Brie Gowen

Savor the Essence of Life

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.

What I Thought When My Daughter Said She Wanted to Be a Nurse

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This morning when I woke I realized that I had been dreaming about work all night, and I already felt worn out about the idea of completing a thirteen hour shift at the hospital after nursing in my sleep for the past six. That’s the thing about being a nurse. It’s all consuming; it’s not just a job. 

And it was this knowledge that persisted when my daughter said she wanted to be one too. She’s only four, mind you, but she’s started becoming interested in things that interest me, and I wasn’t very surprised when she cuddled up under my arm to watch a medical show with me this past week. 

Mystery Diagnosis, one of my faves, played across the flat screen, and rather than the Disney movie that held her little sister’s interest, my almost-kindergartener wanted to watch along with me. I let her watch the less gruesome shows, and she actually seemed to like them. 

“I love these medical shows, Mom.” She stated with glee. But then she caught me off guard by adding, “When I grow up I want to be a nurse like you!” 

I was honored, for sure, yet I was also hesitant. But instead of sharing the multiple thoughts that bombarded me at the time, I just kept them to myself, and I said, “You can be anything you want to be, baby.”

See, the thing was I knew more than she did. Naturally. She was just four as previously stated, but it was more than that. I knew what being a nurse meant. 

Being a nurse meant more than just a job. It was a lifestyle, a vocation, a calling, and one that once held turned the individual upside down. 

As a nurse I was connected with my patients through my care. I knew them intimately, I cared for their physical and emotional, and even when I left the bedside they were still on my mind. There was no leaving your work at work. Not really. I had tried. 

I understood that once you became a nurse the way you viewed life changed. You no longer took health for granted, you appreciated life, family, and time spent with those who made you smile. You had seen things you couldn’t unsee, horrors that changed your perspective. 

You couldn’t look at bulging veins on a stranger’s arm and not imagine cannulating them anymore than you could ignore keeping an eye on your spouse’s blood pressure and cholesterol. You couldn’t drive by an accident without feeling like you should stop, and when children played haphazardly outside you stood ready to intervene if necessary. A nurse knows they’re never really off duty. 

In nursing you dreamed about it, you worried about it. It wasn’t just something you did, but rather who you were. 

My little girl saw cool gadgets and excitement on the television screen. I saw a mother crying in the background, not sure if her son would pull through the traumatic accident. 

My daughter saw a job she respected, and I saw a profession I gave my heart and soul. She didn’t know I prayed for strength before each shift, or that I often cried in frustration over the parts of it that I was powerless to change. 

I knew that being a nurse meant stretching yourself physically, mentally, and emotionally to the point of breaking. And then stretching some more. 

I knew the occupational hazards the field contained, the physical hardships it entailed, and the emotional stress that a nurse carried every day. I knew these things, and I worried for her. I wasn’t sure I wanted my baby to experience any of that!

Yesterday I was on the phone with a military bank I use that also specializes in assisting veterans. As I spoke to a woman and gave her some personal information, such as occupation, she interrupted me saying, “Thank you for your service. I mean, thanks for your past military service, but also thank you for what you do now. I know that’s a tough thing you do.”

I was honestly shocked silent by her words. I was humbled, but I was also reminded that nursing is something very special indeed. 

Yes, it is difficult, and you betcha it’s frustrating, but it’s also a wonderful thing to be a part of. Words can’t express the satisfaction the field can bring to your spirit, or the fulfillment you have after being a part of something miraculous. 

A newborn baby’s healthy cry, a tearful thank you from a grieving mother, or a strong, hearty handshake from a man you were certain wouldn’t pull through no matter how hard you all tried. 

The camaraderie felt amongst a fluid team, that self-satisfaction when you achieve something you felt was unobtainable (even just a crazy-hard IV stick). Or the joy on someone’s face when they finally go home!

A stranger thanking you for your service in the field of nursing. That pride only a nurse can feel. 

Maybe that was something I did want my daughter to experience, and at that thought I finally relaxed. 

Now I knew how my own mother (a nurse) felt when I told her I wanted to go into the field. Now that distant look in her eyes at the time made perfect sense. 

“You can be anything you want to be, baby. Anything at all.”

To the New Nurse: Don’t Stop.

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I watch you, you’re unconsciously chewing on your lip as you study the intake and output of your patient, and you slowly backspace the paragraph you just documented. I watch you, wide-eyed and nervous, and I remember.

