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.

The Side Effects Nurses Are Having From COVID-19

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I fell asleep the other night feeling so beaten down and defeated. I had tried to scroll mindlessly through my Facebook newsfeed before bed as I used to do to decompress after a long, thirteen hour shift at the critical care bedside, but it had only succeeded in making me more upset. I wasn’t even mad about the ridiculous post I had seen shared by a friend claiming coronavirus was a “Democratic hoax.” It would have made me mad back in April, when I knew this thing I fought was really real, but at this point, as numbers climbed even faster than I had imagined they would, I was just tired. I had erased the very true comments I had written on the aforementioned post, and I had fallen asleep knowing that was just one more thing I had no control over.

I had zero control over the public’s perception of this virus, and even though I had intimate details of what Covid was really like, it didn’t matter. I could change opinions about this about as much as I could about mushrooms being gross. The fact was a lot of people really liked mushrooms, and I had zero chance of making any of those folks agree with me that they were slippery and weird. Touché. I guess what ground my gears was having an appetite for fungi was a matter of preference, but in my book COVID-19 was as sure as the button nose on my masked face. For me, standing in the muck of this mess, it was not debatable.

And so I drifted asleep feeling bummed that public perception was just one more thing I couldn’t control. This concern toppled over the crown of a hundred other uncontrollable factors I held as a nurse during a pandemic. My healthcare peers and I faced a novel virus, new to us all, and we swam through the treacherous waters together. Initially, much fanfare and support had followed the medical community as we stood bravely against this foe. But now? Not so much. Nurses were no longer the darlings of the working world. We were lumped in with all the other exaggerators, seemingly wringing our hands for a bug that experts on social media described as “basically the flu.” I mean, you can’t applaud someone who combats a fake virus.

The thing was/is, I didn’t need applause. But I did desire someone to take our words for it. Instead it seemed a large part of public opinion favored the advice of YouTubers or folks with one-lettered names like ‘Q.’ I couldn’t tell if people were so scared they convinced themselves it was fake, so distracted by the conspiracy theories that they truly believed it was all a political ploy, or so dense that they didn’t care. After all, I had even seen some people in nonclinical healthcare suggest we all go out and catch it.

Just the day prior I had heard such an idea of herd immunity, and while I understood the general premise and points, I could only reply, “I still can’t figure out what makes you the type of person who this affects like a mild case of the flu versus the people whose lungs are attacked and die. Until they figure that out, I don’t want to roll the dice with my family.”

See, that’s the burden bedside nursing carries. The physicians, respiratory therapists, and nurse aids in the trenches too. We all see what it can and does do to a person. Young, old, healthy, sick. Doesn’t matter. It will kill anybody it so desires. We wish we could end this crap already too, but we’re too personally involved with corona to play roulette.

I see people protesting being required to wear a mask in public places. Meanwhile, I’m triple checking the seal on my respirator to make sure I don’t take this virus home to my family. I see people griping about wearing it for a thirty minute shopping trip. Meanwhile I fall asleep with my nose still feeling numb from the pressure of a mask for thirteen hours straight.

The next morning when I arrived at work, all prayed up, and mostly rested up, almost immediately someone asked me what was wrong. You see, I’m the singing nurse, the smiling nurse, the uplifting one who always lightens dark moods. So when I’m not exuding those things, it’s noticeable. After a second person asked, I realized I was suffering from the side effects of a pandemic. No, I wasn’t sick with a virus, but I was sick with the emotional, physical, and mental toil of the virus. You can only exist in so much uncertainty, sickness, and sadness before you succumb.

I thought of the patient who breathlessly called family to say quickly, “well, they’re putting me to sleep for a while. Talk to you soon.”

The memory left my heart hurting, and I recalled how at the time my eyes had met those of a coworker, both of us hoping that was true, but knowing that statistically and according to gut feeling, the patient likely would not wake up again. And that’s the biggest battle we face. That was what kept us awake at night. That’s what might create future PTSD for many, and it’s what made my spirit feel so heavy since this had begun. The rising case numbers, incidents, and COVID admissions only worsened an already aching heart. It was the thing we wanted to control the most, but the one thing that sadly we could not. No matter how hard we tried. People were dying, a lot of them, and for those accustomed to healing, this bitter pill was especially hard to swallow.

