Brie Gowen

Savor the Essence of Life

A Window Into COVID Critical Care

by

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

by

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.

by

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How I Fell in Love With Nursing. Again.

by

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How to Find Peace in Patient Care

by

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.

The Most Unpopular Nursing Post Ever

by

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.

Dealing With Difficult Patients

by

I can recall taking care of a patient once who was younger than myself, and naturally when I saw the age I wondered what terrible diagnosis had led to the downward spiral of his health. As the report continued I couldn’t quite pinpoint why he was so sick, but it became apparent once at the bedside. He was the reason he was sick! Have you encountered this type of patient before?

“Just leave me alone,” he yelled!

Even as I tried to explain myself in a soft, reassuring tone, he still refused my care. He didn’t want his vitals taken. He didn’t like being turned. The SCDs were annoying. And he didn’t want to take his medicine right now. Except the pain medicine, that is. He refused finger sticks and lab draws. He scowled at his caregivers and just wanted to sleep. Naturally, my immediate response in caring for someone who doesn’t want my interventions is to bristle like an angered porcupine.

In fact, at one point I remember saying, “fine. Maybe you should be your own nurse since you know how to take care of yourself.”

And I left the bedside angrily.

Trying to take care of noncompliant patients is probably one of the hardest things we do as nurses. It’s aggravating to see that same “frequent flyer” grace your floor again because they haven’t been following the medical advice of their provider. They’re the diabetic patient whose family brings them a six pack of Mountain Dew. They’re the ones who set their alarm to wake themselves when pain medicines are due. They’re the CHF patient eating fried chicken from the local gas station, or the morbidly obese patient who refuses physical therapy to regain strength, day after day. They’re the Hypertensive Crisis who didn’t fill their prescription for Lisinopril, or the COPD exacerbation who still smokes two packs a day.

With this particular patient I listened as another staff member called him a name I had honestly thought myself, but I couldn’t stop thinking, what happened?! I mean, what made this guy just decide he was going to let his health go down the toilet? And at such a young age? As I contemplated this question I realized that surely he didn’t want to be bed bound. Surely he didn’t want to go through the painful procedures his body now required. So what had happened in his world that made him give up on a full life? It’s a question we should always ask before we write a person off.

I’ve realized over the years that a big part of being a nurse, and more importantly a decent human being, is the ability to try and walk in another person’s shoes. It’s not easy. I think it first really began to occur to me when I saw my coworkers talking about an overdose patient. They called the woman crazy, and I guess it hurt me because I come from a family full of generations of people who had problems with addiction and suicidal ideation. When I saw this patient I saw a hurting mother, not simply a crazy, attention-seeker who had caused her own problems. Yes, she had been the cause of many of them, but did that mean she truly wanted them? I doubted it.

So, back to my young fella refusing care. As I stared at the computer, scouring his history, I realized there really wasn’t a physical cause that accounted for his physical decline. He had just stopped caring about his life. And how sad was that?! What I had in my bed was a hurting individual, and he wasn’t just hurting from the physical ailments his own noncompliance and neglect had caused. He was hurting emotionally, psychologically, and spiritually. I couldn’t even get him to accept a thermometer under his tongue, so it was unlikely I could cure his scarred psyche. I wasn’t under some delusional savior complex, but I was willing to try and lay down my own anger and offense to offer him the only thing I could provide that he couldn’t really refuse. It was the thing he probably needed most.

Love.

I approached his bedside again. I approached in a spirit of love. Despite his erroneous decisions and disrespectful demeanor, I approached him with an attitude that he was worth something. Even if he had caused his own problems he still was worthy of respect. I did not know the road he had walked, or what had led to this moment. I just knew being sick stunk. I spoke with kindness, I empathized, and I didn’t really explain my purposes for the interventions I needed to perform any differently, but I suppose my own attitude and assumptions were different. So in turn, he responded differently. He accepted my care and allowed everything he had previously refused.

