Brie Gowen

Savor the Essence of Life

PTSD in Nursing

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Last night my family and I drove to pickup dinner. I had asked my husband if he still felt uncomfortable taking our young daughters into a public restaurant, and he had been quick to say, “yeah, I don’t want to do that.”

The numbers had gone down, but that did little to change the routine we had carried since April. I’m very honest with my spouse about my work, and as such, he suffered from the same problem I did. We knew too much. There was no way in hell we could be blissfully ignorant, and I don’t mean that offensively. I truly wish I could forget this year.

As we pulled up to the restaurant to get our curbside pickup I noticed the large group of people sitting outdoors. The tables weren’t spaced like they had been just a month prior, and people milled about inches from other groups, laughing, smiling, not a mask in sight.

“That doesn’t look like continued social distancing to me,” I said to my spouse, pointing towards the outdoor dining.

The thing was, I didn’t want to be the social distancing police! I didn’t want to see pictures of church gatherings on Facebook and wonder why no one wore a mask. I didn’t want to cringe at friends starting to gather again, throw parties, and enjoy life. I didn’t want to be wary of strangers. I didn’t want to worry about my daughters drifting over to play with some new kids at the pool. I wanted everything the way it used to be, but I couldn’t for the life of me forget the past four months. I just couldn’t.

For nurses and other healthcare professionals who have been in hotspot areas of the COVID-19 pandemic, I think we’ve received injuries that are invisible. We’re nursing wounds no one can see, and the scars we carry are still raised and angry. So while a large part of society has basically forgotten a pandemic was here, nurses are still trying to catch their breath.

I think of a skittish cat, jumping with shackles raised at every tiny sound. I think of someone who has been abused, how they’re always suspicious for when the next hand will be raised to harm them. It wasn’t fear that griped me, but rather an awareness of what the virus could do. For so many people COVID-19 was like a really bad cold, or maybe the flu, but for the hundreds of patients I had seen in an inpatient, critical care setting, it was a death sentence. All that people with no hands-on experience could say about the virus was that its mortality rate wasn’t that high, but you know who I never heard say that? Those of us at the bedside the past four months, sweating profusely in our respirators, while we pumped aggressively on someone’s chest to help their heart restart. The reason you didn’t hear that from us? Because 90% (or more) of those patients did not live. Last I knew, our hospital had tried to save over 200 people, without success. We did everything humanly possible. The virus is that bad. For the families of those two hundred and something lost, statistics for survival rate meant very little. For those of us who had cared for them, it meant even less.

So, here we are with case numbers declining, but I still don’t feel comfortable allowing my children to go to a restaurant or play with other kids in the neighborhood. To me, it’s life and death, and until someone can tell me what makes one person just get a scratchy throat, and the next guy (with similar age and health) be unable to survive, I must remain the way I am. I cannot help it. My poor husband, who has seen my defeat amidst so much death, he cannot help it either. We’re still over here self-isolating, wearing masks in public, and social distancing when we do get out.

Today my husband said, “I hope they’re wrong. I mean, it doesn’t have to get bad again, right?!”

You see, the healthcare field, based on their knowledge and models, has their own predictions for the next few months. Those of us knee-deep in the muck of this novel virus are like the skittish cat I mentioned. We’re waiting for flu season 2020. It will be like the two tropical storms converging, but when COVID couples with flu, it will be a level 5 we fear. I don’t want to listen to projections, but I try to be realistic.

Y’all, I don’t know if it will ever be the same. I don’t know if I will ever be the same. I’m so aware of germ transmission at this point, I’m surprised the skin on my hands isn’t falling off from hand sanitizer and washing them. Today I let my daughters play with two little girls at the public pool. Then I spent the next twenty minutes praying silently for God’s hedge of protection around them, worried I had made the wrong decision. I don’t want to be that mom, but I’m that nurse. I just can’t seem to be any other way.