The side effects to COVID-19 on healthcare workers are multifaceted. They’re not just placing their physical bodies at risk, or even that of their families. They are also investing their hearts. The emotional and mental toil cannot be imagined unless you have faced it head on personally. I am a veteran, and I don’t use this term loosely, but I do consider this a battlefield of sorts. Nursing is fighting a war, one they feel they are losing, both at the bedside and in the court of public opinion. We’ve got battle scars already. I can’t imagine how it will feel down the road.

So, if you see a nurse, please cut them some slack. If they’re sharing about the benefits of social distancing, hand hygiene, or wearing a mask, realize it’s because they care. They’re not pushing any hidden agenda, playing politics, or even in on the “government hoax.” The fact is, we’ve seen far too much death already, we anticipate to see much more, and we want to prevent that if at all possible. There’s so much with this pandemic we cannot control, but maybe we can help save a life.

And for goodness sake, stop trying to convince us it’s not a big deal or as bad as the media says! I don’t even watch the news. But I do believe what my eyes tell me. And right now, sometimes through tears, they tell me we have to work together to stop this thing. Please.

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.

What You Can’t Anticipate About Nursing

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I enlisted in the military a year before 9/11, and after that day that I watched the second plane crash into the South WTC Tower things changed. It didn’t take long for our country to spring into action, and before I knew it my base was announcing a deployment to Iraq. I wasn’t naive, exactly. I knew when I joined the military that war could happen, but I suppose I just wasn’t ready for it when it came around. I mean, I was proud to serve my country, and I had every intention of doing whatever my service required, but I was scared.

I remember calling my mom and dad on the phone and crying, “I don’t want to die.”

Some things you’re just not ready for, I guess. You can train, prepare, psych yourself, get motivated, or whatever. You can listen to the stories of those who have gone before you, hear the concerns of well-meaning family and friends, and be certain that you are prepared for the worst that can be thrown your way, but then when your number gets called, you’re stunned. When the crap hits the fan, you’re shocked. When the hard job becomes trying and more difficult than you ever imagined, you’re thrown off balance.

After I had cried to my parents, I dried my cheeks. I puffed out my chest, and I stood tall. I was still afraid, but my pride for country, dedication to duty, and commitment to my job helped me tell my folks it would be alright. Then I hung up the phone to go about my day. What I’m saying is, I was thrown off balance bad, but I stood back up and kept walking. It’s no wonder I became a nurse.

My mother was a nurse, and I still remember her saying, “are you sure?”

She wanted to ensure a career in nursing was really something I wanted for my life. She knew the difficulties I would face. At the time, I thought she meant long hours or working holidays and weekends. I had grown up seeing her do those things. I had heard her complain to my dad about documentation and staffing shortages, but I figured I could handle that too. I still remember the strange look on her face after I told her I was going into nursing, and before she asked if that’s what I really wanted. Her eyes had shown a mixture of pride, amusement over my ignorant excitement, and a concern for her child thrown into the mix. I realize now that she knew. She knew I’d be thrown off balance, but she didn’t know how it would go after that.

I still remember my first Code Blue. I was a new graduate, mid-twenties, on orientation, and green as spring grass. I was on night shift when we ran quickly to the ER as part of our Code Response Team. I was excited, scared, adrenaline pumping, hands shaking. It was just like all the medical shows I had watched with my mom, but better. We were saving lives, man! It was awesome!

But then it wasn’t. I felt the tone of the room change. I watched in shock as the man’s slack skin jiggled back and forth while a nurse violently pushed up and down on his chest. His flaccid body jerked up and down on the cold, narrow gurney. He face looked contorted from the large tube coming out of his open, drooling mouth. It was terrible. It was nothing like TV. This man was dead.

“Push another Epi,” the ER doc commanded!

The drawer I had been pulling from was depleted. Someone pushed new medicine cartridges into my hand, and with frantic fingers I assembled the syringe.

