Brie Gowen

Savor the Essence of Life

Have the Conversation!

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Have the conversation.

Even if you think you’re too young.

Believe me, you’re not.

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

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

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

Trust me, he wouldn’t. He’s gone.

Have the conversation.

Even if you’re not sick.

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

Have the conversation.

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

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

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

“Why did she put this on me?!”

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

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

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

Have the conversation.

Even if you’re facing a hard battle ahead.

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

Have the conversation.

Even if you’ve gotten better.

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

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

Have the conversation.

Even if you’re healthy as a horse.

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

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

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

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

Have the conversation.

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

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

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

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

Have the conversation.

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

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

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

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

Have the conversation.

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

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

Have the conversation.

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

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

Did you never want a machine keeping you alive?

Let them know.

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

Tell them. Get it in writing.

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

Don’t wait. Have the conversation.

I Cried About a Patient Today

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

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

The horror of it.

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

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

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

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

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

Your dad didn’t make it out of surgery.

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

Not yet.

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

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

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

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

How to Find Peace in Patient Care

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

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

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

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

You have no control over out of control things.

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

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

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

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

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

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

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

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

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

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

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

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

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

What 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.

An Informative Letter for Politicians. And Any Other Idiots.

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To Whom it May Pertain,

Recent erroneous and poorly thought-out comments by a senator concerning how nurses spend their “breaks” made me aware that a public service announcement was needed. An informative letter, so to speak, inviting you into my little world as an ICU nurse. Don’t worry about finding a seat. You won’t be here long enough. In the infamous words of Jack Nicholson, you can’t handle the truth.

So without further ado, allow me to tell you about a recent shift I worked.

I took a break. I did, I’ll admit it. You’re right, but there were no cards.

I got lunch about 3:45pm, and I was grateful for it. You see, I didn’t think I’d get lunch. I had resigned myself to that fact, and my plan was to throw some Saltines down my gullet while I took my one potty break. I mean, it probably wasn’t the most hygienic, but it beat passing out. I did get a lunch though! My charge nurse made me take it.

I had planned to eat earlier than 4:00pm. Not having had breakfast, I hadn’t eaten since the night before. I’ve heard of this new diet trend called Intermittent Fasting. It’s supposed to be great for weight loss. Basically you go 12-15 hours without eating. Heck, I don’t know why this is such a groundbreaking thing nowadays. Isn’t this simply #nurselife? My OBGYN asked me in December how I maintained my slim frame after three kids and being in my forties. I told him I didn’t know, but now I guess I should have just said it’s The Nurse Diet. As it was this particular shift, over 18 hours had gone by before I put any calories in my body. Go me. But I digress.

I was saying that I wanted to eat earlier. I did. I love food. Lunch is my jam, and I had tried to leave right at eleven. The plan was to run down real quick before I discharged a post-op patient. Because I knew once that bed was empty, another far more sickly patient would take its place. That’s just how the cookie crumbles.

Mmmm. Cookies. Not yet.

Nope, no cookies or even a coke at eleven. The doctor wanted to try and extubate my other patient. For the layman, like yourself, who apparently knows enough to know how I spend my break, but may not understand medical terms, extubate means remove the tube that has been breathing for the patient. And you know, it takes breathing to survive, so it’s kinda a big deal.

I had to wean down some pretty dangerous medications. I do that a lot. I hold in my little fingertip the ability to change the dosage of medications that keep your heart beating, ones that keep you from going into a diabetic coma, ones that keep the seizures away, and about a hundred more. I have to keep the dose limits and how much I can change things around in my head. Otherwise someone could die.

I found this funny meme on the internet. I showed it to my husband. He said skeptically, “I’ve never seen that many machines in a patient’s room. Look, there are seven of the same machine!”

I rolled my eyes and explained, “that’s an IV pump. We infuse multiple medications at once. I had that many machines in a room the last time I worked!”

See, my husband is married to a nurse, but even he didn’t realize how crazy things got. With that in mind, I didn’t go to lunch at eleven. Yep.

I was going to go after the sedating medicines were turned off and the patient woke up a bit more. That was the plan. Just run down real quick. My lunch buddy, the person who would assume care of my critical patients while I raced to grab a sandwich before the cafeteria closed, she had just gotten a new admission. Way sicker than mine. By a little bit. She said she could handle watching my people too.