It’s not easy taking care of noncompliant or difficult patients. It’s easy to get angry and feel taken advantage of just for doing your job. It’s easy to be offended, and no one faults us for doing so. We’re all humans just trying our best. But it’s also easy to only look at things from our view. He’s refusing my care! Right?! The harder and more challenging part, though, is to try and take the focus off self and see the patient. Why are they this way? What must they have endured to get to this point? You may never know the answer to those questions, which is hard, but asking them opens your heart to take care of even the most apparently difficult patient.

I always consider myself a work in progress, and this is just another area I know I could improve. I’ll never advocate taking abuse from patients or their families, and I’ll never suggest we should be martyrs for the cause. Nurses should stand up for fair treatment for ourselves and our patients. But perhaps sometimes that fair treatment starts with us. We desire the world to see the hard road we walk as caregivers. Shouldn’t we also try and see the hard road our patients have traveled?

What You Should Know When Your Nurse Doesn’t Come

by

She was gurgling. Oh God, she was gurgling as she breathed, and my heart was certainly beating even faster than the high rate I saw displayed on her bedside monitor. I grabbed shakily for the Yankauer suction above her bed. I knew that’s what it was called. I was in my first semester of nursing school, so I knew what the suction was for, but I hadn’t actually used one on a real person before.

My mother didn’t look like a real person at all. Laying there in the bed, swollen, bruised, with about a billion lines and tubes running from her. She had been flown to this trauma ICU bed after a horrific car crash, and being in the best hospital in the area should have given me peace, but it didn’t. The truth was I was scared to death, scared I was gonna lose my momma, and despite me sticking that suction thing half-heartedly into her mouth, she was still making a sound like she was breathing through water. I hit the call button frantically.

Where was the nurse?!! I wondered. Couldn’t she see this was not a good situation? Shouldn’t someone be stationed right here at her side until she could at least open her own eyes and ask for help? Why was it taking so long?!! Why wasn’t the nurse coming?!!

Fast forward twenty years and now I’m that nurse. I’m the one who wants to be at your momma’s bedside, but who also has someone’s father, husband, and son in the other ICU room. I’m the one who is limited by space and time in my physical body, but who more times than not, wishes I wasn’t.

Here’s what you may not realize as a concerned family member.

  • I am concerned too. Your family member is also important to me. They’re more than a patient number. They’re a human being who is loved. I have been the daughter at the bedside, and one day, as my husband and I age, I realize I may be the concerned wife also.
  • I don’t want you to wait. Seriously. I really don’t. I want to attend to your need as quickly as possible, but when you don’t see me I am attending to another patient’s need at that time. Another important, unique, loved family member who occupies another bed. Or perhaps I am even tending to myself. Trust me when I say you want a nurse with a full belly and empty bladder. We can focus so much better in that condition.
  • I know that being sick is difficult, and I know that watching someone you love fall ill is even harder sometimes. I understand that emotions are raw, nerves are frayed, and angry words come easy in such a stressful, uncertain environment. That doesn’t mean I don’t get hurt feelings or frustrated occasionally, but it does mean I try my best not to because I truly sympathize and empathize with each patient and family member. Those are the things you cannot see under the surface of my calm, efficient manner.

When the nurse finally arrived to my mother’s bedside she quickly took the suction from my hand. She seemed so blasé, as if she was not concerned at all. She went about quickly settling my mother down, and then just as quickly left the room. I wasn’t sure what to think at the time, although I was grateful that my mother seemed to be breathing easier. Looking back I realize I didn’t know that important oxygen readings were being transmitted to a monitor outside the room so they could know immediately if my mother was in respiratory distress.

I didn’t realize at the time that what may have been concerning and scary for me was a natural and expected presentation in a critical care setting. I took the nurse’s demeanor as indifference when it was in fact an attitude of efficient knowledge and calm clarity to act on my mom’s best interest.

