and sores, or that it left me feeling drowsy and cloudy headed after so many hours on straight. It didn’t change the fact that I was paranoid about the seal, worried that the tiny virus could somehow get through.

The stress made me become the type of person I didn’t want to be, short tempered and easily frustrated. The high acuity of the severely critical patients forced me to become the kind of nurse I didn’t want to be, hurried, harried, just struggling to keep them alive, keep my head above the water. My shift would end and I’d be sure I had missed something, which drove me crazy, but at least they had lived through my shift. They would likely die after I left. The prognosis was always poor.

Seeing the fear in their eyes, or hearing the words, “am I going to die,” remembering those words after they were gone. Holding their hand, offering comforting, muffled words, but knowing you were no adequate substitute for their loved ones.

Speaking of loved ones. We had those too, and just this week my nine year old said sadly, “Mom, I don’t want you to go to work. I’m worried you’ll get sick.”

But then I also had loved ones who had no idea. As I was leaving work today it occurred to me that not many of my family members had called to check on me. It wasn’t their fault; they didn’t know. I had not told them the toll this pandemic was having on me, and that’s when I knew I needed to. I see Facebook posts of people who don’t even think the pandemic is real, or that it’s like the flu. They have the privilege of not knowing how hard this is hitting me and my coworkers. I don’t normally try to play a pity party or seek attention, but I realized that a lot of people just didn’t know. They didn’t know that we’re not ok.

I have spoken with my coworkers and peers, and all the ones I have questioned are feeling the same pressing weight as me. They’re tired, worn thin, worried, beyond the typical stress of saving lives on a daily basis. It’s beyond skipping lunch and bathroom breaks to keep someone from dying. That’s just a regular Thursday. This, this is different. This is harder.

I don’t know the answers, and I don’t know if things will ever be the same. I don’t know if there’s anything you can do to make it better for your nursing friends. You can pray. You can send us a message, drop off some toilet paper, or even just a long-distance hug. We need so many hugs right now, and social distancing is messing that all up. The typical outlets aren’t available to decompress, or the ways we deal with stress are not allowed. Nurses have the added weight of homeschooling, when that’s not something they are used to, or a spouse out of work. We’re dealing with all the same stress and aggravation as the rest of the population, but also the additional stress of facing this monster up close and personal.

We can’t pretend it’s not happening or busy ourselves with conspiracy theories. We’re too preoccupied with telling ourselves, “it’s not your fault. You did everything you could do.”

This is all I can write right now. There’s more, so much more, but I am exhausted after a day of the above. I need to lay down so I can wake up and do it again. See, that’s the great thing about nurses. We are not ok, but you’ll still find us when you need us. We’ll be in the clinics, ER’s, and units ready to do all we can do for those who need us. We’ll worry about us later.

COVID-19: An Inside Look

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Perhaps it’s because I’m a registered nurse working the bedside of this virus, but I feel like I’ve seen plenty of information about what it’s like for healthcare workers fighting this COVID-19 fight. I’ve seen stories about violence towards people in scrubs out there, but personally I’ve received nothing but support and encouragement. Most of my friends know about our struggles with personal protective equipment (PPE), be it the fears it will run out or the frustration with the ever-changing guidelines of safety by the CDC. People have seen the struggles nurses and others have wearing the same masks for twelves hours or more straight, and aside from them seeing the bruises and pressure sores on my face, I’ve told my family how the continuous wear causes me to feel fuzzy-headed and drowsy (not a good feeling for a critical care nurse).

We (as a healthcare team) mostly keep quiet about the inconveniences of no bathroom or water breaks. I mean, it’s just how it is. Another straw to add to the back of an already sagging camel. Yet, despite any struggles we face physically, or even the fears we attempt to overcome mentally, it’s been so helpful to have the praise and support of family and friends. I know they see me, and they try to sympathize with the war we’re waging against this tricky contagion. I guess, what I’m trying to say is, I feel like a lot of thoughts and prayers have been directed my way, but recently my heart has been breaking for the patients I serve.

If you could see inside my little world, behind smudged googles and hot breath, you would see how COVID is attacking more than our ability to go to the mall, or even beyond our inability to pay bills. You see, this pandemic is more than being forced to stay home, schooling your children, or even (sadly) being unable to gather with your church or extended family. I saw it went beyond missing my baby brother’s wedding, or not being able to find our favored toilet paper. Because beyond sinking stocks and failing businesses were people dying. Scared, alone, and confused.

If you could stand here beside me you would see the real effects of COVID-19. You’d see the frightened eyes of a patient when a crowd of strangers rush into the room, moving quickly, with a sense of urgency. You’d glimpse the fear the patient exuded over all the people surrounding them in hoods, masks, and billowing gowns. The worst part about a mask? They can’t see you smile.

If you stood in my shoes you would hold a patient’s hand with your own gloved one, attempting to offer comfort, wiping away a stray tear, patting their arm compassionately.

“You’re doing so good. It’s ok. Don’t be afraid.”