I could feel it in the air, though. This round wasn’t going to work either. The look on everyone’s face told me it was so.

“Hs and T’s, guys,” the doctor asked. “Anyone have any ideas?”

It was that last ditch effort, a collaborative meeting of the minds to try and think of something we could reverse to magically restore this man to life. Everyone stared ahead, silent, searching the database of their knowledge, but coming up with nothing.

“If no one objects,” the MD announced flatly, “we’ll call it. Time of death, 2357.”

And just like that it was over. The floor lay littered like a battlefield, the trash, drops of spilt blood, and empty syringes a reminder of the fight we had lost. Our prisoner of war still lay on the hard stretcher, a victim to the iron grip of death, despite our valiant efforts. I stood slack-jawed, surprised that we had stopped, and that the patient was really gone. In the back of my mind, as if through a cheesecloth, I heard the doctor say something about going to speak with the wife. It wasn’t supposed to go this way at all.

“Come on,” my preceptor called cheerfully. “We got a lot of charting to catch up on!”

That was fifteen years ago, but still fresh in my mind. I think, though, the one that shook me the most was an unnumbered Code. It wasn’t my first, nor my second, and not even the third. I had gone through dozens of codes by the time this one occurred, and as I assembled a medication syringe from the crash cart, my fingers moved at lightening speed. Like a liquid team, my SICU coworkers and I ran the event. We followed the steps smoothly, we did everything right, yet it ended the same way as my first code. It wasn’t as if death was a new thing for me. In fact, I had even done a stint as a Hospice Nurse. Death was a part of life. It was what happened to everyone. Yes, it was never “good,” per se, but it was inevitable. It was out of my control, in the end. So, I did not feel guilt. I didn’t feel overly traumatized by the event. It felt like any other work day, and maybe that’s why what happened next happened. Maybe God was trying to shake me up, make sure I could still feel.

You see, in nursing, after seeing death day in and day out, you build up a certain barrier. It’s not that you don’t care. It’s kinda hard to explain to the layman, but it’s like you stop making tears about the sad stuff, because you know that if you ever started crying, you may never stop. That’s the part you don’t anticipate in nursing. How the loss will affect you, how it will rock you, shake your foundation, threaten your faith, or harden your heart. You don’t realize how all the pain, death and dying, grief, and overwhelming helplessness will affect you. You don’t understand the pain of a hopeless situation or the trauma of being unable to change the downward spiral. You don’t understand it until you live it, and even then it changes.

This day, the day of an ordinary, unsuccessful code, I broke. Y’all, I fell apart, and I didn’t even see it coming. After this old woman died we called the family back to the room. It had been so unexpected. They didn’t even realize we were coding her until after she was already gone.

I stood in the room, readying the body before calling back the son. And at that moment, as I looked at the woman’s face, I saw her son kissing her cheek. Less than half an hour ago he had swept his lips across her cheek, telling her bye before she wheeled away for a simple procedure.

“See you in a minute, Momma,” he had said.

And that’s what I thought of as I straightened the sheet across her chest. He had no idea that would be the last time he saw her alive, and the thought of it made me bawl like a baby. Right there at a stranger’s bedside. My mother had passed away in much the same manner, and I never knew that particular kiss of mine on her cheek and “see ya later” would be our last. I also never knew when I became a nurse that the pain of others could become like my own, that I would build stoic fences to keep me strong, but let them be torn down just as easily to keep me empathically tender. Nursing hurts. I think that’s what that particular look in my mother’s eyes some twenty years ago was trying to say.

Not long ago my husband and I were watching Grey’s Anatomy. One of the surgeons was tore up by the loss of their patient. They were really having a hard time, and I told my husband, “I totally get it.”

I explained to him how after my last code and patient death I had trouble getting it out of my head. I had three days off after it happened, and I needed every one of them. And even after that, it was still hard to return to work. You see, I questioned myself. I didn’t do anything wrong. There was nothing I could have done to prevent his death, nor anything I could have done differently that would have been better. I knew this to be true, but it didn’t change the fact that I still asked myself those questions. When you hold life and death so closely, it’s hard not to take it personally, to feel responsible, to feel the pain, to feel grief, to feel defeat in some sort of strange way. I couldn’t stop my feelings of responsibility anymore than I could stop breathing. It came just as naturally. I don’t think I ever anticipated it would be this way.