I’m not alone, y’all. I cannot unsee the frightened look in a patient’s eyes before we stuck a breathing tube down his throat. I cannot forget the fact that although I wanted him to live, he didn’t. I can’t erase the images of the handful of critical care patients who did leave my floor alive, but did so forty pounds lighter, unable to do the things they had done prior to being a COVID survivor, some with holes in their neck to keep breathing. I think back to when I was active duty military after 9/11. At some point, as we continued to receive soldiers from The War on Terror, I grew so very tired of seeing young men (boys, really) with only one limb remaining, or their face mangled. I just wanted the war to end. I think your civilian healthcare workers of 2020 are feeling much the same. We’re tired, we’re anxious, and we’re depressed. We’re overly protective of our families, but we’re also happy to be alive. We’re in need of a break, and even though the case numbers are on the downtrend for now, we don’t really believe the end is even close. We can’t catch a break, and our patients can’t catch their breath. It’s an ugly scene for bedside nursing, and so many of us will never be the same.

When you say your prayers tonight, try and remember your frontline workers. We feel like we’ve been forgotten. And although we’d keep doing what we do even without accolades or good vibes, I personally covet your prayers for my team. This year has been traumatic, and I don’t think it’s something we can ever forget.

A Window Into COVID Critical Care

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My eyes ached. You know that gritty, raw feeling, like you’ve been crying razor blades or something? That’s what it felt like. I made an extra effort to focus on the freeway lines that zoomed by as I drove towards my safe place. Home. That’s where I could forget my day, where I could escape, leaving the sadness and stress sitting in the seat of my car, ready to be picked up again in the morning.

I had told my coworker that afternoon that it felt like 10 pm. My eyes had been hurting then, at what surprisingly was only four o’clock. I had assumed it was because of the tears. Now that I think about it, though, it was probably just the weariness of what I had seen. Not just that day, but every day for months. It was like being witness to a horrible car crash, and being unable to extract the victims. Except the wreck never ended. You relived it every day. I realized my eyes hurt from watching that repeated carnage. I wasn’t sure I’d be able to unsee it.

There is a weight sitting heavy on the heart of healthcare right now. From a critical care point of view, it feels like the dreaded elephant on your chest. It’s this heaviness brought on by unspent grief, coupled with a frantic frustration over the things we cannot change. You see, COVID-19 has brought us something we’re not used to or comfortable with. Defeat. It’s beating us, pretty much every time.

The world, and certainly the United States, has experienced the unparalleled effects of this novel virus. We’ve all experienced the shutdown, the isolation, and the economic loss. What a large percentage of people, outside of the healthcare system, are not seeing is the wicked behavior of this disease. They don’t see the cruel nature by which it attacks, making certain that stories of survival are few and far between for those poor people who happen to fall into respiratory distress under its grip. Y’all, it just won’t let the people go.

Here it is in a nutshell. Because we’ve shut the hospital doors and won’t allow you in. Here is a window into COVID Critical Care.

Death. Over and over. It does not matter what we do, or what we don’t do. It doesn’t matter if we follow every recommendation, give every medicine, and check every single box. Nine times out of ten, if you end up on a ventilator with COVID-19, you are not coming off until your heart stops. That is why my eyes hurt.

You can see your patient turn the corner, start looking better, wean down the oxygen from 100%, finally. You can say to the spouse something you try not to say lately, like, “I’m hopeful. Things are looking better. I’m very optimistic about this.”

You can say those things one week, a few weeks into the particular ordeal, and you can want to believe it in your heart so desperately, but then you can have your hand on that same spouse the following week, praying for comfort while they cry, holding them while they weep in grief because your hope just didn’t pan out. That is why our eyes ache. You cannot unsee some things. Some pain etches itself into your retinas.

Listen, we knew what we were getting into with nursing and medicine. We knew that death and dying occur. We’ve dealt with this our entire careers, some of us for twenty or thirty years. What we were not prepared for was constant death. See, in nursing you win some and you lose some. But you win some! Do you see where I’m going? We’re used to having some good news to throw into the mix, but this pandemic hasn’t been playing by the usual rules. It has its own book, and sadly that manual is still being written. As it stands now, and since this began, the odds are not in our favor. The real Hunger Games are worse than you ever saw on TV.

We are fighting, y’all. We are doing all the things we do so well. There are many times over the years that I’ve been part in successfully reviving and continuing the life of someone who probably should have been allowed to pass on to the hereafter. In those moments I have said, “we are too good at what we do.” Well, this year has upended that statement. This year, we can’t seem to be good enough. We can fight, and we can do all the great things we normally do, but nothing can seem to alter the poor outcomes of critically ill COVID-19 patients. It. Is. Killing. Us. All of us. It is breaking our hearts, but it hasn’t stopped, so we just keep fighting.