But just as I was about to tell the charge nurse my plan, the doctor decided we needed to do a bedside procedure. I gathered the supplies, I gathered the required paperwork. I even gathered a collection of coworkers to help me turn the patient for the procedure since he outweighed me by over 150 pounds. I drew up the dangerous medications, ones that require special training and education to administer. Then I waited for the physician. He had gotten called to another patient.

I waited.

I thought I’d go to lunch after the procedure. That was the plan. I had taken care of all of my patient’s needs for the time being, and I wanted to grab some grub. I was starving!

Then CT called. That’s where they do radiographic scans. The doctor had ordered a STAT CT. Stat means right then. Pretty important. Life and death stuff. Something about a possible brain bleed. So yeah, no lunch for me.

You see, I had to go down to the test with my patient. Cause he was that sick. Someone had to control those life-sustaining meds. Someone had to watch the heart monitor. The someone was me. I had to coordinate with my Respiratory Therapist since the patient couldn’t breathe on his own yet. Yeah, we had to breathe for him, as we rolled down the hall, pushing rolling machines alongside him through narrow passageways and onto an elevator just big enough for an ICU bed.

Good thing I’m so skinny from starvation, I thought, as I stood pinned behind an IV pole up against the wall.

Funny story in the elevator, though. My Respiratory Therapist hadn’t eaten lunch either.

After the CT. After the transport. Then I’d take a break. That was the plan. But you know how plans are. They’re like pie crust promises. Easily made, easily broken.

My patient’s wife had arrived bedside in our absence. Poor dear. And I mean that from the bottom of my heart. She was so worried. He had been sick for so long, so unexpectedly, and we didn’t really have any answers. I thought of how I would feel if my husband was in that bed. My heart broke for her. I spent extra time explaining in detail everything I could. I offered her emotional support. I offered her hope based on my knowledge gained through the years. I hugged her and held her while she cried. I mean, who could go to lunch with that going on?!

I got to eat, though. Eventually. The hot line was closed, but I grabbed something. I had clocked out for lunch, and after giving directions to a lost family member in the hall, then letting a patient transport take the elevator before me, I had a good ten minutes to eat. I loved every bit of those ten minutes. I reveled in those ten minutes. I mean, I got ten minutes. Ten glorious minutes! I had started to think I would not.

You know what I didn’t do in my ten minutes of break throughout my thirteen hour day? I didn’t play cards! Ain’t nobody got time for that.

Sometimes nurses just long for a drink of water. We can’t have it at the nurse’s station, though, and we don’t really have the time to drain the urine that coveted drink of aqua would create. So, we don’t think about poker or gin rummy. We think about if it’s worth sucking down that styrofoam cup of water when we know we’ll be running the hall later holding our bladder beyond what’s healthy. We just wanna pee. Are there decks of cards in the bathroom?

And it’s not just me, an ICU/CCU nurse. It’s all of us. Nurses. We’re all stretched beyond what we can handle sometimes physically, mentally, and emotionally. We’re all stressed out, with sore backs, and missed family get-togethers. If we happen to have a cold day in hell, pigs are flying, and we can break out into a card game in the break room, then we darn well deserve it. I mean, I’ve never seen it, but if you do… I mean, miracles happen. If you do catch a card game, maybe you could grab us some snacks to go along with it. After all, we love food! It’s like the Holy Grail of Nursing. Many seek it, but few find it.

Next time, consider my very normal and common day before making some ridiculous future comment.

That is all,

A Hangry ICU Nurse

This is the Number One Thing Nurses Forget

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I’ve always been fond of saying that nurses wear many hats, and over the years I’ve worn some more than others. Some of those hats I’ve wanted to hang up, if you know what I mean. Some of the hats nurses wear feel like a dunce cap some days, and some feel like a crown on others. Maybe one more than the other. I’ve had days where I feel like I’m wearing a maid’s hat, and I’ve had others where I feel like I’m wearing one stamped “doormat.” It can be downright exhausting wearing all those hats! Especially the ones you didn’t plan on, like babysitter, drug dealer, or punching bag. It’s those hard-to-wear hats that bring us down, wear us thin, and push us away from the bedside.