It’s like that, you know? You stand straight, firm, tall, proud. You laugh so you don’t cry. You feign indifference even. You break down, you piece it back together. You march on, battle after battle, a soldier for good, an angel of health, moving forward in the calling you wear so mightily. Broad shoulders, air of confidence, liquid efficiency, like a well-oiled machine. You fall, you get back up. You cry sad, salty tears. You dry your eyes, you smile again, you laugh. Sometimes you do all these things in a single afternoon. You keep going. The pride, courage, and commitment continue. It hurts, it makes you happy. It breaks your heart, it repairs your confidence in mankind. It is Nursing, and I never anticipated it would be this way.

Can My Mom in Heaven See Me?

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Do you know what made me saddest about my mother being dead?


I remember when I first introduced my mom to my boyfriend’s daughter. She hurried to a back closet, found a cherished toy she’d kept tucked away, and gave it to the blond-headed five year old. 

“I’ve been saving that for when I have grandchildren,” she added with a grin. 

I watched the contented look on her face as she sat in the floor with the young girl who would become my stepdaughter two years after my mom passed from this earth. She had looked so happy, as if a missing part of her had been found. 

When I birthed my first daughter I was filled with joy, but skirting on the edges of my happiness was a melancholy sadness. It was the reminder of things I could not change, of things that I wished were different, but were not. I would look at my baby’s face and see my momma there. Then I would push that thought away. 

I would watch my children walk for the first time, or say something very clever, and out of nowhere my heart would grieve that I couldn’t share these wonderful moments with my mother. She had wanted to be a grandmother more than anything, but she didn’t live long enough to glimpse a single one. Now there are eight. 

People would say things they thought were comforting like, “your momma is looking down on y’all smiling,” but I would find no comfort there. Not really. I just couldn’t believe that such a thing was so. Why would someone in Heaven have the inclination or desire to look back at a world that had caused them such pain? I never told anyone, but I just didn’t believe she could see us. Thoughts of her made me sad, and thoughts of her not enjoying the things that caused me such joy made me even sadder. The fact that my grief made me not want to think of her period was the saddest thing of all. 

I recently began seeking and studying about Heaven. There was so much I didn’t understand, and there were even more preconceived notions that I held, but in all reality had no true idea. As I began to dig deeper into Heavenly research based on scriptural truth I discovered some things that have turned many of my thoughts upside down. 

I now believe that my mother can see me. I read in Revelation about the martyrs seeing down on earth. I read in Hebrews about the great cloud of witnesses. And I read in Luke about Abraham and Lazarus seeing the rich man burning in hell. I read about Samuel being aware of what had happened since he died, and of Moses and Elijah knowing the same. I read different things and my heart began to believe that it’s highly plausible that my mother can see us. I’m not sure why, but that gave me a measure of peace I’ve never had before. I suppose I’ve always wanted to please her, and knowing she can see me at such a high point of my life makes me happy. It just felt right in my spirit, for the first time ever, that she knew I was doing well. That the girls were beautiful and had her wit. 

Knowing what I do about Heaven from scripture I do not think she sits around all day watching our life, or pining for our arrival. I know for the first time ever she is in total peace and free from every kind of pain. I know her heart is full of joy, and I’m pretty sure she keeps contentedly occupied in Heaven. So I’m under no impression that my life is akin to The Truman Show for her, but I do think a Father like our God has shown her the twinkle of her eye, her beautiful grandchildren growing here on earth. I think she knows that we are happy, and that must just be a cherry on top of the already abundant joy she is experiencing. She’s far too full of God’s glory to be impatiently awaiting our arrival, but I’m certain she smiles a special smile at thoughts of meeting her grandchildren one day. 