While foreign tubes are being inserted, with language barriers in place, you’d try to explain why rolling onto your belly in the hospital bed is needed to perhaps help getting a breath be less excruciating.

If you sat at my desk you’d try and calm a family member, over the phone only, since visitors aren’t allowed.

If you stood outside the glass fishbowl, like me, watching lifesaving procedures being performed in unprecedented ways, to keep staff contamination at bay, you’d feel your heart break while staff worked feverishly to sedate the anxious patient, just prior to passing down a endotracheal breathing tube. If you could read the patients frantic thoughts at that moment just prior to sweet sleep, you would be certain he wondered worriedly, “what if I never wake up?”

Because people aren’t waking up.

Y’all, I can’t understand all this. It’s not like anything we’ve ever known, and I’m sure you’re getting that Sci-Fi movie vibe too. As if we’re walking through a dream we can’t wake from, we all feel that surreal mood. It’s hard for everyone, and we all feel the sting, but we have to remember to feel more than just how this is affecting us personally. We gotta try to imagine how it’s impacting the world at large, how we’re all hurting in one way or another. Because, you see, it’s our ability to empathize with another than binds us, and if we can stand together (even as we’re physically apart), we will stand stronger when the dust settles. Eventually it will.

Thank a Nurse, Today

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We all stood in a rough circle, listening to another briefing about safety policies and fluid plans going forward. I looked around at the nodding faces of my coworkers, asking important questions as needed, or giving suggestions to improve overall outcome. No one griped, guffawed, or rolled their eyes. We listened to conversations of personal protective equipment running low, and straightforward statements that a nursing shortage was on the horizon. Stoic, we stood tall, and not one person said, “that’s it. I’m outta here!”

That’s not what nurses did. When the going got tough, we got tougher. I was reminded of my time in the military. Serving during 9/11, I was active duty when the war in Iraq first began. I watched my spouse and 90% of my coworkers leave the hospital to deploy overseas. In their absence I worked 12 hours shifts, seven days a week, for thirty days straight until reservists arrived to help. And although I held honor, courage, and commitment at my core, let’s be honest; I didn’t have a choice. I belonged to the U.S. Government, and I worked in hard conditions because, “that’s what you told me to do, Lieutenant Dan.” But seriously, I did my duty without question. Civilian Nurses, they’re a little different.

I want you to understand something very important. All the things you’re feeling, you are not alone. Feeling scared? Overwhelmed? Worried for your family? Despite the frequent assumption otherwise, nurses are indeed human, with emotions and needs. We don’t want to become sick with COVID-19 anymore than the next person, and we don’t get jazzed about possibly taking it home to our young children, elderly parents, or immune comprised spouse. We get tired when we work extra, and we need to go grocery shopping too. Today, after my twelve hour shift, I stopped and picked through the scraps left at my local grocery store.

Your bedside nurse isn’t immune to deadly viruses, but they go to work each and every shift, fearless. We utilize our training and knowledge to stand on the frontline despite the fact that we have all the concerns you may be feeling right this very moment. Any nurse could call out sick, walk away, or refuse that request to work overtime, but we don’t. We face the music, no matter how screechy the melody, and we dance a graceful waltz through uncharted waters.

I guess it sounds like I’m tooting our own horn, or uninvitedly skywriting “Nurses Rock,” but doggone it, I can’t help it. I’m proud to be a nurse, and I’m proud to stand firm alongside some amazing men and women. They come in each shift, already, with sick children at home, a chronically ill, aging parent in their thoughts, or a relationship on the rocks thanks to long hours and less weekends off. Never mind showing up with a smile when a pandemic is on the rise.

Today was a crazy day at the hospital bedside. I saw more movement than we wanted, and I saw a team pick up the reigns. I heard a stray, “I’m tired,” or as 7pm neared a weary, “I’m ready to go home,” but I never heard a real complaint. I never saw a bad attitude today, and there was more than a few things that could make a person flip. I saw what I see most, every day. I saw nurses caring for their patients with compassion and skill. I saw my peers intervening to save lives, and advocating for the people in their care. In this regard, it wasn’t much different than any other day, other than all the masks, gowns, and protective eye wear. We still washed our hands, like we always do, and we used required precautions to prevent the spread of contagious disease. Again, like we always do.

I stood on the frontline today with a team that superbly carried out their duty, and despite the odds stacked against us, carried it out well. So, while a lot of things are uncertain and ever-changing in our world right now, one thing is the same. One thing is steady despite the storm, firmly rooted despite the slipping sand. It’s your bedside nurse. They are doing what they have always done. Excellent patient care with a smile. Your local Walmart may be out of toilet paper, and your child’s school may be closed, but your hospitals are still open, with all the amazing healthcare staff present and doing what they do best. In uncertain times, you can still count on that.

So, thank a nurse today! Thank the doctors, techs, therapists, and many other frontline staff. Show your gratitude to your police officers, and all the other people who go about their work just like any other day, with just a bit more stress in the mix. Wink, wink. I’m proud to stand in the ranks with so many who help keep this world going, even when life wants to shut it down.