It’s like one day you look up and you say, “this isn’t anything like I planned it to be. I didn’t sign up for this. Things have changed! I can’t do this anymore.”

Sound familiar?

Resigned to an unfair, rarely rewarding career, you trudge through each extremely long twelve hour shift with dread and dissatisfaction. You rack your brain for how to make a change. You may even feel trapped in a situation that no longer brings you joy. I mean, if Marie Kondo told you to hold up your job in one hand, you’d probably toss it. Am I right?

Perhaps you’ve just forgotten why you do what you do.

There’s a section of my blog analytics where I am shown Google searches that led to my posts, and I often find a reoccurring theme. Yesterday one read, “help me get away from bedside nursing,” and my heart broke a little bit. I had been there myself at one time, and my burn out almost pushed me away from nursing completely. I almost left something I love and something that I was called to become.

That’s the thing about hats. They’re like bad haircuts. You get a bad haircut or color and it transforms your whole look. You glance in the mirror and cringe. You get to where you don’t even want to look in the mirror until something is different. Nursing hats are like that.

If you have a shift where you wear a hat that makes you feel unappreciated, used, taken advantage of, or pushed beyond your limit, then you feel like a failure at what you do. It doesn’t bring happiness; it just brings frustration. Wear that hat enough days and you don’t even wanna look in the mirror. In fact, you forget what you ever looked like before. You forget the appeal and shine of your very best hat. You forget it even exists.

A few years ago my husband came home from work and told me something I’ll never forget. At the time my husband owned a small restaurant in our town. He had offered to feed for free the participants in a drug rehabilitation ministry. So naturally the minister overseeing the program wanted to meet this man who was offering pizza at no charge. Upon introductions the minister recognized my husband’s last name. He recognized it because of me.

As my husband retold the conversation to me, it seems that the minister had come across a past patient of mine in his work. The reformed addict had told him something that stuck with him. Something that made him remember my name.

The addict had said, “I went into the hospital tons of times with overdoses. And each time they treated me like a piece of garbage. They saw me as a lost cause! But then there was this one nurse. She made me feel like I was the CEO of the hospital. She made me feel like I was somebody special. She made me feel like I was worth something, like I could beat this thing. So I decided to do just that.”

Y’all. This story floored me. But it also reminded me of something that’s too easy to forget in nursing.

We make a difference in people’s lives.

Not always. Sometimes you don’t. But then sometimes you do. And those times? They’re special. They’re worth putting on a shelf and pulling out after a bad day. Cause you’re going to have bad days.

The thing you have to do with that is remember what hats are important, and forget what hats are not.

Some days you get treated like you’re a waitress. That’s okay. Because what really matters, I mean, what really, really counts is the truth of what you are. How you’re treated (sometimes) doesn’t define you. You are more than that.

Nurses have the opportunity to serve mankind at their worst! And yes, while it does feel that way sometimes, consider this. You have the chance to make a lasting impact. Nurses not only saves lives, but we also change lives. During a time when patients are their weakest, lowest, and most discouraged, we are allowed to enter their private moments and give them what they need the very most. We give oxygen to those that cannot breathe, but we also give laughter to the depressed. A song can brighten the day of a patient feeling down, and the right medication and therapeutic touch can lift them higher than you realize. A smile soothes the soul. As a nurse you have this power.

You’re not simply a pill pusher! You’re a hope dispenser!

You’re not “just a nurse.” You’re a life-changer.

You’re not just a servant! You get to be a servant. You are allowed the chance to serve mankind at its most difficult time, when ill, and your work makes them feel better. This isn’t just some little thing. It’s huge.

It’s easy to get so distracted by all the hats we wear (especially the hard hats) and forget that the most important hat we wear is Life Impactor. We impact lives, we change lives, we make lives better. We leave them better than we found them, and that’s worth celebrating. It’s a lofty calling. Is it always appreciated? Of course not. Little in life is. We ignore a beautiful sunset as easy as a buzzing fly. But many times you’re the light coming over the horizon, your patient notices, and they are better for it.

Now, it’s your job to be better for it. Realize the light you shine, understand the impact you make, and never forget that it’s the grandest hat you wear. And at the end of the day, it’s the only one that matters. It’s why we do what we do.