I remember what it was like to be the new guy, to feel like all that excitement over finishing the grueling task of nursing school was suddenly not that big of an achievement after all. In the face of so much unknown you feel like the air is slowly being let out of your balloon, and I remember that too. You feel lost in a world of so much left to learn, and I don’t envy that part of it at all.

My first year out of nursing school was a scary, overwhelming test of my commitment to the field, and there wasn’t a day that I didn’t question had I made a mistake. And as I watched you fretting over every tiny minute detail I saw myself twelve years prior. The frightening fear of screwing up royally was that fresh in my mind.

But aside from watching you with a nostalgic remembrance of the towering task that is being the new nurse, I also smiled at your fresh commitment and steel determination. I watched you checking, and then double-checking, and I wanted to scream, “don’t stop!”

Don’t stop being so worried about messing up that you cease to pay the utmost attention to every detail. Keep doing that! It will get easier, you’ll develop a fluid rhythm, and a confidence in your performance, but never, ever, ever allow that self-confidence to become a comfortable complacency that makes you miss something important.

Don’t stop asking questions. I know you feel stupid right now, and you feel like all you do is ask questions, but consider it a learning experience. Your entire career will be a learning experience. Your knowledge base is going to increase dramatically over the next couple of years, but never assume you know all the answers. Keep asking your peers.

Don’t stop being so kind to your patients. You’re so fresh and untainted by the frustrating difficulties that can accompany interpersonal relationships with people who are in the pit of a serious illness. Hold tight to your kind heart, and hold even tighter to your calling to care for people. Some days that calling will be what carries you, and you must never become hardened and bitter to those who need you. This is hard.

Don’t stop doing the right thing. As time goes by you’ll see how real world nursing compares to theory nursing. You’ll learn short-cuts, and you’ll develop your own way of doing things based on a mixture of all the nurses who are currently showing you their skill. You’ll see some you wish to emulate, and some you definitely don’t want to be like. Whatever tips and advice you decide to adapt to your practice you must never compromise your ethics. Never forget that your actions affect a living person. Keep your integrity, and never stop doing the right thing.

Don’t stop seeking areas where you may grow as a nurse. I know right now you feel as if all you have is room to get better, and that’s fine. That’s all of us! Every time I step on the unit I learn something new, and I build upon the base I started years ago just like yourself. Don’t become satisfied with where you are in your knowledge, skills, and abilities. Keep stretching, keep growing.

I see you new nurse, and honestly, I’m kind of jealous. You are a blank slate, more or less, with a promising career before you. You can do anything you put your mind to, and your commitment to further yourself as a professional is written all over your anxious face. While I don’t envy your feelings of being overwhelmed and your desire to stay afloat in a sea of so much information, I am envious of the strength, integrity, and crisp outlook you have for the road ahead.

You’re determined, you’re eager, and you are steadfast. Don’t stop. Whatever you do, no matter how much you evolve into the profession, don’t stop being exactly how you are right now.

When a Nurse’s Patient Becomes So Much More

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Being a nurse isn’t easy. Aside from the physical stresses of the job, there also lies an emotional component that makes it extremely difficult and taxing on the caretaker’s ability to perform. When faced day in and day out with so much disease, poor outcome, negativity, and ultimately death it becomes necessary for the nurse to place a protective barrier between the patient and herself. It’s not that they wish to develop a hardened heart; you couldn’t do the job without compassion. It’s simply that a professional wall of sorts must be erected to prevent full exposure to the nurse’s tender spirit. If she didn’t do this she would burn out quickly after multiple episodes of collapsing in the hall floor like a useless piece of sobbing jello. 

I have done this. In my professional life I have an invisible shield that protects my heart. It’s like it is semipermeable, allowing empathy to affect my care, and allowing compassionate kindness to connect with patients as real individuals, but it also always whispers in my ear the hard truth. You are the strong nurse. They are the sick patient and struggling family. They need you at your best!

When faced with performing quickly, skillfully, and without mistake to execute lifesaving intervention in a critical care setting it’s pretty much necessary to keep a small divide of emotional connection from patients and family. To prevent a nurse’s eventual, emotional collapse it’s imperative. 

It’s required, kind of like licensure renewal, so imagine my surprise when I let him become more than just a patient. 