You can watch a patient you’ve personally fought for, die every shift, every day, and it’s draining. Sometimes it’s more, sometimes it’s less. I don’t know the numbers, but I know how it feels. It sucks. Where’s some good news?!

I can count the success stories, on one hand, and I’m so very grateful for them. But they’re not enough. The bad is still outweighing the good in intensive care. Even when you do have someone get wheeled out the door, they’re not the same. The effects of this continue, and we don’t even know to what extent yet. I’m not a negative or fearful person, but gosh, that’s scary. The significant and lasting damage to lung tissue is real, and it’s crazy. We won’t even talk about the other physical and emotional tolls.

Our eyes hurt from the things we cannot unsee, from the tears we sometimes cannot stop. Our hearts hurt for the grieving families, for the pain of our patients and their loved ones. Our brains ache from trying to understand the vast variations of presentation and progression of this virus, and our minds are blown by the damage it can do. This virus is cruel, it’s uncertain, and it’s unlike anything we have seen. We have worked beyond what we believed we were capable of doing. We have carried ourselves to physical points we have never experienced before, but also emotional roller coaster rides we never anticipated. So, while the Nation at large is angry to watch football and not be made to wear masks, we’re just over here trying to survive. We’re just over here trying to make our patients survive, even as we know that statistically they will not.

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.

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.

How to Find Peace in Patient Care

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Not long ago I encountered a new nurse with multiple questions, and while I adored the fact she sought answers to the things she did not know, I also sensed a self doubt within her. I totally got it. I saw myself in her wide, startled eyes, and even fifteen years later I could easily recall the hesitancy prevalent in being a new nurse. I remembered well the fear, worry, and realistic concern that I might do something wrong. I mean, it’s true. Hastily made mistakes could kill people. But I also could remember the irrational fear I had held, the anxiety that I would mess up even the things I knew how to do. For years that irrational worry had made nursing far more difficult than it needed to be for me. And though a whopping, healthy dose of attention to detail and awareness could save your license, as well as a person’s life, one step over the line into performance anxiety and bedside-care doubt could tire you quickly. No one could survive the burnout of that particular feeling. I saw that fear in this new nurse’s eyes.

As a newer nurse you have a choice to learn from your mistakes and press on, or you can crumble under defeat. You have the choice to build on your knowledge and gain much-needed confidence. I’ve seen the other side of the spectrum, mind you, as I’m sure most of us have. It’s that overly confident, cocky new grad who thinks they know everything. They don’t ask questions, and it’s usually the patient who suffers. They teach their incorrect knowledge to the new hires that follow, and safe technique goes out the window. So, I’m all for the pursuit of knowledge, asking questions, and taking an extra pair of eyes along. Heck, after twenty years in healthcare I still ask questions and seek new answers daily. That’s not what I’m talking about. I’m talking about doubting the knowledge you do have or anxiety over skills you hold under your belt.

This problem of bedside anxiety won’t go for everyone, and if it doesn’t pertain to you then I say, that’s awesome. Truly. Because it sucks. I think it’s the introverted, overthinkers who encounter this problem the most, and it will surefire make you resent your career. I used to be that nervous nurse, but no longer. I found my peace in patient care.

So, here’s what I said to this new nurse when she spoke anxiously about the continued stress of making a mistake in nursing.

You have no control over out of control things.

And that’s the truth of it, my friends. I used to be one of those people who desired control over all the things! I think most critical care nurses have that desire within them. I wanted everything just so-so, my ducks in a row, and my plans laid out. Basically, I desired a Mary Poppins kinda day, everything practically perfect, and anyone who’s nursed for like five minutes knows that ain’t happening. But it wasn’t just that. I also put too much pressure on the control I had over a patient’s outcome. And, yeah, while my performance could positively or negatively affect my patient, my ability to do well couldn’t stop someone from checking out to the great beyond. Somewhere around my tenth code, where the patient didn’t make it, I realized this.

I don’t care if you knock out your compressions like an ACLS guru, if a patient’s heart is tired of pumping, they will probably die.

I don’t care if you give every medicine correctly, checking allergy lists and the five rights, if a patient is too far gone to respond to the treatment ordered, it won’t matter.