Finding Joy in Nursing

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Before I started my most recent travel nurse position in a Cardiac Critical Care Unit, I had to complete some online education and checklists to prove I was proficient in the knowledge and skills I claimed. As I went through the skills checklist marking “very experienced” on almost all of them I felt a surge of adrenal. Seeing the scenarios in print made me feel like I was almost doing them, and I realized I was excited at the thought.

I frigging love this stuff, I thought.

And it surprised me a bit. At the time I was back home on vacation, lounging in my pajamas, with hardly a care in the world other than the email from my compliance office of things I needed to complete for my next assignment. But rather than being perturbed over the intrusion of my off time, I was eager to get back at the bedside. I suppose that’s what really surprised me. I wasn’t dreading returning to work as an ICU RN. I was eagerly anticipating it.

It’s not that I didn’t love my time off. Of course I did! But I also loved taking care of my patients. The thing is, it had not always been this way.

Don’t get me wrong, now. It’s not that I hated my patients. I had always enjoyed caring for people, but somewhere in the frustration over increased charting requirements, low staffing, and bosses who forgot what it was like to be at the bedside, I didn’t enjoy it as much as I wanted to. In fact, some days I had right near hated it. Some days I drug myself home and wondered how much longer I could make myself stay at the bedside. It became an exhausting, exasperating exercise in what felt like futility. Between the noncompliant patients and family members you couldn’t please, I was burned out. This made me sad. Not only sad for myself, but also my patients. They deserved more from me.

It got to where every little thing made me furious. Another “mandatory” meeting? Oh please. The double charting of restraints made me fume. New policies caused me to roll my eyes, and I got on the bus that no one cared about the bedside nurse. No one! I was a body, a number, a workhorse to be used and abused by surgeons with a god-complex. Whatever.

I dreaded going to work, and I didn’t want to be a nurse anymore. It broke my heart. I had always wanted to be a nurse, like my mother, but I told myself the field of nursing had simply changed. It wasn’t the same, and because of that I’d lost my spark.

I ended up taking a step back. I cut down my hours, and thankfully financially I could. I focused on raising my babies, and that was where my joy was. It worked for me. But I was still sad about the time I did work. Something wonderful would happen. A patient would tell me how I had changed their life. A family member of someone who almost died would spot me in the store and suffocate me in a grateful hug. A former patient would bring a gift by my husband’s work for me, and brag about the care I had provided in their worst time. I felt overflowing with pride at theses situations, but I also felt like a fraud. If these people could see how frustrated I had become at the field, they probably wouldn’t feel the same about me. No matter how kind and cheerful I remained at the bedside, I wasn’t blind to the bitterness that had crept unwanted into my heart.

And then came the time for me to return. Seasons changed, circumstances altered, and I found that a full-time return to the bedside was required.

I can do this, I thought.

I wanted to do it. But I also wanted to not hate it. One day I stood in the hot shower, extremely exhausted from my prior shifts, and I began to pray.

“Give me a joy for it, Lord,” I prayed.

That’s what I wanted. I didn’t want to just get by. I didn’t want to just be able to endure. I didn’t want to do like so many other of my fellow Americans and just countdown the days until I could retire. I wanted to love my job again. We weren’t made to trudge through life miserable. I mean, life is not easy. That’s the reality of it. But it does make a difference how you view what’s before you.

The fact was nursing had changed. I had seen it change drastically just in the past decade. There were frustrating things about the field. But there were frustrating aspects of anything. My kids could ruin a fun day with fighting and complaining, but I didn’t stop taking them places. I focused on their happy smiles, not their tired whines. I focused on their “thank you’s” and “this is the best day ever’s” rather than the pulled hair and dirty tears. That’s how I had found joy in the difficulty that’s parenting. It’s how I could find joy in Nursing too.

I began to see things differently. Instead of focusing on frustration solely, I focused on the parts that gave me happiness. I counted it all as joy. I saw myself as a servant, not a slave. I saw myself as a helper, not a doormat. I saw myself as a lifter of spirits, not one crushed by my own bad mood. I recognized the gift of what I did. I had the privilege to care for people when they needed it the most. I had the lofty task of saving lives, of changing lives. I had the opportunity to positively impact people at a time when they were at their lowest and most vulnerable. I had a chance to shine.