I noticed right away the lines on his face. They ran deeper than many I had seen, and his white, full head of hair crowned his murky, blue eyes. I knew before I even looked at his chart that he was a very old man, and it seemed like we saw more and more of his demographic as medicine progressed. But more than I noticed how the deep wrinkles on his face defined his age was how they seemed to transform when he laughed into the most perfect joy I had ever seen on a human countenance. His eyes crinkled, the murky blue cataracts seemed to disappear, and all I saw was a happy man content no matter his circumstance. I fell in love with him immediately. 

It happens I suppose. There are certain patients you connect with on a personal level more than others, but this seemed different. I listened to the stories of how he and his perfect little wife met, and I found myself honestly enthralled to hear more. I wasn’t biding my time until I could slip out the door, and it hit me then that I had stopped really enjoying listening to my patient’s personal stories some time ago. I had been missing out, and as I laughed heartily, a real chuckle and not just a forced guffaw to be polite, I wondered if I had done the right thing. 

I was of two minds as I reminisced with my new friends, and I found myself guarded and slightly frightened that I was enjoying their company so much. I quickly excused myself to go and chart, and as I sat at my computer I understood my complex feelings. I hated that I didn’t do this sort of thing more as it was really wonderful, but I also knew why I didn’t. 

My eyes looked at the monitor screen of my advanced age patient, I scanned the new orders for upcoming interventions, and I was afraid. I feared for him, something I tried not to do, but I couldn’t help myself. Over a period of two days I had allowed him to become more than just a patient to me. I had let down my normally ever-present guard, and I had developed a true affection for him. I mean, I love all my patients, even the difficult ones, but I really cared for this old man. And I realized as I sat at my desk that I was overly worried that he would die the next day. Medicine is a wonderful thing, but years of experience had shown me that once you reach a certain age the risks inherent with us fiddling around in your insides increased exponentially. 

I spent the remainder of my shift trying to push my fears away, and even though I wished to remain polite and kind, but safely distant, I just couldn’t. He was sad I wouldn’t return to be his nurse the following day, and with tears in his eyes he said, “I really need you to come hold my hand before I go to surgery tomorrow.” 

Before I left I hugged him tight, and I said, “I love you.” I probably would have whispered it any other time, but he was as hard of hearing as the day was long, so instead I screamed my unique farewell. 

And I left. I clocked out, and I tried to leave him behind like I left them all behind. I had to! Do you know how many times I return and the bed is empty or occupied by someone new, not because of getting better, but because they got worse? There’s no where to go above and beyond critical care except the OR or the morgue, and I left work at work for that very reason. It protected me. It sounds cold I suppose if you’ve never been there, but sometimes calculated indifference is the best thing you can offer for the longevity of your vocation. 

But I couldn’t leave him behind, and I couldn’t forget about him and his darling little Missus I had wanted to bring home. I went to bed with prayers for them on my lips, and I awoke with a strong desire to know how he was doing. I tried to push it away all morning long, using my time to care for my children, but he persisted at the back of my mind. 

I suddenly knew why I was delaying the inquiry. I was worried he would be gone. I was worried my fears would be realized, and I knew that in my attempts to separate myself I had not gone and just held his bony, pale hand like he had asked. I would feel guilt, grief, and I just wasn’t ready for that. 

I pushed it away as long as I could, but by lunch time I found myself calling work and asking for my replacement in his care. Please be okay, I whispered to myself as the on-hold music played, and I realized my left hand was clenched. 

I don’t think words can express how I felt to hear he had pulled through just fine, and as I thanked the other nurse profusely I finally let my fisted hand relax. I started to chastise myself for my worry, and I was still surprised I had let it get to this. I had allowed him to become more than just a patient to me, but I realized then that it was okay. I was glad in fact. 

Whether he had made it or not, whether he lived through the week, or made it ten more years, and even if he died that day, I knew I wouldn’t regret our interaction. It had reminded me why I do what I do, and even though it was emotionally stressful much of the time, it was because of the person behind the hospital gown that I existed as a nurse. 

The person who was the patient, they were why God had placed me in the field to begin with. It was still necessary to separate myself to some degree for my own sanity, but there was also nothing wrong with falling in love with an elderly couple who had broken my normally solid shell. 

The field was full of disease, but it was also full of healing. It was full of bad outcomes, but I also had the opportunity to see some really amazing miracles. It was riddled with negatively, but the positive situations were what really shined the brightest. It was true, there was a lot of death, but there was also life. There were stories of falling in love, gut-busting laughter, and wonderful relationships that reminded us why we became nurses in the first place.