What to Say When You See a Nurse Sitting Down

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I think part of the problem is you’re not used to seeing it. A nurse sitting down, I mean. There’s a reason I put a step counter app on my phone. It helps me feel justified when I’m scarfing down a couple of donuts at 4pm because I’m starving from a skipped lunch. Point being, the miles I walk on any given day at the patient bedside would trump just about any exercise routine I might try to begin. Between back and forth trips to a room or quick dashes to the pharmacy, I definitely burn my fair share of calories. What I don’t do a lot of, in comparison, is sit. And even if I am sitting, I’m usually charting. Yet that’s not the moment a passerby will catch me.

If you’ve been a nurse any length of time then you know that nursing has its own cruel version of Murphy’s Law. This happenstance will mean that uttering the word “quiet” makes crazy things happen, or that saying you’re all caught up will make the stool hit the fan. It’s that peculiar nuisance that makes your face itch like crazy when you’re fully donned in PPE, or your patient’s blood pressure plummet right after you lose your one working IV. You know what else it is? It’s the fact that the moment you sit down to take a break two things will happen. Either a call light will go off, or someone who isn’t working the bedside will walk by.

Ahhhh. You see the nurse, phone in hand, leg propped up. My, they almost look like they’re on vacation. I totally get it. First thoughts might be, “wow, guess nobody works here,” or perhaps “they need something to do!” It does look that way. But I wonder what might happen if we all put ourselves in the shoes of another before making snap judgments in haste?

I think you’d find out some things you might not know about your nurse. The propped leg? Maybe that’s to rest and alleviate pain in their bad knee that aches something awful after 13 hours on their feet. I find as a middle-aged woman that my body no longer agrees with how young I desire to be, but instead reacts like someone much older, especially after lifting the weight of others for three days straight.

Did you consider the phone use is a quick text home, checking on a sick child or a parent who’s fallen? It’s easy to forget in a population that spends the majority of its time caring for others, but nurses have families with needs of their own. As your nurse is giving 100% to the sick people under their care, their hearts still cry internally for whatever is going on at home. But you know what? Even if that nurse was checking their social media, it’s the first time they’ve relaxed all day, what, with keeping that post-op patient who’s been circling the drain from buying a one way ticket to heaven.

I think we forget the emotional stress and physical strain nurses go through on any given shift. It’s easy to forget the weighty stress of keeping someone alive. We miss the fact that the bedside nurse can spend hours at one person’s side, forgoing their own needs, to alleviate whatever ails the one under their care. But those are the unseen things. Those are the hidden gems a nurse performs each shift. They just see it as part of the job, and they certainly won’t brag. You’ll never know how they made that suicidal woman feel special for the first time in her life, or how they intervened for the safety of their patient, preventing what could have been a deadly event. You won’t see those secret steps a nurse makes each day, but you will see them sitting at the desk, apparently with nothing to do.

Maybe next time we see that nurse in that brief moment of respite and much needed rest we can think something like, “good for them. They need that moment of stillness to recharge for the difficulties ahead.” Because, you see, nurses are like a vessel, pouring out so much of themselves, but as everyone knows, any container eventually runs dry. So perhaps the next time you see a nurse sitting you should just know that they’re there for a refill before the next round of serving begins.

How I Fell in Love With Nursing. Again.

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First love is easy, isn’t it? With stars in your eyes and a naive nature, you swing headfirst and heart-strong into the relationship. You have dreams for the future, the butterflies for excitement to spur you forward, and even a bit of healthy hesitancy to keep you honest. But somewhere between that first date (or shift in the case of nursing) and eventual broken expectations, you end up feeling betrayed. It’s nothing like you hoped it could be. You end up disappointed, likely broken-hearted, and sadly, if your experience was especially harsh, guarded and skeptical for any silver lining that might exist up ahead. Sound familiar?

A profession you can truly love isn’t that different from a romantic relationship. It’s something that gives your life a new purpose, a reason to hope, excitement, and the ability to get better at it as you go along. It’s the chance to think of someone other than yourself, but like any relationship, the one with your career can become strained. I’ve been in the medical field for 20 years now, and I think I’ve experienced every stage of the process. I mean, if Nursing was Dante’s Inferno, I probably transversed through every circle. Y’all, I fell out of love with it, and it took purposeful determination to make my way back into my partner’s good graces. At one point, I think I hated it. Just being brutally honest here.

That first year was something, am I right? Fear, panic, but somehow an exciting adrenaline rush, a pride that I’ve discovered you can’t let slip away. I was proud to be a nurse. I was proud of my vocation, and I was proud of the hard work it took to get me there. I was proud of that R, and of that N, and for a while no one could take that from me. But then came the bad apples. Damn, if they don’t ruin the barrel.