It doesn’t matter if you give the best Diabetic education and insulin administration teaching on the planet. If a patient wants to chug Mountain Dew like it’s the air they breathe, they’ll be back next month in DKA.

It doesn’t matter if you provide the most encouraging and uplifting advice to the addict, you may find out they’re dead next week. I’ve had this happen.

It doesn’t matter if you provide the best care in the whole hospital, certain families will still complain.

I don’t care if you do everything right, catch every mistake before it happens, and think three steps ahead for your patient’s best outcome. If it’s their time, then it’s their time.

It’s not you. It’s not me. You can’t control an uncontrollable situation.

For me, I had to realize that I can only do what I can only do. I can’t get everything done. I won’t check all the boxes administration wants me to check. I can’t place myself in two rooms at once, no matter how much my charge nurse may wish it was so. I can’t control what a patient’s family does when I leave the room, and I can’t change what a person does when they wheel off my unit. I can’t save everyone. Sometimes because they don’t want saving, but most of the time it’s because healthcare is bigger than me. Life and death is bigger than me. Destiny, God’s will, or whatever you personally call it, is bigger than us all. We can only do what we can only do.

We come in and do the best we can. We work with what we’re given, which often times is less than we need. We do the absolute best we can, and to quote my favorite work-husband of all time (love you, Terry), we try and “leave em better than we found em.” But then we just gotta let go; let go of this idea that we hold life and death in our hands. I mean, yeah, how I titrate those three vasopressor drips can mean the difference between life and death for my patient! And giving the correct med or wrong one will have good versus bad outcomes. It’s my keen eye that catches a potential problem before it becomes a real problem, and that makes me feel very good. Yet I can’t keep bad from happening if it’s gonna happen. I can do my best, but that’s all I can do.

In nursing we hold much responsibility. As we’ve seen in the news, our mistakes can be costly, to more than just ourselves. That’s why we keep learning, keep asking questions, and keep trying hard. What we don’t do is fear. Fear, worry, and anxiety have no place at the bedside. Fear and anxiety will tell you that something bad might happen. Realistic thought will tell you that something bad will happen. Maybe not today or tomorrow, but one day it will. You can do everything flawlessly and it still will. You have to let go and just do what you know to do, realize that you’ll make mistakes, but you’ll learn from them. Sixteen years ago I failed a clinical exam because I didn’t give my patient up in the chair his call light before I left the room. Do you think I’ve ever forgotten to give a patient their call light since? I haven’t.

You’ll mess up, miss something, and forget plenty. Personally, each day before I work I pray in the shower. I ask God to “help me hear His voice and do no harm.” It has worked well for me thus far, but I also know I had trouble hearing that small, steady voice in my heart until I let go of the fear that I wouldn’t. I had to become confident in where God had placed me as a career, and each day I go to whatever floor and whatever assignment with that same peace. I’m going where I need to be, with the patients I need to have.

I can’t control everything that happens at the bedside, but I can control my own thoughts. After all, it’s my thoughts that drive me.

What’s a Bad Day in Nursing Like?

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I walked quickly along the crosswalk, the little, illuminated, man-figure on the street sign guiding my way. My hands in my pocket, head slightly down against the smattering of cold rain, and body and mind weary from a long day at work, I made the short walk to the parking lot where I could make the much anticipated journey home. It had been a bad day.

When suddenly, out of nowhere, a car jaunted through the dark, directly at my person. Startled and shocked I froze, much like a deer in headlights, stuck to the pavement I stood awaiting my impending death. I stared in terror at the driver who had turned quickly into my path across the street, and I saw them staring back just as surprised.

I kept walking.

My heart hammered. They almost killed me! I thought.

A moment later, that is the perfect representation of my day.

It almost killed me.

As I got into my truck and drove home I felt certain I would cry. I mean, all day I had wanted to. Many moments throughout the horrendous day I had desired to duck into a supply closet and release a torrent of tears. For surely that would let loose the stress that mounted within me.

On a bad day in Nursing you may want to cry, but you don’t. I think it’s because you’re afraid you won’t be able to stop.

Yes, I had felt certain I would cry on my way home, but once alone and away from my bad day I realized I could not. There was nothing left. I felt so spent, so dry, so expended, that not even a single tear could fall. I wanted to cry. I felt like I needed to cry. Surely it would make me feel better!