I didn’t take into account other patients. I only saw my mother. I didn’t see someone else’s mother in the very next room. And that’s ok; it’s human nature. Even today if one of my children found themselves in the hospital, my mommy heart would feel they were the patient needing the most attention at that moment. The thing is, nurses feel the same about their patients. To nurses, each patient is important and deserving of our care, but it’s our difficult responsibility to triage out our resource of self as fairly and efficiently as possible.

But here’s the other thing I probably didn’t see back then. I am quite certain that nurse cared for my mother. Cared, as in had great concern for her welfare as a human being. From my experience, nursing is a chaotic, challenging, and frequently a poorly compensated profession. So if a nurse is there it’s because they have a heart for the vocation. Their patients are their purpose, and even if it may not appear that way, they care.

I’m a Nervous Nurse

by

I sat counting his respirations, and when I didn’t like what I got, I started over and I counted again. I counted a full minute. My patient slept soundly, and his oxygen saturation wasn’t just within normal limits; it was good. He was good, so it seemed, but still I watched almost nervously. I watched his monitors ready for any change I saw. 

Sometimes I had feelings, you know? They were like an itch under the skin, the ones where no cause of irritation is seen, but that urge to scratch presents itself nonetheless. Sometimes I felt that way about my patients. Sometimes I felt like under the surface something awful lurked just waiting to pounce unannounced, and in my nervous anticipation I would be keenly aware of any minute change. 

I had let him sleep as much as I dared. He woke, although sluggishly, and answered my questions appropriately. His respiratory rate remained stable, and so too did his other vital signs. His lungs were essentially clear, and no problems were observed with his chest tube, or his other body systems for that matter. He was fine. He was fine and dandy, and later as I watched him conversing with family I wondered if perhaps I worried too much. 

It seems I’m wired that way. I’m a nervous nurse, and when all seems well I still keep watch. And especially when a voice inside my head silently urges “watch,” that is what I do. I watch, I wait, and I run through possible scenarios of negative outcomes that might come my way. 

I’ve been in the medical field for eighteen years, and I’ve been an RN for eleven, but no amount of experience and time can ever take away my tense state of mind when someone’s life is on the line. Time has softened the edges of my anxiety, and experience has given me the calm, collected demeanor of a professional even in the face of a hot mess. After all, I’m certainly not the shaking, fearful girl I was my first year out of nursing school, but I’ll be honest. I still get scared sometimes, and occasionally I still shake before my extremely sick patient arrives. So despite the improvements of my clarity over the past decade, I still get nervous. 

Sometimes my nerves prove negligible, and my patient sails smoothly through our time together. But sometimes I wonder if their outcome would have been as positive had I not been so diligent and watchful. I may never know. What I do know is that often times patients crash despite your rapt attention, and there’s nothing you can do. But I try not to give them the opportunity. 

So I stay on edge. I don’t get relaxed, and even if I look like I am, I’m usually not. Instead I’m nervous. It may not be a panicky, wringing hands kind of concern, but it’s always an observant, expectant mode of operation. 

Sometimes I wish I wasn’t a nervous nurse. I watch so many of my peers that I respect and admire. Some get excited at the thrill of chaos, and others seem almost unfazed by out-of-control scenarios that later cause me to question my abilities as a nursing professional. I see their nonchalant approach, and I secretly wish I could be so unconcerned, or rather unaffected. 

But instead I’m a nervous nurse. I suppose I always will be. I don’t stray far from my patient’s bedside. I double-check things, and I persist at assessment of unchanging systems. Just in case. I listen. I listen to my patient, and I listen to the voice inside my head. And I remain nervous. 

Why Your Nurse Keeps Asking About Advanced Directives

by

I believe most everyone thinks they know why there’s such a thing as advanced directives, but I’m not sure if they truly understand the significance. I’m uncertain if they can comprehend why as nurses and physicians we keep asking the question, “do you have advanced directives or a living will?” I’m sure our line of questioning is annoying at times, and I can also understand it’s probably unwelcome. After all, who wants to think about what should be done in the instance of the unthinkable?