Somewhere between holding an elderly woman’s hand and double charting for the billionth time, my heart started to harden. Do you know the difference between a good nurse and a great nurse? I was always a good nurse. I took care of my patients, and I got the job done. I was honest (for the most part), and I did no harm (that I’m aware of). I smiled at my patients’ faces, and I even meant about 80% of what I said. This will sound so harsh to the layman, but my fellow nurses will understand. It’s not easy giving all of yourself with little to nothing in return. I mean, yeah, you get the paycheck, but that even seems paltry in the face of preventing death or giving up Christmas with your family. So, it becomes a job. A thing you do, day in and day out. I can even recall telling my husband I felt stuck. Lord, help me, I did. I could think of no other “job” where I could work 24 hours, yet get paid for forty hours, while maintaining the best benefits offered in our little city.

I ask again, do you know the difference between a good nurse and a great nurse? A good nurse gets the job done, but a great nurse loves the job they get to do. I guess I had to move from one to get to the other.

All I know is, I entered the field like a young, star-crossed lover, but about a decade into it, I wanted to breakup. I had become disillusioned, and it wasn’t what I thought it could be. Maybe I entered the career thinking I could make so many differences, but I wasn’t open to what could change in me. I became a woman focused on the obstacles before me, and blinded to any blessings scattered throughout. I wasn’t heartless, mind you; I still felt contentment when a patient told me how much my care had meant to them. But those Hallmark moments couldn’t outweigh the injustices I felt. I focused on every single hardship in my field, and I took personally each offense. I allowed the Negative Nancy’s to feed the fire of bitterness inside me, and I assumed every demanding patient canceled out the kind ones. There’s certainly that need for self-care, but I think I came to a place where it was almost always about me.

“Why is this so hard,” I asked, never contemplating for very long how it must be on the other side of the bed.

“What do they expect of me,” I would question angrily, without asking myself what I might give.

I saw my field only as a difficult endeavor, and seldom as a privilege. I carried the weight of a thousand martyrs, except I had forgotten the cause for which I gave myself. I was a good nurse, who did my job, but not a great nurse who loved the opportunity to do it. And I suppose that’s many of us. It’s not that we don’t enjoy what we do; it’s just that sometimes we hate it just as much. That sounds so terrible, when I type it out like that, but if you’ve never held a position where you don’t cry while cleaning the dead body of someone you just hugged that morning, then you may not understand. If you haven’t been punched, kicked, or called the worst of all swear words by someone you’re trying to help, then you won’t get it. If you haven’t cringed over calling someone in a position above you, knowing they will scream at you merely for doing your job, then this may seem like harsh words. If you haven’t felt the anxiety of trying to do the work of two people, while not making a mistake that could cost someone else’s life and your career, then you just won’t have a clue. It’s not easy to carry the weight of so much on tired shoulders, and for many who do, they end up angry and perhaps even resentful for a profession they once loved so much.

Back to the relationship bit, it’s as if the marriage is falling apart, and you don’t want a divorce, but you can’t look at his socks balled up on the floor another day or you might snap. I guess sometimes, when you realize you don’t love them like you used to, you have to take it back to the beginning. You have to remember the first time you saw them, that first date, or first, tender kiss. The spark is still there. You just gotta know how to stoke it.

I recall sitting in a computer class taking a critical care course, and I was digging it. Us Critical Care folks, we love all that medical stuff! Sitting there, I knew I loved the knowledge. I loved the dynamics. I loved the process. I loved the people. I loved making a difference in people’s lives. I loved nursing. I did. It was time to act like it.

Back when my husband and I were just dating, I remember we had been off again, on again, at one point. I had found out some stuff, and each of us had been idiots. We loved each other, we knew that, but we were kinda just coasting along, existing as a couple. Like, maybe involved, but not committed entirely to the future of it. Well, anyway, I remember standing in the card aisle on Valentine’s and I had found the perfect, mushy card for him, when suddenly God smacked me upside the head.

It was like, God said, “Brie, if you’re going to give that to him, you need to mean it.”

And I was like, dang, you’re right. I love him. I really do. We can work through this.

And we did. Every day since our relationship got better, and even now, each day is better than the last. I guess, I had to come to a place in my nursing career that was similar. I loved it, but I had to start acting like it. I had to do more than just show up. I had to get invested. I couldn’t focus on my husband’s faults, any more than I could deny my own. And I couldn’t selfishly fixate on what nursing took out of me. I had to start giving of myself more. I had to see through clear eyes. If you focus on a stain, that’s all you see. What you should look at is the fact that the fabric is still good. It can be washed. Nursing was still good. I think my vision of it had just become tainted.

My career truly began to change when I focused on the opportunity to provide care, the privilege of meeting people at their darkest hour, and leading them back into the light. I threw off sympathy and instead embraced empathy. I put myself in my patient’s shoes. Heck, even the administrators’ shoes. I saw my occupation as the ministry it was, my chance to care for the hurting, and to help those in need. I didn’t face the relationship with what I could gain, but what I could give. I didn’t focus on what wrong was being done to me, but rather what good I could sow into it. Y’all, I fell in love all over again, and it wasn’t because the object of my affection was perfect, but because it gave me purpose, passion, and a sense of fulfillment. Was it still hard, at times? Yes! But beyond that it was good. In fact, it was great. And then I realized, I was great too.