But there was nothing left. I had used it all.

A bad day in Nursing can be like that.

You give all you have, you hit a wall. You think to yourself, I can do no more, I can go no further!

But then you do. Why? Because you haven’t a choice. Your patients need you.

As I drove home I thought about my day. I wondered how I could have done things better. I wondered if I had given my patients the best of me that they deserved. My guilt over human limitation weighed on me, and I knew I had to push it off.

“Lord,” I prayed, “help me to let it go, to leave work at work.”

A bad day in Nursing can follow you home. Your family can suffer, your marriage take the brunt. My children already had to deal with a tired mother after twelve hours bedside, a mother who wished to cuddle and hold her children, but often was so exhausted from a day of caring for others, had little left but to sit on the sofa like a stump. I couldn’t take home thoughts of work stress too. They didn’t deserve that.

So I tried to leave the bad day behind me. I imagined it floating from my body and being left in the air behind my vehicle as I sped away, turning up the radio and smiling at the Tracy Chapman song, my bad day like dust that I shook off, exhaust from my tailpipe.

I still thought of it a little. It was as if I had to slowly let go and let it drip away, rather than the dramatic leave behind scenario I imagined.

A bad day in Nursing can’t really be quantified. You can try and say, “well, this wasn’t the worst day I’ve ever had.”

The worst day was when that baby died.

Or, it wasn’t as bad as the day I had chest pain. That day I fought for twelve hours straight to keep that man alive. Something about the stress of knowing your actions mean the difference between life and death for someone you don’t even know personally.

A bad day in Nursing isn’t something that can be walked away from. You can’t just go take a break. Sometimes a coworker can help, but usually they are just as busy as you. So you hold your urine. You count on invisible fingers that it’s been 19 hours since you last had something to eat. You try and figure out how you can make the anxious patient calm, the angry family member happy, or the condescending physician a decent human being. You hold one portable phone to your ear while the unit secretary announces another call for you on hold.

Just a minute.

Be right there.

I’ll take care of it.

A bad day in Nursing isn’t something you can check out of mentally. When you’re fed up, finished with the day (emotionally, that is), and certain your nerves can take no more, you still keep going. You can’t decide to do it halfway or to give less of yourself. You can’t go somewhere else in your head or give a mediocre, halfhearted performance of your duties. When life is on the line you always have to be vigilant and present, 100%, no matter if you feel you have nothing left to give.

That. Is. Nursing.

It is giving your all, even when you think you can’t. It’s hitting a wall, and then walking around it. It’s reaching the end of your rope, then miraculously finding there’s more. It’s being empty, yet still pouring out your tank. It’s running, even though you feel as if your legs have been cut off. It’s reaching the end of yourself, and then starting again. Sometimes it’s a time clock perseverance, where you ache for the end of your shift, because only then will it be over. The bad day, that is.

After a bad day I always question myself for a moment.

Did I do the best I could do?

How could I have done better?

And of course…

Can I keep doing this?

This morning I saw a friend on Facebook. It was someone the field of Nursing had brought me. It was someone who had happened upon my hospital bed (if you believe things just happen), and it was someone whose life had changed. They had told me it changed because of the things I had said. This person had come to my ICU bed as an overdose, another one in a string of so many before. Broken in so many ways. Some people saw a pointless case, repeat offender, hopeless addict. I saw a hurting heart in need of love. For some reason my kind words, encouragement, and love showed this person that they were capable of change and worthy of a better life. Just an ordinary day at work, nothing spectacular, yet a life had been saved and changed. This friend was still clean six years later. An event that almost ended in death had instead turned into a new life. And I had something to do with that.

That thought (the one that what I did mattered) brought me peace and joy. I was reminded that while there will be bad days, there are also good days, and what I do has an impact. I am where I need to be, with purpose, and I can meet each day with the expectation of doing something wonderful. Sure, some days will be hard ones, ones where I feel like I barely got by, or that I did horribly, but then they won’t be.

Bad days in Nursing are like nothing else you know, but the good days can have a positive impact you never imagined possible.