I realized recently that after this shift in thinking for me I am able to reminisce more on her. I am able to pull up memories of her laugh, her smile, her love for me, and not be overcome by sadness. I am able to remember her with a happy grin on my face, a comment of “I love you, momma,” and an anticipation of sharing it all again one day soon. I believe my mother can see me from Heaven, and that has somehow changed the way I grieve. 

Being the Nurse When Life Doesn’t Seem Fair

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Being a nurse is very rewarding. I mean it’s great to have the answers when patients ask, and to be able to educate family when they’re in need. There’s a pride in being a part of something so noble, and despite the many difficulties of the job, the feeling when you help someone feel better is wonderful. 

It’s a boost to your morale when you hit that difficult vein, and when a patient compliments your care, well, nothing really compares to that. Seeing someone smile because of something you did, thank you notes, and grateful hugs all make you well up with fulfillment. Nursing has so many moments where you know you chose well in picking your career, and while on the hard days you may question your vocational decision, overall your certainty of your calling is cemented by seeing something great like that really critical patient wake up and make a full recovery. 

But then there’s the other side of the coin. There’s those moments that don’t make you feel warm and fuzzy. They just break your heart. 

They say the only thing certain in life is death and taxes, and nurses see a lot of both. Sometimes death is easier than others, and while losing a loved one is never what I would term enjoyable, there are moments where it’s expected and prepared for. These instances seem to bring a small measure of peace or relief when you can say, “at least they’re no longer in pain.” But saying that about a cancer-ridden 98 year old seems more comfortable than saying it about someone’s child. 

After many years of seeing death and dying I try to separate myself to some degree, and I’m able to do that for the most part to maintain my own sanity, still provide efficient care, and not fizzle out from the field completely. I’ve worked hospice nursing and honestly found a lot of joy in helping people cope with death and loss. It’s a fine balance to emotionally support and empathize adequately while keeping it professional, so to speak, and it gets even harder when life does not seem fair. 

When children die it doesn’t make sense, and caring for an infant that you know will pass away soon takes a certain kind of thinking. After all it’s hard to smile at chubby cheeks and large eyes that so similarly appear like those of your own baby at home. It’s difficult not to break into racking tears every time you speak with this mom nonchalantly about the weather and reality tv even as you both know her world could rip apart at any moment. It reminds you that though your baby doesn’t carry a fatal health diagnosis, that your rug could just as easily be ripped out from under your own two feet. 

When young lives are snuffed out in silly, unexpected accidents it shakes the ground of so many, and when you stand at the bedside with the weary mom in denial of her now brain dead son, you search yourself for the right words to say. “Your boy isn’t there,” just won’t come out right, and the dull spark of determination in her moist eyes makes you think of your own reaction if the roles were reversed. It would probably be the same. 

When you watch a dad with his hand on the chest of his son as his breaths get longer and longer in between, each loving pat representing both “I love you” and “please don’t leave me,” you want to cry out, “it’s not supposed to be this way!” But instead you just place your own hand on dad’s shoulder, or hand him a box of tissue, because sometimes that’s all you know to do.  

When children left behind weep for a young mommy who will never rock them again, or a daddy whose strong hands of comfort have become still, your soul cries out. It mourns with the mourning, and it grieves shakily with the grieving. And sometimes those tears that you always hold inside, well, they get out. You hear the shocked, racking sob of a formerly strong son who just lost his daddy, and unexpected cries escape your own heart. They run out right down your face. 

It seems that nursing is reality. It’s a profession where you’re not allowed to bury your head in the sand against hardship or pretend that the good don’t die young. Your confronted with it daily, and you’re reminded of the frailty of life. You’re often accosted by the fact that it just doesn’t seem fair. 

So you hand out your tissues. You bring in extra chairs to the bedside. You hold another mother as she falls apart in your arms, and you soak up the tears from a hurting widow’s face. You say things afterwards like, “I’ll take care of it; don’t you worry,” and bite off pointless sentiments like, “hang in there.” Instead you just let your eyes meet their eyes, allowing your heart to speak I care, and hoping that your actions displayed that very fact. 