I have spent many years in the field of nursing, and in that time I have had the pleasure to care for a vast array of patient populations and diagnoses, but there is one type of patient that I hate to care for. No, it’s not the alcoholic in Delirium Tremens or even the frequent flyer, narcotic abuser. While there are many types of patients that are difficult to care for there is one that especially breaks my heart, and that is the living patient who was ready to die. I’m not talking about suicide either. I’m speaking about chronically ill people who are ready for nature to takes its course, but instead are forced to remain here on earth because they forgot to put their wishes into writing, never let anyone know their wishes, or God forbid, distraught family completely disregards their desires to not prolong the inevitable. 

I’ve seen it too many times, and even recently I’ve seen the torment. A body grotesquely swollen, eyes barely able to remain closed due to the protrusion of their orbital area. A once lovely, regal woman will resemble an alien form of herself. Toes and fingertips purple from diminished blood flow, the bluish color of her digits only rivaled by all the bruising from multiple, repeated pokes and prods by the medical team. Tubes, lines, and wires protruding from every orifice imaginable, and grimaces of pain, despite all the sedatives and narcotics, being the only sign that anyone is even home in there. 

The scene I describe is a common one; it’s critical care. And overall it’s a great thing. It’s a great thing because we’re saving lives, and sometimes you must go through a lot of ugly trauma to find your way out to the other side. But other times it’s beyond just the usual unpleasantness we have become accustomed to. It becomes tragic. A travesty of sorts. 

When a 95 year old man with several, chronic and life-threatening conditions ends up in the hospital with a critical admission related to his progressing disease process it’s always a devastating event, both to family and the medical team. But if this same gentleman has expressed desires to not prolong his life in the event that death is imminent, and his wishes are neglected, it’s a shame. It’s a disgrace to the strong, honorable life he has lived thus far when you take away his dignity and choice to pass from this life on his own terms. 

As the healthcare team we fight to prolong life by all means available to us. That’s what we do. It’s our job, but it’s also our job to fulfill a patient’s wishes. And when a patient cannot speak for themselves due to their condition then that lofty, yet difficult decision falls on the shoulders of emotionally stressed and physically exhausted families. It’s honestly hard to know what to do for someone’s health care choices in the midst of so much chaos. Sadly, sometimes wrong decisions are made by everyone, and you’re left with grandpa hooked up to life support when all he wanted to do was go ahead and join grandma in heaven. 

It’s a sensitive subject, and I completely understand that it’s not one many wish to have a discussion about, but it’s necessary. It’s absolutely necessary. When you have stood at the bedside and seen the futile, honestly ugly efforts to keep a shell of a body going, you would understand. 

If it goes on far enough grandpa eventually dies, but not before spending his final days with a tube down his throat and another up his rectum. Then the question is what it should have been all along? Is this what he really wanted?!

In the end nurses are patient advocates, and in the fulfillment of our duty to do the very best for our patients we will encourage everyone to make educated, compassionate choices. We won’t tell you what to do, but we will offer every available avenue, and hopefully prior to having to make the tough, last minute decisions, we will emphasize the importance of making a health care plan beforehand. 

That’s why we do it. That’s why we always ask about advanced directives. 

We want to save future pain, heartache, and the undue suffering for a human being who only wished to let go. It’s not easy to think about what should be done in the case of physical decline, but the uncomfortable act of obtaining advanced directives is far easier than standing at the bedside and being witness to an agonizing continuation of interventions that were never wanted or deserved. Trust me. 

If you have experienced a family member in this situation then I am sorry, and my heart truly breaks for you. My honest statements of care in these circumstances sound very brutal, but they are only spoken with such raw truthfulness to hopefully save you from having to experience this situation firsthand. 

We don’t ask to be annoying, and certainly not to make our jobs easier. Although it does. No, we ask for the patient. We ask for you. We ask now so as to prevent pain later. 

So, I guess my final question is, do you have advanced directives or a living will?