The Unseen Toll of Nursing

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I lay down on the couch cuddled with my toddler as she watched Paw Patrol, and I could hear my other daughters giggling loudly in the bathtub. I would need to help them wash their hair shortly, but for now I just enjoyed laying there. I pulled the comfy throw blanket up around my shoulder. We still had homeschool lessons ahead, but for now I snuggled deeper into the sofa savoring the way the cushions caressed my weary body. I was so tired! Why? I had gotten a great night’s sleep. My eyes even burned, though, as if I hadn’t slept a wink, and then it hit me why.

Yesterday I remember at one point feeling a pain in my chest. I knew what it was right away. I suffered from some pretty intense acid reflux (for which I was medicated), and the burning feeling in my lower esophagus was definitely the familiar pain of a flare up of my Gerd. I wished for Tums. Then I also realized it was likely an empty stomach causing me discomfort, with nothing on it to neutralize the stomach acid.

I had looked at my watch. Almost 2pm and no lunch yet. I could have asked for someone to relieve me, and I even knew there was a plethora of snacks in the break room at my disposal provided by our administrators. But I couldn’t make myself walk away. I was invested. I was deeply invested in the outcome of my patient, and I just didn’t feel like I could walk away until the patient was more stable.

I had looked at my watch. Seven hours. Seven hours had gone by with me on high alert, at a point of performance far beyond that of an average day. Due to the seriousness of the situation and the intensity of my critical patient, my senses had been in overdrive since I arrived. My heart beat a little faster, my brain functioned a little quicker, working to anticipate the next change. It was like being on a roller coaster. For seven hours straight. I could feel the adrenaline still pumping and I wondered briefly, “how long exactly can one go at this pace? You gotta step it down a notch, Brie. You’re gonna fizzle out.”

I took a deep breath, working to mentally and physically slow my senses that seemed more alert and expectant than usual. Then something else intense required my quick thinking and action, and I was right back at it.

It wasn’t all bad. It felt good to do good. It felt rewarding to fix things, to explain alarms to family, to answer questions and ease fears. It was wonderful to see the low blood pressure come up, to watch the high heart rate come down, and to obtain the orders I needed from the physician to make those things happen. It was an honor to be a part of life-saving healthcare, in the trenches of serious situations, catching minute changes before they became a more serious issue, but it was also immensely intense.

At some point between four and five o’clock I looked at my watch again and thought with relief, “just three more hours. I only have three more hours I still have to keep this patient alive until I pass the torch to the next shift. I can do that!”

That may sound awful to anyone who hasn’t been in that situation. It’s not meant to be. It’s just that when you’re on overdrive you can only keep going so long.

When I had gotten home, feeling tired yet satisfied, I had bragged to my husband about how cool I was. “Aren’t you proud to be married to someone who saves lives for a living? Is it hard being in love with an angel who wears scrubs?!”

He knew I was just joking. Because that’s how you had to look at it sometimes. You could either say, “oh my gosh, I’m exhausted, that was the most intense, awful day ever,” or you could say, “oh my gosh, I’m beat, but I got to be a part of something intense and amazing today.” Everyone deserved a chance to live another day, and if I had any small part in keeping things headed in that direction then it was a good day.

But as I lay on the couch this morning I realized that the intensity of the day before had caught up with me. I’ve never ran marathons, but I would imagine it’s a little bit like that. Sometimes work is like a race, and you don’t stop running until the finish line. You don’t slow down, you don’t give up, and you keep your eyes on the prize. But the next day off you’re grateful for ice water, Motrin, and rest.

A Day in the Life of an ICU Nurse

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I breeze into work fresh and energetic from an almost two week break from the bedside. When you walk into work, anywhere in nursing, but especially in critical care, you have absolutely no idea what you’re going to get. It’s completely the reason that I mentally and spiritually prepare myself while I stand in the shower beforehand. If ever there were an environment that could embody Forrest Gump’s box of chocolates it is indeed the intensive care unit. Sometimes you get that sweet little grandma who secretly is in no shape or form ICU criteria, but then other times you get the exact opposite.

So I find myself assuming care of a patient with as many IV drip medications infusing as I have fingers, and they also happen to have a little device called a ballon pump inserted into their body. If you’re unfamiliar with one just realize it’s basically pumping the heart for the patient. So I guess you could say it’s getting pretty serious.