Sometimes you never really know. But then sometimes family comes back. You receive a note, a card, a token, or a visit, and when you hear words like “thank you for all you did,” you kinda glimpse the impact you had. You realize the privilege of being present in someone’s life during such a detrimental event, and though you may not have changed the circumstances, perhaps just maybe you made them a bit more bearable. And even if you didn’t, you know you tried. 

Then you remember that nursing is rewarding. It’s rewarding despite it all. Even when life doesn’t seem fair. 

From Your Nurse: I Am Privileged

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So many times perhaps it seems like I complain. 

I am so tired. 

My feet hurt. 

This dang computer is driving me crazy. 

In the midst of my seemingly perfunctory care, I may appear hurried, harried, or aggravated. 

I’m sorry. 

As I unintentionally heard you behind the curtain whispering to your mother, it dawned on me the weight of what I do, and although I know this, it’s always nice to remind myself. To remind myself that I am privileged in this position I hold. 

When I explain the grave prognosis of your family member, and you nod with tears in your eyes. When you hug me afterwards, and I feel your tears soak into my cotton scrubs. I am privileged. I am privileged that you allow me into your moment of grief. 

I sit and I listen. I listen as you tell stories of your loved one, painting a lovely portrait of the person they were before they became the silent, still patient hooked to a thousand lines and tubes. I am privileged you choose to share these memories with me. 

I answer your frantic questions, and sometimes explain the same thing over again. I watch you nod, processing it all despite your shell-shocked response to the situation in which you find yourself. I am privileged you trust my knowledge so completely. 

I go about my work as you speak private words with your dying spouse. I almost feel like I’m invading on your personal moment, yet you know that I am there. I’m privileged you feel comfortable enough to have me serve as a witness to such extraordinary love. 

I support you when you want to fight a futile battle for your dad, and I pray with you when you decide it’s time to let him go. I hold your hand when it starts to shake uncontrollably, and I give you an abundance of tissue for your cascade of tears and dripping nose. I’m privileged to be included on such an emotionally frail, vulnerable, volatile, and uncertain situation in which you have fallen. Thank you for allowing me to try and comfort you in the middle of it all. 

I hear you cry uncontrollably, trembling with grief when your mother’s heart stops beating. I see your eyes search mine for the final word that she is gone. I watch as you leave her in my hands to prepare her body, even though her spirit has gone, for one last visit here on this earth. I am privileged that you open yourself to me, that you seek my counsel and comfort, that you trust me with the one you hold so dear.  

My job as a nurse is a challenging one. It’s stressful and emotionally draining. It’s physically exhausting and mentally challenging. But at the end of the day, even if it’s been an extra long one, I am privileged. I am privileged to be called your nurse. 

How Do I Continue to Be a Nurse?

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I vividly remember my first code blue. I was a new nurse, scared stiff to mess up, yet intrigued by all the action around me. I opted to pull medications for this particular situation, and I could feel my adrenaline pumping as I silently urged my hands not to shake while readying the epinephrine. 

I can recall being that weird kind of frightened/excited ball of emotions, but then I also remember my feelings at the end. I can remember hearing “he’s only 42,” and the way his large stomach jerked violently with each and every furiously executed compression. Then I can remember the physician asking the team, “does anyone have any other ideas?”

It was at that point, while chest compressions continued, as I saw the downcast face of the seasoned nurses around me, that I realized we were not going to get this man back. His bulbous belly rocked violently and I heard a voice say quietly, “I think his son just arrived.”

I can also recall my last code blue, twelve years later from the first, yet the latter just as clear. In the last I had recorded the medicines and pulse checks as they were performed, a not quite so exciting task, but one that left me open to record mentally the actions and reactions of those around me. 

How the cardiologist’s grim expression told the outcome before we had even begun, or how the eyes of each person present visually begged the monitor to give us something good. 

Or how we all looked defeated when time of death was finally called. 

What I couldn’t forget was the way the husband cried like a small child, bawling in a collapsed heap when he heard his bride had left this world without him. I remember wanting to say something profound and beautiful, but my tongue being stuck to the roof of my mouth, powerless to offer even a meager attempt at sympathy. 

I remember the patient I didn’t code. The one whose family finally made the difficult decision to let mom go. I can recall hugging the daughter, surprising myself when I cried right along with her, feeling all too well the pain of her loss like it was my own. 