A Word of Advice for the New Nurse

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I was walking down the hall this morning with a new nurse, and she asked, “so, were you an IV nurse before this?”

She said it with genuine respect as I followed her down the hall to the room of her “hard stick.”

“Nah,” I replied. “I’ve just been putting em in for twenty years.”

“That’ll do it,” she replied in awe.

I wasn’t even working on that floor. It was one I sometimes floated to, and I had run quickly there from my Intensive Care Unit to grab a stowed jacket. When this new nurse had seen me her eyes lit up, and she eagerly let me know she needed me. It seems I had quickly garnered the reputation on that floor of being very skilled at inserting IV’s. As I walked with her to her room (confident that whatever veins awaited me I’d nail it first try) I realized just how odd this was.

I had become the nurse you asked to help you get an IV started in a patient with “bad veins.”

It was crazy, but I was the one you came to when you had a question, needed a second opinion, or encountered something you had never seen before.

Even more crazy, it had occurred to me over the past year that I had become that older nurse with decades of experience that I used to look up to. Now I was the more seasoned RN on the floor.

I bet you’re wondering when the advice is going to come in. Well, here’s the thing. Most of the time it seems like only yesterday that I was the one with shaking hands when I started my first IV (or two, or three), or that I was the one going insane questioning every single move I made. I was the anxious young woman with a nervous stomach. I was the one afraid to call and wake up the doctor. I was the nurse scared to death of making a mistake, running my butt off to try and get things done on time, but leaving an hour late regardless. That was me. But now, it’s not.

Time passes quick at the bedside. It may not feel like it when you’re trying to make it through a crazy, twelve hour shift, but trust me. One day you will look up and realize a year has gone by, then two, five, and beyond if you decide to stay. On a side note, the patients hope you will. There are far too few of us seasoned (but not salty) bedside RN’s left.

So, here’s what I want you to do. I want you to enjoy yourself. I know that’s not always easy when you’re trying not to bang your head against the wall in frustration, but bear with me. You see, right now is a wonderful opportunity for you. You have the chance to be a sponge, to ask a thousand dumb inquisitive questions, and to take every instance you can to learn.

I remember as a young nurse feeling like I should know more, and often times I neglected to ask for confirmation on a situation because I didn’t want to appear like an idiot. Don’t get me wrong. I never did anything to put my patient at risk, but I did lose many opportunities to increase my knowledge in favor of saving face.

I can also recall not taking chances, not grabbing at situations where I could grow my knowledge base and skill level. Rather than missing an IV that looked hard, I might just ask someone else to do it for me. When faced with the chance to take care of a really critical patient, I would be more than willing to pass it along. This only hurt me. My fear of messing up held me back. Don’t do that.

Being a new nurse is hard. Even though you went to school there’s still so much to learn! I get it. But don’t let this keep you from grabbing those extra certifications and educational opportunities. These things will only add to your knowledge, making you a better nurse in the long run.

So, if you’re just barely keeping your head above water as a new grad, hang in there. Know you’re not the first to feel that way. But just make sure you don’t end up floating along content on still waters. Stir it up. Realize that while being a new nurse is hard, what can be really difficult is being an older nurse who everyone comes to. Because one day you will look up to ask a question, and you’ll realize you’re the most experienced person there. You will be the one people come to. You’ll be the one teaching others, mentoring new nurses, and offering your venipuncture skills to the masses. It happens before you know it. So enjoy your season to learn and grow. Your future patients will thank you.

The Curse of Healthcare

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We’ve gotten really good at what we do. Have you noticed that? Hey, I’m all for it, for the most part, and if you or your family have come through my doors, you probably are too. The technological advances are amazing, and the things we can do are such a blessing to so many! I mean, diabetes used to kill little kids, but now modern medicine gives us the ability to live longer despite chronic illness. Widow Makers no longer make widows as much anymore, and the number of people who survive things like a ruptured aortic aneurysm has increased. Teens are surviving that deadly car wreck that no human should have survived, neonatal medicine saves babies that would have been doomed, and cancer no longer automatically spells death sentence. It’s wonderful! Except when it’s not.

It’s been going on a while, but I’m starting to see it more and more. I can glimpse pieces of the unraveling fabric that is good medicine. I can see where healthcare fails by being so damn good. I watch us become our own worst enemy, playing God a little too sufficiently, and we’re left with nothing but the hope that He can get us out of the mess we ourselves created.

Let’s say an elderly woman walks into the grocery store and falls face first into the frozen food shelving. Her heart has stopped. The blood is no longer pumping to her vital organs, and without that precious blood she lacks one other important ingredient for life. Oxygen.