I had not taken care of one of these types of patients in a hot minute (that’s southern lingo for a long time), so I had to wade into the murky water and remind myself I still knew how to swim. I had to remember to see the forest despite the trees (all those wires and IV lines), and keep in mind that in essence you just gotta look for one thing: is this normal? After fifteen years at the critical care beside you just kinda know when something isn’t right. And even if you do find yourself assuming care of that sweet little MedSurg granny, you watch her exactly the same. Cause if something ends up being “not right” then she transforms into a critical care patient. Hence you are always on guard.

As a critical care nurse sometimes you hold someone’s hand while they cry. But other times you hold a pressure bag in the air of rapidly infusing packed red blood cells hoping to obtain a blood pressure in your hemorrhagic patient.

As a critical care nurse sometimes you feed parched lips spoonful after spoonful of coveted ice. At the same time you may be titrating a handful of stout cardiac medications to keep the patient’s vital signs compatible with life.

As a critical care nurse I spoke compassionately and patiently with family, educating them on the well-being of the patient. But sometimes I breezed quickly past them to hit the Code button and start compressions.

As a critical care nurse I wiped bottoms and gave baths, upholding patient dignity in the process. Other times we barely had time for a bath with hourly vital signs, hourly intake and output, hourly blood sugars, and constant medication changes based on all of the above.

As a critical care nurse I “only” had to care for two patients. Sometimes I only could handle one, and even then I needed my fellow nurses to help me.

As a critical care nurse I enjoyed many a day laughing and joking with my patients. But other times the atmosphere required such concentration that I could hardly utter a word. In those instances I often hummed to myself to calm my frazzled nerves.

As a critical care nurse I could go all shift and never encounter a thing that even caused me to bat an eye. Or I could see something on my monitor screen that caused me to feel like I was going to loose bowel control. Just being honest.

As a critical care nurse I could fight tooth and nail, no holds barred, give em everything but the kitchen sink to keep them here on this earth. But other times we let them go, I held hands, I prayed, and I held family while they cried on my scrubs.

Some days in critical care went by slowly, and at the end it definitely felt like a 12 hour plus shift. Other days went by quickly, and by the end, as you drug yourself to your car, it felt like you had been at work a week.

But some days I got to explain to a worried family what was going on with their loved one, and I had the honor to update them on all the many interventions that had taken place to take the absolute best care of the patient. On those days I smiled with pride when they said things like “we sure are glad you’re here” or “we really do appreciate you.” Those moments were the best, and they made whatever kind of day I had gone through completely worthwhile in every way.

The Truth About Your Critical Care Nurse

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I stood at the bedside of a critically ill patient, conversing with a colleague. We discussed the numerous IV Vasopressors on-board, and what options were available to optimize heart function while maintaining kidney function. 

It was a dance; single, smooth steps to hopefully maneuver the dance floor as gracefully as possible without tripping over any toes. 

“Will I ever be as smart as you guys?!”

I turned in surprise at the question from a nurse orienting on our unit, and I felt a slight blush rise up my cheeks. I also felt a strange sense come over me, as if I were an imposter standing at the bedside. 

Certainly she didn’t mean me!

After eleven years transversing through the complicated arena known as intensive care I had to admit it had gotten easier. I no longer feared coming on shift for example. But still…  

I still had a lot to learn. And so many days I felt as if I would never catch up to an ever-changing, always evolving field. 

It was a dance. Some days I led, but other days I followed. Many shifts ended with me feeling like the most graceful performer on stage. Yet others ended with me licking my wounds where I had fallen clumsily. 

And someone had asked if they’d ever be as smart as me?!

Sure, some days I felt incredibly wise. But other days ended with me certain I was a blundering dunderhead. 

I flew triumphantly through some code situations, while others concluded with me wanting to bang my head up against the wall for what I could of, should of, would of done better if given a second chance. 

Some shifts I emerged from the building feeling like a game-changer, a life-saver, a calculated risk-taker. Then other times I slinked slowly off the unit surrounded by a cloud of defeat, an aura of loss, and a feeling of uncertainty for my abilities competing with a certainty that I had chosen the wrong career. 

Sometimes I knew all the answers it seemed, but more often than not I still had questions. Lots of questions. And I knew without a doubt that I couldn’t do what I did without the assistance of those around me. 

“Will I ever be as smart as you guys?” She had asked. 

I honestly hoped she’d be smarter. Certainly smarter than I felt on even my most brilliant of days. 

