Brie Gowen

Savor the Essence of Life

2020 Tried to Crush the Spirit of Nursing

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“He what?!” I replied in shock.

“He died last night,” my nightshift coworker answered.

I didn’t tell him goodbye.

I didn’t say that last part out loud. I simply thought it to myself. I guess I couldn’t speak it out loud. It was as if I feared giving my feelings a verbal voice would cause the cool, professional demeanor we all strived to maintain to instead crumble in grief. I suppose that part is wrong, though. We didn’t strive to be aloof; we just had to remain disconnected in a sense to keep doing the job. Especially this year.

If any year could go down in history for trying to crush the spirit of nursing, it would be 2020, the year of COVID-19. As a critical care nurse I have watched too many people die this year. I mean, outcomes are often poor in the ICU, but this novel virus has taken things to a whole new level. There was a period of time this year where I watched at least one patient die per my shift, and many times more. One patient doesn’t seem like a lot, until you add them together, day after day, month after month, shuffling in for another crazy shift, praying that a success story would emerge.

A story. You see, it wasn’t just a room number or patient vacating a bed. It was a story, a beautiful life story, a real person, with family, friends, and a purpose in this world. As a bedside nurse you learned these people’s stories. You spoke to crying wives on the phone, you watched hysterical daughters try not to fall apart as they waved through the glass window to their mom who didn’t know they were there.

You said things like, “he seemed like he was doing better yesterday…”

Or you lamented, “I feel so bad for her three, young children at home.”

Sometimes we shared the stories. They were just too heartbreaking to keep inside. We didn’t mention things like names, but rather the way the father of four had made us appreciate life. I had told my husband about this most recent life story.

“Can you imagine,” I asked my husband, “being stuck in a glass box for over three weeks, not seeing your family, just strangers in masks who come in every once and a while? Can you imagine not being able to breathe good enough to even take a bite of food? I feel so bad for him!”

I had not taken care of him the day/night he died. They had given me another assignment. All day I had considered going into his room to say hello. I kept meaning to go in and try and brighten his day, but the hours had passed without me doing it. Whether it was the busyness of my own assignment, or the fact of all the personal protective equipment I had to put on to enter his room, I had missed the opportunity to say hello, or even goodbye. I knew he was doing bad, but I was hopeful he’d make it. I was always hopeful.

“I wish I could hug your neck.”

That’s what he had said, in between labored breaths and the roar of the sealed mask pushing air into his stubborn lungs. I had sang to him. He frigging loved it. He said I made his day. I had come in frequently, even though the gowning up was a chore, and we weren’t supposed to overly expose ourselves. Lord, I had even gotten down in his face, through his sputtering coughing, trying to hear what he spoke in his weak, short of breath conversations. I remember simply praying for God to keep the seal of my own mask tight. That man needed someone to know they cared, to give him a quick sip of water before he frantically asked to put the oxygen mask back on. And it made me feel good when I scratched his back and he said, “you’re the best!”

That’s what I thought of when I found out he didn’t win his battle with COVID-19. His story. And his personal story stacked on top of all the other stories from this year. The woman my age, who also had three daughters. Or the guy who couldn’t speak English and looked scared to death as we tried to explain emergent intubation without an interpreter present. I thought of all the weeping families, and I also thought of the gratitude they had bestowed our way even in the midst of their own grief.

I think about those sad stories, too many lost for a single year, and I try not to think about the coming months, the tragedy they could bring. I cling to things like memories of where I helped ease pain, prayed with a spouse over the phone, or the hope that this virus is getting weaker. I think of Queen Esther in the Old Testament, and how her uncle surmised amidst danger and possible death, “perhaps you were made for such a time as this.”

Maybe that is why we do what we do. Perhaps we were made for such a time as this. I’m pretty tired of unprecedented happenings this year, but I would encourage all my nursing peers with this thought. If not us, then who? Who would care for the hurting and dying? Who would scratch backs, offer a cool drink, or sing a joyful song in the middle of a trying situation?

2020 has tried to crush the spirit of nursing, but we’re pretty good at fighting back. Just know, I grieve with you. I recall life stories cut short with you. I link gloved hands, across the world, and I lift you all up in my prayers. We will beat this.

PTSD in Nursing

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

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

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

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

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

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

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

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

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

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

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

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

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

A Window Into COVID Critical Care

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

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

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

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

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

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

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

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

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

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

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

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

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

The Side Effects Nurses Are Having From COVID-19

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

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

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

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

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

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

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

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

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

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

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

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

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

Check On Your Nurse Friends. We Are Not Ok.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank a Nurse, Today

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

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

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

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

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

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

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

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

How I Fell in Love With Nursing. Again.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.