A bystander who remembers enough from the community CPR course they took last summer arrives to the scene and initiates first response. 9-1-1 is called, EMS arrives quickly, the woman is zoomed to the nearest ER (which is really close because we’re building more and more satellite ERs everyday). Everything goes seamlessly, y’all. The CPR was high quality, the paramedics fast-acting, and the ER physician on-point, but despite the stellar work of the healthcare team a delay in the previously mentioned oxygen happens. You can’t die and not suffer some sort of repercussion of that, but what’s changed is how easily we can go forward from there.

Is your heart too weak to pump on its own? No problem. We have a machine for that.

If you don’t have a blood pressure high enough to pump blood throughout your body, no worries, we have medicine for that. A good handful, actually, and we’ll give you the maximum dosage of every single one!

Can’t breathe? You guessed it. We’ll breathe for you! You just rest a few days and we’ll handle the tough stuff.

And while all these advances are amazing and much needed, the problem is that sometimes they aren’t. Or perhaps they shouldn’t be. The problem with getting so good at playing God is dealing with the consequences of our actions.

So, remember our 86 year old grandma who passed out by the frozen ice cream? Well, ice cream is part of her problem. According to lab results and an ultrasound of her kidneys, she hasn’t been controlling her diabetes. Her kidneys are shot, her body is in shock, the waste isn’t exiting her body like it should, and all those life-sustaining medicines we’re pumping in aren’t really being dumped out on their own.

No problem, though. We can be her kidneys. We got this.

She’s swollen to the point of her skin busting, and her nurses are changing pads underneath her constantly from the fluid that is literally oozing out of her pores. We have medicines for this too. We call it a balancing act, you see, maintaining a blood pressure compatible with life while pulling off excessive fluid. As of now, it’s building up, backing up from her already damaged heart into her already supported lungs.

Kidney failure, heart failure, respiratory failure, these are nothing new to your critical care team. We see it all the time, and we’re pretty frigging good at keeping you alive despite all the failing organs, infection, and unexpected complications. What I’m trying to say is maybe sometimes we’re too good.

See, we’re great at fixing what’s broken, but some things we cannot fix. We can’t fix things like our precious aforementioned grammy not getting enough oxygen flow to her brain before her heart was restarted. We can’t make an EEG show brain activity when none is there. We can’t cure chronic conditions; we can only extend the life of them. And even then, when is enough enough?

I don’t want to sound heartless or cruel, because that’s not what this is. It’s the opposite, in fact. It’s the voice of a caring bedside nurse who sees the pain in a daughter’s eyes when her mom’s poor prognosis is explained and she’s asked if she wishes to withdraw care.

The blessing of healthcare is we’re so good at what we do.

The curse of healthcare is we’re so good at what we do.

We can artificially feed an individual who has no awareness of the world around them. We can do this forever.

We can bring back and sustain a life that probably should have moved on to Heaven. We can create prolonged suffering. It’s not the intention, but it happens. Without our high-functioning intervention a son would have had to suffer through the unexpected, quick death of his dad. But, he wouldn’t have had to watch his father waste away, a shell of himself, skin turning purple, skin breaking down. I don’t say these things to downplay the travesty, but rather to highlight it, to bring awareness to the devastation that can occur when a body lives on, when perhaps it should not have.

So, where do we draw the line? I wish I knew. As of now, we have advanced directives, and unless those say otherwise, we, as the healthcare team, will fight tooth and nail to ward off demise. We will throw a patient everything we have, which with today’s technology, is almost literally the kitchen sink. And I am so proud to be a part of these crusaders against death. Sometimes, though, in retrospect, you see the suffering all around you and you wish you hadn’t.

When keeping a body alive hurts, and there’s no known or likely chance of recovery, you wish you weren’t so good at what you do. When the lights are on, but no one is home, you wish nature could have taken its course. When suffering is prolonged, healthcare almost seems like hurt-care.

The number of nurses are declining, but the number of patients are increasing. People live longer (which is a good thing), but sadly a large number of the bedside nurses who see on a daily basis the suffering of patients, they’re leaving that same bedside. They’re going to further their education or into administrative positions where they don’t have to explain to another family that their loved one has zero chance of recovering after they were revived.

Quality of life is sacrificed just for life, often times a shell of one, and it’s not up to nursing to decide what is considered quality and what is not. They just watch from the sidelines where that conversation is concerned. It’s emotionally exhausting, and I think where a lot of burnout derives. Many times the healthcare team is the only one that sees the reality/downfall of sustained life that should be let go. The families don’t come. They call frequently, make demands, but they don’t come to witness the hard stuff. I get it; it just doesn’t make it any easier in the end. I can’t tell you how many hands I held when they needed it most.

But I guess that’s what we’re here for, right? We’re here to save them, and to rejoice when they improve. But we’re also there to suffer with them as they slowly die. It’s hard for everyone involved. I suppose we take the good with the bad. We give a man with a 100% blockage to his heart muscle a second chance, where he holds his grandkids, and sits on the front porch swing with his wife. But we also break ribs. We put surgical holes in people, place lifelong tubes there, and whisper a desperate prayer as we try and do no harm.