Did some days still suck? Of course! But underneath it all was joy. Joy that I got to be a part of something pretty darn amazing. I could make a scary situation a lot less frightening for someone. I could pull someone from the brink of death and watch them walk out of the hospital a week later. I was a ringside witness to amazing technology that could give a goner twenty more years. I got to be a part of some pretty spectacular stuff, and I got to smile and be loving to people along the way. It was a choice. And I chose joy. By God, I chose joy.

That was just the beginning, though. It was like, the more I walked in joy, the more I felt joyful. The more I focused on the good stuff, the less I saw the bad. When people griped, I walked away. I sang a happy song to myself, I had a conversation with a lonely old lady, I taught someone something new about their health, I lent a hand to a drowning, new nurse. I smiled. It wasn’t that I was blind to the problems inherent in my field. I wasn’t sticking my head in the sand. But I was seeing more than the suck. The joy was there all along. I had just forgotten how to see it. I had been blinded by my own indignation, side swiped by injustice, defeated by the doomsday talk, the wind sucked right out of my sails. But then I found it again. I found my love for nursing again.

Again, it had always been there. I hadn’t changed. The field had changed, but I didn’t change along with it. I didn’t adapt. I stood rigid. And yeah, some things I needed to stand firm on. Nurses did have rights. But we also had responsibilities. It wasn’t the dying man’s fault the budget had been cut. It wasn’t the lady with a STEMI’s fault that Medicare had changed. They still needed my best. They needed a woman who wanted to be there; not just a woman who wanted a paycheck. To be that woman, the one they needed, I had to put my focus on the people who needed me. I still saw the things that needed fixing in healthcare, but I didn’t let those overshadow the joy that came with making someone feel better.

Making someone feel better! That was the best of it. That’s where the joy was, and that’s where I found it. I reckon you can find joy in almost any circumstance. You just have to be willing to look.

The Biggest Difficulty in Nursing

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Yeah, yeah, I know. We all realize the field of nursing isn’t a cake walk. Everyone has heard about or experienced the long, exhausting hours. Anyone with eyes realizes that short staffing is a problem. Of course, the expectations often heaped on bedside nurses, whether by administration or from the patient and their family, are many times unrealistic. The risks for communicable disease is ever-present, the harm to your back and knees is unmistakable, the wear and tear of your mental and emotional state is huge, regardless of your capability to handle stress. And we all know this. It’s frustrating. It’s hard, but it’s been this way for some time. We know. But even all these things aren’t the big whopper of what makes my job hard. Nope, not it. There’s something far worse.

Most of us have seen the reports out of Vanderbilt Hospital, but if you’re not familiar, a serious patient harm occurred. I won’t go into details, but here’s the link if you’re interested. Basically, a nurse gave the wrong medication to a patient. The patient died. A horrible death. The nurse was wrong, and she now faces criminal charges. She made a mistake. A very huge mistake.

I think a lot of nurses, like myself, when reading the news reports were quick to think, “man, how did she make that mistake?! No way I would have done that!”

But on the tail end of that train of thought was another. One we didn’t dare to ponder too long. Like, a bad juju, not gonna think about it, makes you cringe thought. In that secret place we whispered, “it could have been me.”

Yeah, maybe I think to myself that I couldn’t possibly make a med error that huge. But would I be lying if I said I never made a med error? Would I be kidding myself if I tried to pretend I’ve never messed up and later on, with my heart hammering in my chest, locked in the bathroom, thanked the Lord my misstep didn’t cause any true patient harm?

But here’s the thing guys. We can’t make mistakes. Yeah, we all have made at least a little snafu, where we overlooked an order or forgot something. We’ve been lucky enough not for it to be a huge problem, but it could have been. And that’s the hardest part.

Nursing is a career where you can’t mess up. You can’t make mistakes, because when you do, people can die. Like, really die. Don’t pass go. Don’t collect $200. Just go straight to Heaven, die. That’s a big deal.

I can remember when I returned to the critical care bedside after a two year, much-needed hiatus to hospice nursing following the death of my mother. Suddenly I wasn’t helping people transition to death. Instead I was striving to prevent death. Y’all, I was scared to death. I wasn’t a new nurse. I was a good nurse, with experience, but I still felt fear over returning to a field of nursing that required a high level of skill from myself. I would stand in the shower before work and just pray.