I can remember that helpless feeling of wanting to do something. I either needed to fight for her with all I had in me, or I needed someone to say, “let’s just keep her pain free.” I didn’t want any of that idle business in between. 

I just remember praying that God would take her on home. And when they finally said, “let’s turn the machines off,” I think we all breathed a collective sigh of relief. 

Sometimes I think of all the things I’ve seen in between, and I wonder how. How do I continue to be a nurse? 

I look at my infant daughter sometimes, so small and fragile, and all the knowledge I have comes to mind. All the thoughts of how fleeting life can be threatens to rock me to the core while I rock my precious cargo, and I have to push every reality of it from me before I succumb to that awful thing called fear. 

Then I can recall the first time I saved a life. I can easily remember the hugs, the high fives, and the way my breath seemed all hung up in my throat, blocked there by the disbelief that I had been a part of something so wonderful. 

I can’t recall the first time I caught an error that helped make a patient better, or the first time I suggested that one little thing that turned a life around for the better, but I know it happened. Many times. 

I can remember the first time a patient’s family member thanked me for my care, and especially what an impact I had on the fella and his wife who stopped me at the grocery store to tell me so. 

I can remember being proud of myself last week for successfully starting that difficult IV, or how good I felt after spending the extra time with my patient to listen to his fears about his upcoming surgery. 

I can remember those precious moments of much needed pride in myself and my field that rescue me from despair at just the right moment. 

I remember them now. 

I try to cling to that. I try to hold onto the smiles, the hearty handshakes, and the people I leave better than I found them. And when I’m able to do that I keep going, despite all the rest. 

A Letter to the Grieving Family From Your Nurse

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To the Family of My Patient Who Died,

I know you see the nursing staff, albeit blurry through your veil of fresh tears. I know you automatically hold out your hand to take the box of tissues we offer while a torrent of racking sobs attacks your body. I’m sorry tissues are all I can offer at that time. 

You see, we wish to console you, and even as we stand there rather helplessly, we are trying to think of the words to say to somewhat soothe your frayed emotions. Even as we know there is nothing we can say or do. 

Do you know that when I back up to allow you time to grieve that I’m also turning my back trying to choke away my own tears? Do you know that when I hear your painful sobs it pains me too? I care for you in your grief, I empathize with your loss, and I feel pain right along with you. 

I’m not supposed to do that. I mean, I am to an extent. I am to carry compassion for my families, but I’m also expected to be strong enough to comfort you in your torment. I skate along a fine line of feeling your pain yet separating myself from it so that I can be who I need to be for you when you are weak. 

That’s why I turn away. That’s why I walk away. I don’t leave your side to abandon you in your grieve; sometimes I just collect myself so I can try. Try to help. When I hand you a simple box of tissues know my gesture means more than that tear-soaked paper. When I pat your back or hold your hand, please know my soul is reaching for your soul to carry some of the burden. And when I hold you in my arms as your tears soak my hair understand that I am no stronger than you. I’m just trying. 

Did you know that when they said it was the last cycle of CPR we would try that I cried out to God for your family? I knew you weren’t ready, and I prayed fervently, “please God, let the pulse come back.”

Sometimes your prayers are my prayers too; I just wanted you to know. When God’s will is not our own I am crushed also. But if it’s any consolation please realize that your loved one left this earth on the lips of my continuous prayers for them. And now I pray for you. 

My pain is not your pain. I would never be so daft to assume that was so, but when I hear you cry my heart breaks. When I see you grieve my throat burns with emotion, and in that moment my strongest desire is to take your pain away. 

When you cry, “momma,” I think of my own mother in Heaven. When you throw yourself on your husband’s body I am reminded of how fleeting life can be. When you break down and fall apart at the loss of your child I see my own babies’ faces. Every. Single. Time. 

Although I am strong for you, I am not without emotion. And even if you never see my tears, they are there. Sometimes all I can do is say I am sorry for your loss, so very sorry. Know that in your grief my heart is there with you. 

Sincerely,

Your Nurse