I try to focus on the successes. I try to listen to God’s voice really hard. I pray. I pray a lot. But mostly I just love on folks. Every single one. The ones we save, the ones we don’t, the ones we shouldn’t have, the ones where we didn’t know. Because in the end, many times, love may be all we can give.

Have the Conversation!

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Have the conversation.

Even if you think you’re too young.

Believe me, you’re not.

I’ve seen muscled, young men, college bound, who haven’t met the right girl just yet. I’ve seen them laying there, those same muscles wasting away, and the truth hanging in the air that they will never meet the right girl.

I’ve watched Mommas fall flat on their face in a torrent of hot tears, torn over what decision to make.

“Maybe he’d want us to keep fighting for him!!”

Trust me, he wouldn’t. He’s gone.

Have the conversation.

Even if you’re not sick.

I’ve seen thirty year old men who run marathons have a widow maker. I’ve seen the most fit fall to a heart attack that not only steals the oxygen from their heart, but also takes the blood supply from their brain far too long. A young wife with a toddler on their hip shouldn’t be forced to decide whether it’s time to tell their daddy goodbye. She should have the peace that letting go was what he would have wanted. Now she feels like she’s literally pulling the plug as a five year old, wobbly waif of a child pleads, “when’s Poppa coming home?”

Have the conversation.

Even if you think your although aging, but robust and spry parent will be offended by the topic.

“I’m not sure what Dad wanted. I always thought we had more time.”

“Maw was too proud to talk about dying. Now I don’t know what to do!”

“Why did she put this on me?!”

I’ve seen siblings fight over what they think Mom wanted. I’ve seen ugly spats and downright barroom brawls, except they’re fought right over a hospital bed. No parent wants that. I’ve seen no one want to make the call. I’ve seen everyone think they know best. Why guess?

“My brother is the oldest. It’s his job to decide.”

“You haven’t been around in ten years! What qualifies you to know what she would want to do?!”

Have the conversation.

Even if you’re facing a hard battle ahead.

Making your wishes known doesn’t equal defeat. You can say, “I want to fight this,” while also saying, “when the battle is over, I want to surrender in dignity.” Talking about the what if’s doesn’t mean “I give up.” It just makes it easier for your family to let go if and when you do.

Have the conversation.

Even if you’ve gotten better.

I’ve seen doctors break the news to a patient’s family that were all just celebrating remission that the cancer is back.

“It’s everywhere. There’s nothing we can do.”

Have the conversation.

Even if you’re healthy as a horse.

“Mom has always been so healthy. She doesn’t even take any medicine!”

I’ve watched children cry over the bed of their previously healthy parent. In the shock of terrible news, in the wake of unthinkable odds, no one should be expected to make life and death decisions, but they have to.

I’ve seen a husband flabbergasted that his wife he kissed that morning before his shower is now hanging by a thread after a car wreck.

“We never talked about it. We meant to; we just didn’t.”

Have the conversation.

Even if you think you have all the time in the world.

You don’t. Tomorrow isn’t promised. Don’t wait.

We buy life insurance. It’s considered prudent. If something happens to you, you want your family taken care of financially. But what about their emotional well-being? Do you really want to place upon your spouse and children the hard decision of how you want to leave this world?

Do you want to let nature take its course? Do you want to fight until there’s no fight left? What about when the fight is lost? Can they let you go then?

Have the conversation.

I’ve seen shells of a former person laying in the bed. A machine does all the breathing. Rows of intravenous medications keep the blood pressure and heart rate compatible with life. Fingers and toes cold and purple. The nurses turn the patient every two hours because they can’t even shift their own weight to prevent their skin from eating away to the bone. Tubes in every open hole, food through the one sticking out of their nose. It’s hard to see, hard to talk about. No one wants to imagine.

I’ve seen family stay away because it’s too painful to watch. We’re left to hold the limp hand of the dying, the last face they see. No one wants to talk about it.

Medicine is good. I praise God for the knowledge and skill to bring people back from the brink of death! But there’s also only so much we can do. That’s why you have to have the conversation. You have to help us know when you would want to stop.

I’m all in favor of giving it everything we’ve got! I’ve seen so many miracles, I could write a book! I’ve seen physicians say, “it doesn’t look good,” and then my God pick up the pieces and show out. I’ve been wrong. I’ve been certain a patient wouldn’t make it, wouldn’t get better, but then they have. So, I’m not asking you to wave the white flag before it’s time. But when there’s nothing left to do, know what they would want you to do. Tell your family what you would want. If it’s not your time, don’t worry, despite our clasped hands, you’ll bounce back just fine. I’ve seen it so many times. Sadly, I’ve also seen when it’s time, but family won’t let us let them go.

Have the conversation.

Have it when you’re young, when you’re older, when you’re well, and especially when you’re not. Have it now, while you still can, so your weeping family doesn’t have to have it then. Don’t do that to them, don’t do it to us, don’t do it to yourself.

I’ve felt arthritic bones crack under my compressing hands, and I’ve heard an elderly woman scream “it hurts” as the joules of electricity racked her body. When an organ is done, there’s not much we can do except prolong the agony. I got into the field of nursing to bring healing, not pain. When healing is no longer possible, only hurting remains. It’s not fair.