I’d say, “Lord, help me to hear your voice and do no harm!”

You know what? I still pray that every morning. The fear has dissipated over time, but the reality of knowing I hold life or death in my hands has not. I take what I do very seriously, as I should. I give medications that can start your heart if given correctly, but ones that can stop it if given incorrectly. And a lot of times with this stuff there’s no take-backs.

There’s no “oops, my bad.”

There’s just, “I’m sorry ma’am. Your husband didn’t make it.”

That’s the biggest difficulty in nursing. The monumental responsibility, the weight of something so precious on your shoulders, and the knowledge that the space for error is a very tiny one.

There are nights I’ve had insomnia and it’s tore me up. I went through two different stages of newborn babies with marathon breastfeeding sessions. I would wake up to my alarm, blurry-eyed, and hope I didn’t kill anybody. That sounds terrible, but in part it’s true. You can’t go take a lunch break much of the time, so it sure ain’t kindergarten. No naps allowed. If you didn’t get enough sleep, too bad. You better wake up and stay alert. No mistakes. No do-overs. No be kind, rewind. You fall asleep at the helm and you’ll crash the ship. It could be worse than the Titanic.

No, I’m not being melodramatic. That’s my job. Nursing isn’t the only job that deals in life and death. Many of my medical field counterparts feel the same way. There’s no room for error, it’s not feasible to make a mistake, and the fact that you’re human, and you can, and you do, isn’t an excuse. Nah, that’s not stressful at all.

The biggest difficulty in nursing is trying to keep your mind so sharp that you don’t make a mistake, but not thinking about it so much that it causes you to cave. I mean, if I thought about all the unintentional errors that could make me guilty of negligent homicide, I’d probably crack. Instead I just tell myself not to mess up. And I don’t.

But there’s always that little voice in the back of my head that says, “you could, you know. Mess up. One slip, one overlooked assessment, one mistaken order. It could be you.”

And I guess that’s probably good. It’s probably good that voice is there. A little fear is likely prudent. After all, I never want to assume it couldn’t be me. That’s when it probably would be. When my own pride and cockiness caused me not to question my own actions each and every day.

It’s weird, you know. I work in a setting where my confidence in my knowledge and skill set needs to be pretty high, but I also must never place myself on a pedestal of perfect. I am human, after all. So while nurses are superheroes in our own right, and ICU nurses are B.A., for sure, I also walk into each encounter with my eyes open wide, my ears ready to hear, my mind prepared to learn more, and always ready to receive the advice of that still, inner voice that tells me to beware. That voice is never wrong.

What’s a Bad Day in Nursing Like?

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

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

I kept walking.

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

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

It almost killed me.

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

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

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

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

A bad day in Nursing can be like that.

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

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

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

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

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

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

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

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

The worst day was when that baby died.

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

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

Just a minute.

Be right there.

I’ll take care of it.

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

That. Is. Nursing.

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

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

Did I do the best I could do?

How could I have done better?

And of course…

Can I keep doing this?

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

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

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

The Most Unpopular Nursing Post Ever

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Recently an older, male patient said something to me that made me pause.

“I want to thank you for serving me today, and doing it with a smile.”

Service with a smile. Sounded like some slogan for one of those restaurants that makes you wear lots of gaudy buttons and that hangs sports memorabilia all over the wall. I bet they sang some original yet ridiculous birthday song complete with clapping and out of tune voices.

“Thank you,” I replied. “Are you done with your tray?”

Then I hefted his heavy lunch tray into my arms, and it rested slightly on my shoulder as I exited his room.

“Please turn out the light,” he instructed. “And close the door.”

As I pulled the door to, making certain it didn’t slam loudly, a fellow nurse walked quickly through the hall.

She noted the tray on my shoulder, and she commented, “you look like a server in a restaurant.”

I always had drawn many connections between waiting tables and being a nurse, but as I carried his used tray down the hall I considered my role as a nurse and a servant. I supposed I was fine with it.