The fact was I didn’t feel special, or above and beyond. I felt capable, but often times incapable. I felt sufficient in my duties, but honestly, often times I felt terribly insufficient to perform the weighty task assigned me. When handling something as lofty as life and death, many times I felt very, very small. 

I stood at the bedside of the critically ill patient, watching multiple monitors, titrating cardiac drips, and I was hopeful. Not all the patients that came through my area pulled through, but many did. And though I felt small, in essence God had placed me in the midst of something very big. My responsibility was huge. Perhaps I was doing okay. 

Maybe I didn’t always feel like the smartest, the best, the most efficient, but I was where I needed to be. I did what I needed to do. I did the best I knew how. Of that I was sure, and maybe that was what she saw. 

You May Be Ready to Leave the ICU If…

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Some days as a Critical Care Nurse it seems like a lot of people are coming to the ICU. On a Sunday night, close to change of shift, it appears that errbody is being admitted there. In a critical care setting you see all kinds of patients, and varying degrees of illness. Motor vehicle accidents, sepsis, overdoses, respiratory distress, Myocardial Infarctions. Anywhere from guarded to stable, and whatever falls in between. 

But occasionally you’ll get a stable patient who doesn’t quite meet the requirements for intensive care nursing, and since we’re so darn likable there’s a lot of times that patients want to overstay their welcome in the critical care setting. 

Critical Care Nurses thrive in an uncertain environment. Action is our oxygen, and give us an intubated patient any day of the week. Heck, give us two of them. We love taking care of critical patients, and definitely love making them well. If you need to be in ICU then we’ll work for you. 

Sometimes, though, the lines get blurred between what’s appropriate ICU criteria and what’s not. So here’s a cheat sheet I came up. 

You may be ready to leave the ICU if…

  • When you know your pain medication orders and schedule better than your nurse. 
  • When your family has been present long enough to obtain a staff ID badge or paycheck (or even if they act like they have).
  • When you can get up out of bed by yourself and unhook all your monitors. 
  • When you’re stable enough to come off all monitors for a five hour test in nuclear medicine. 
  • When you complain continuously about the menu. 
  • When you request to have your nails done by the staff. 
  • When your blood pressure is better than mine. 
  • When you’re well enough to bring up chronic health problems you haven’t felt worth dealing with on an outpatient basis. 
  • If your “hypertensive crisis” is resolved after one dose of IV Lopressor. 
  • When you walk down the hall to visit with other patients you’ve come to know well. 
  • Just about anytime you leave AMA. 

  

  • When your main concern for the morning is getting your make-up on. 
  • When an order for telemetry isn’t a necessity. 
  • When you not only know all the nurses’ names, but their kids’ names too. 
  • If an IV isn’t necessary to maintain!
  • When you can keep track of your own intake and output. 
  • When you can, and do, push the call button for requests more than four times in an hour. 
  • If your “respiratory distress” is relieved after applying 4L O2 via a Facemask. 
  • When you’ve memorized all the TV channels. 
  • When you can move across the room faster than your nurse. 
  • When you can sufficiently entertain more company in your room than we have nurses on the unit. 
  • If you’re not actively bleeding with your GI bleed, your blood pressure is perfect, and your H/H is probably better than mine right now at 6 months gestation. 
  • When you order out pizza for lunch. 
  • When you update your Facebook status Q1 hour. 

I know the atmosphere is divine, but eventually you have to tearfully say farewell to the trusty ICU staff. After all, leaving critical care is a good thing. It means you’re getting better, and you’re on the pathway to recovery. 

As a physician, your patient’s transfer to MedSurg means eventual discharge. We appreciate your faith in us, but it might be time for your patient to bid us ado. So don’t be surprised when we ask. 

Basically if a patient is not ventilated/sedated and they’re hemodynamically stable then we may raise an eyebrow. 

Remember ICU doesn’t equal sitter service or a place to keep someone overnight to prevent the phone from ringing. When in doubt refer to the above list. If the patient meets 1-3 of the above then they might be ready to leave the ICU. 

As ICU nurses we take great pride in the thorough and skilled care we provide to our critically ill patients, and we love to see them get better. But then it’s time for them to go. 

The bottom line is there’s no greater reward for an ICU nurse than to see their smiling patient wheel out of the unit in better health than when they arrived, and we also celebrate with the patient when they’re well enough to not require being here.