Have the conversation.

Trust me. Ask your family now what they want done if there’s nothing left for the healthcare team to do.

Tell your family now what you would want in the case that you’re unable to speak for yourself.

Did you never want a machine keeping you alive?

Let them know.

Do you want the whole kitchen sink thrown at you as long as there’s a chance, but then the drain pulled when there’s nothing left to be done?

Tell them. Get it in writing.

What if your brain is gone, but your body lives on? What if you’ll be unable to speak, eat, move, or recognize loved ones? Do you want to be kept alive with liquid food through a tube? Don’t leave the weight of these decisions on the people you love. Because sometimes they can’t make them. Then they count on us to have the hard conversations. We’re the ones holding your family as they weep, and we don’t mind it, but wouldn’t you have rather saved them the pain?

Don’t wait. Have the conversation.

I Cried About a Patient Today

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The day was over. A long shift had finally ended and I gathered together my belongings for the brief trip back home to sleep before returning tomorrow. I smiled at thoughts of my children. My six year old daughter had learned to ride her bicycle without training wheels, and though I had missed the momentous event in person, my spouse had been good enough to capture video evidence for me. I looked forward to dinner together, even though I knew I’d be exhausted and ready for bed. The idea of a hot supper and quick sitcom before snoozing made me smile again, but then I didn’t. Because I thought about my day. I don’t guess I had really thought about it. I hadn’t allowed such a thing. You couldn’t.

As I stood behind closed doors, the bathroom door and break room between me and the patient care world, tears began to well in my eyes.

The horror of it.

I swallowed hard trying to dislodge the lump of emotion that had taken up residence in my throat, but that exercise was as futile as trying to will the tears not to flow down my cheeks. The emotional heaviness of such a horrible happening for my patient had left me deflated. I hadn’t realized it before. I couldn’t.

And as the empathetic emotions reared their ugly head, the raw tears streaked my face in frustration. I couldn’t change my patient’s circumstances anymore than I could have prevented the befalling of such tragedy, for the patient and their family. I wiped a stray tear away. It had snuck up on me, this emotional outpouring. I hadn’t felt it all day while I was in the thick of the awful. I hadn’t. I couldn’t. That’s not how it worked.

Nurses see a lot of pain, their beyond, fair share of heartache, but also occurrences so terrible that words can’t even begin to describe. You wouldn’t know it by their face, though. In death, work continues. In patients’ and families’ grief, condolences and support are given, but efficiently. To some it might even appear aloof. It’s not that.

We feel pain. We know pain. We know it so intimately that we wish we didn’t. We have held hands, heard prayers, and passed out Kleenex more than you can imagine. We’ve held shaking daughters who never got to tell mom goodbye, and we’ve picked up inconsolable mothers off the floor when their only son passes suddenly. We know pain.

We’ve stood there silently, back against the wall, hands wringing behind us, silently praying while the physician delivers the news no parent of a toddler wants to hear. Cancer. We’ve made the long walk down the hall to the waiting room. The one where the family all look up at the sound of the door, like a group of deer caught in the headlights. We hope our face doesn’t betray the sentence the surgeon is going to have to say.

Your dad didn’t make it out of surgery.

We watch your pain, we see your tears, we hold you up so you don’t hit the floor. But our tears seldom fall. They don’t. They can’t.

Not yet.

As I stood in the private bathroom I allowed my tears to fall, tears that had been there for thirteen hours, tears that I had hidden so well, they were hidden even from myself. I let them fall, I felt the pain of the horrible things my patient had experienced, and my heart broke for my patient. I suppose it had been breaking all day; I had just been to busy to allow it to surface.

It wasn’t that we didn’t feel. It wasn’t that we didn’t care. I think, in my own personal experience, it’s that we care so much. We care so much that we keep our own emotions in check. We do this so that our patient can have all of our effectiveness and thorough care. Yes, we empathize. And yes, we support their turmoil. Our turmoil, though, it stays below the surface. The thing is, we’ve seen so much pain, year after year, that if we let in the fullness of the whole lot, we’d crumble. It’s not just understaffing or overworking that leads to burnout. Sometimes you can only hold so much pain before you must step aside. With this in mind, we have a bit of a fence in place.

We joke, some often times inappropriately. We laugh, we sing, maybe we seem distracted or detached. But maybe that’s just how we cope. It’s how we cope with the pain, the grief, the patients who cause their own demise. It’s how we hold all the awful within without toppling over. Although, sometimes we spill over. We spill over the hot tears behind closed doors. You can only hold so much behind a fence, even if it’s built for your own protection.

I cried about a patient today. I know I will cry again. Maybe not tomorrow, the next day, or even the following week. But I will. I’ll cry, and I’ll probably do it when they can’t see me. You see, when they’re looking at me, I’m too busy looking at them, ready to help with their tears. That’s just how it is, and how it has to be.