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.

Three Things God Says About COVID-19

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Nothing brings character out quite like crisis. You will see some of the most courageous people charge into a burning building, but sadly, you will also see the ones who knock down the weak, trampling them to escape calamity. You will see people who instill fear, take advantage of a bad situation, yet also the helpers, the ones who pick up the fallen, serve the weak, despite their own trepidation, and give more than they take. I would like to think that all followers of Jesus fall into only one of the above mentioned categories, but sadly we all can fall to fear, panic, and survival of the fittest. Yet, in a time of chaos and uncertainty, I believe God calls His children to a deeper level of trust in Him. So, consider this a friendly reminder, to all of us who profess the faith, to follow the commands God has put forth for us in His word.

Without further ado, here are three things God is telling us amidst COVID-19.

1. Stay home! I want to put this as best as I can. I completely understand the fear of losing financial resources. I totally do. Most of us don’t have a huge savings built up, but I’m trying to encourage a kingdom mindset amongst all of this. I want my brothers and sisters out there to try and see this situation as an opportunity to grow deeper in dependence and relationship with Jesus, to not fear the waves that come, but trust the one who controls the storms. It’s not the boat that will save you; it’s the One who controls the ocean. He will provide.

Also, let’s think about what’s important. Is it staying current on bills or human life? Trust me as a healthcare provider on the frontline of this. It’s serious. People are dying. Maybe not you, the healthy twenty-something, but you can be without symptoms at the beginning of the virus and pass it along to people you do care about. Your grandparents, your friend’s immune compromised child. Life will always trump bank balance.

Then there’s this little nugget.

Romans 13:1-2 (NIV)

Submission to Governing Authorities

13 Let everyone be subject to the governing authorities, for there is no authority except that which God has established. The authorities that exist have been established by God. 2 Consequently, whoever rebels against the authority is rebelling against what God has instituted, and those who do so will bring judgment on themselves.

Please trust the experts in disease transmission on this. Let’s not listen to that mom in your private Facebook group.

I won’t say I believe every word from a politician’s mouth or especially the news, but I do obey the authorities God has placed over me. Our government has given very clear and strong recommendations, and a large number of people are still ignoring the highly educated, well established plans to slow the spread of this virus. You are hurting others, you are hurting yourself, and you are disobeying more than the president you don’t like. You’re disobeying scripture. Let’s humble ourselves under the authority God has placed over us, trust that His plans will prevail, and stay home! I’m a nurse and a Christian. I trust medical science, but above all my Savior. God has given us healthcare and healthcare providers with the knowledge to save us. Let’s trust that God-given wisdom that says staying home will keep this from getting bigger than our hospitals and medical supplies can handle. Please.

2. Stop hoarding food! I have had friends inquire of my family, if we have enough. Since we started living in an RV we have limited space for storage period. Our fridge is small, our pantry also. We can store about enough for a week for our family of five, and that means frequent grocery trips. This past week I went shopping after a twelve hour shift at the hospital bedside, and as most of you know, the shelves were bare. Yet as I made my way through the aisles I always found one to two of every item I needed, even if it wasn’t my typical brand. By the way, I only took one, leaving the other for the next person.

Matthew 6:25-27 (NIV)

Do Not Worry

25 “Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes? 26 Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they? 27 Can any one of you by worrying add a single hour to your life?

I’m reminded of the Israelites in the desert. God provided enough manna for each day. Some tried to take more and keep it for the next day, but He caused it to spoil. He wanted them to understand that He was their provider, and they could trust Him to give exactly what they needed. I’ll bet there’s a lot of people today who may end up throwing out some food they bought in over abundance, never realizing that God wanted to show them what He could give them.

Jesus came showing us how to be servants, showing us that the first would be last, and the last first. He saw people in need and He fed them. Never once did He hold onto what God had given Him and not share with the rest. He didn’t take all the fish and bread from the little boy and split it with His disciples. He thanked God for the little He had, then God multiplied that gratitude to feed five thousand. Imagine the blessings we are missing out on because instead of thanking God for what we’ve been given that we need, we’re taking more than enough right out of the hands of the hungry. It’s going to rot.

2 Timothy 1:7 ESV

For God gave us a spirit not of fear but of power and love and self-control.

Don’t let fear drive your actions. I love my family, and I feel the need to take care of them. I understand that you want to get your family what they need, but stop and consider the fact that fear is driving you to load up a shopping cart with sixteen cases of water and twelves packs of toilet paper.

Which leads us to the third yet biggest commandment He’s speaking during this time.

3. Do not fear!

I say it again. Do. Not. Fear. There’s a reason this is the most repeated phrase in scripture. You see, fear is from the devil, and fear is a liar. Is all this kinda scary? You betcha butt! I am walking into a lockdown, negative air pressure, isolation, COVID-19 unit at work. Tons of healthcare providers around the country are doing this. If we let fear rule our actions, we would shut them all in a room and let nature take its course, but no, we go in and provide the very best, life-saving care we can. Are we afraid of catching the virus, or perhaps spreading it to our family? Of course! But we don’t let fear dominate and rule our actions. The reason the Bible says so frequently not to fear is because God knows we will. Sin has created some really crazy, frightening things out there, but faith in Jesus gives us a mode to combat fear and not let it rule our hearts and lives. He has overcome all evil, and COVID is no different. Even death has lost its sting, y’all. I serve a creator who gives eternal life, and the gift He offers is bigger than the most fatal of diseases.

Do you think this surprises God? Do you think He is as shocked as we all are by the death toll in Italy? No!

Psalm 139:16 ESV

Your eyes saw my unformed substance; in your book were written, every one of them, the days that were formed for me, when as yet there was none of them.

God knows beginning to end. He knew this was coming, and He knows how it will end. He knows the solution. He knows the good that will come from this. What the enemy means for evil, God will turn to our good. We have a tendency to forget that.

God is whispering amongst the chaos,

come to me, all who are weary and heavy laden, and I will give you rest. I will give you peace. I do not give as the world gives. Take comfort, for I have overcome the world. There it is. Do you not perceive it? I am making a way in the wasteland and streams in the desert. Hope like a river, it flows to those who trust in me. Do not be afraid. I will uphold you with my righteous right hand. Your foot will not strike the stone. I will rescue you.

If I were to offer any advice during this time of social distancing it would be this. Use this time to read the Bible. Y’all! There’s a wealth of truth and wisdom from the Lord inside those pages. Let them be a healing balm to your worried soul. Let them guide your decisions so that fear doesn’t lead you, but His peace sustains you. Listen to the real expert on what’s happening. Don’t just take my word for it.

Thank a Nurse, Today

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

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

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

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

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

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

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

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

How I Fell in Love With Nursing. Again.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A Word of Advice for the New Nurse

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

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

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

“That’ll do it,” she replied in awe.

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

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

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

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

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

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

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

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

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

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

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

The Curse of Healthcare

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I Cried About a Patient Today

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

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

The horror of it.

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

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

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

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

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

Your dad didn’t make it out of surgery.

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

Not yet.

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

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

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

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