It’s a common complaint among the nursing community. Being a servant, that is. Being treated like a waitress, a maid, or I’ve even heard it described, “I’m not your momma!” Nursing is a profession, not simply a job anyone could do. You can’t, after all, walk in off the street and suddenly start titrating IV Levophed to maintain a blood pressure compatible with life. Nurses go through years of school, followed by years of on the job training to reach the level of knowledge and competence the job requires. They’re expected to monitor for minute changes in condition that could signal a life-threatening decline, they’re required to understand a myriad of medication doses and side effects, and the level of skillful performance of bedside procedures is of invaluable importance to the medical field. As such a well-trained, highly educated, and much needed provider in healthcare, nurses shouldn’t be expected to perform such menial tasks as fluffing a pillow or retrieving numerous popsicles and jello cups. How about a mint for your pillow?!

This idea we get in our heads, that being a servant is annoying or beneath us, I believe it only aids in breaking down the high respect for our profession. We feel sometimes as if we aren’t being highly regarded by the population for which we care, but I’ve discovered it’s the little tokens of servanthood that help close the circle of healing and wellness for patients.

I’ve been there myself. Run ragged, understaffed, and pulled in multiple directions. When you are literally fighting tooth and nail to keep one patient from dying, and then another asks for a box of Kleenex, it’s a flustering moment. To try and be everything everyone needs is impossible. In such a high-stress and extremely demanding (both physically and emotionally) environment it’s difficult to keep a calm head, much less be Betty Crocker or Mary Poppins. And certainly not Florence Nightingale. We’re too busy double charting patient care for reimbursement purposes! And no food at the nurse’s station! But I digress.

The point I’m trying to make is that while, yes, it’s difficult to be a servant, that doesn’t mean it’s a bad thing. It’s actually ok to be a servant to mankind. It’s actually our calling. If you hate people then serving them through the field of nursing might not be something you need to do. After all, people come to us typically in their most desperate and vulnerable state, and service with a smile might be that one simple thing that makes being sick a little bit easier.

I can remember once taking care of a patient when it really hit me how my attitude affects those around me. This particular lady was a walkie-talkie. She didn’t need to be in the ICU. I had a patient in the next room on a billion drips, tubes everywhere, knocking on Heaven’s door, and here was this lady asking to get up to pee. Again. I sighed and said something or other, to her request. My words didn’t matter as much as my face. Because while my words said “yes, I’ll help you,” my attitude said, “I don’t have time for this.” And perhaps I truly didn’t. There never is enough time in the field of nursing. But what struck me at that moment was how I must have made her feel. As a women myself who uses the bathroom frequently, I wondered how I would feel in her shoes. I would likely feel like I was a nuisance, like I was bugging the staff, like my needs weren’t important. No one should ever feel that way. We have to remember that.

I’ve discovered that patients won’t remember when I did chest compressions and helped bring them back to life. They won’t notice the dangerous med error I caught. They probably will never realize how I advocated for them on the phone with their difficult to deal with physician. They won’t even know if my patient in the other room is far sicker than they may be. What they will remember is how I treat them. And contrary to popular belief, we don’t treat people well for better patient satisfaction scores. We treat them well because it’s the decent thing to do. We treat them well because being sick sucks. We treat them well because that’s what we’d want if it was us or our family in that bed. We treat them well because that’s our job. And treating someone well means having a servant heart, a heart that gives of itself for the betterment of someone else.

It’s easy to forget that.

Nursing is a difficult, frustrating, and often times an overwhelming vocation. Yet it is also a privilege. People come to us at their worst and they say, “help me. Will you please help me?!” They place their life and future health in our hands. Sometimes they place their garbage or their bedpan in our hands, but that’s just a small part of the whole picture of making people better.

So sometimes I’ll carry trays, and other times I’ll start an IV to give much needed hydration and pain meds. Sometimes I’ll spoon feed someone who can’t use their hands anymore, and then I’ll also assist the physician in inserting a tube in their side to drain fluid so they can breathe. Sometimes I’ll give a bath to someone, because being clean just makes you feel good. I’ll hold the hand of a patient who is scared of dying, or I’ll educate family on how to use a feeding tube. Regardless of what I do, it will be a service, and it will be one I provide with a smile. Somedays it’s hard to smile. It’s hard for nurses, and it’s hard for the patient who doesn’t feel well. Maybe it’s even hard for that surgeon who’s always grumpy. Yet I’ll still serve with a giving and forgiving heart, a heart that steps into the shoes of someone else, and a heart that remembers an integral part of my job is serving others, in all capacities. That is why I’m here.