Nurse to Nurse. Hang in There.

I have been walking around with a ball of anxiety in my stomach for roughly two weeks. I knew last Friday would be a turning point. When I left my office that night I packed extra things I normally would leave there. I stopped going to hot yoga two weeks ago.

You know that was hard for me. But I knew from the stories coming out of Italy that after even only a handful of cases in our state the worst was yet to come.

I did a presentation once on mass casualties. The head of emergency response of our state was there. I presented on Hurricane Katrina. The largest barrier for them was helicopters. They didn’t have enough helicopters to rescue people, and they waited roughly 5-7 days to contract with private companies. By then many had died.

I asked the head of operations how many helicopters we have in our state. He said, “One”. You could hear a pin drop. He rushed to add that we “would never see flooding like in New Orleans,” to the roomful of 100+ people now freaking out that we were all going to die.

Two weeks ago I started to get a pit in my stomach because I am acutely aware of the estimated number of ventilators in our state. That was part of my presentation five years ago. I was also acutely aware that the numbers coming out of Italy were bad. Very bad. I started feeling like we were New Orleans being hit by Katrina with one helicopter.

A lot of people are going to die. We are going to be faced with tough decisions. I implored my Mom to stop yoga class and any other outings. I bought into social distancing far sooner than the rest of our country because being in healthcare is a double edged sword. We know the limitations of our system. We know how to interpret statistics and death rates and percentages. I knew two weeks ago we don’t have enough ventilators to save people in a pandemic.

I moved my practice to telehealth only. Of course so did the rest of the USA so it’s been a nightmare dealing with insurance companies. Many patients are still canceling though because they don’t have their own incomes and are worried about medical bills, even small co-pays can be detrimental when people are out of work.

In the midst of me worrying about keeping my practice afloat I received messages from the hospital I work at asking for me to work there in the coming weeks. I know the risks. I also know all the people who work there have their own risks.

I know the doctors with kids with cystic fibrosis, the doctors over 60 with cardiac disease, the nurses with respiratory diseases, the social workers…I know everyone’s story just like they know mine. I know they are risking their health and their families every time they go to work. It’s not a question for me. I have to help out. I didn’t go into nursing thinking there wouldn’t be any hard times.

None of us make enough money for the work we do. But we all take these risks to take care of strangers not just for the strangers, our patients, but for each other. The bonds of health care professionals are what keep us all going. Time and time again when I worked in the emergency department I didn’t show up for management or the money. I showed up for my co-workers. The same is true now.

I know how it feels to be short staffed. I know how it feels to be scared of going to work. I’m scared to go to work. But I’m going to go.

To all my nurses and doc’s and techs and hospital staff- hang in there. You are the true heroes in our society. You deserve the tests that the NBA team received. The disparity in our society that we laud celebrity and neglect our most valuable members of society- nurses and healthcare professionals- is despicable.

I know we are afraid. I know we don’t have enough supplies. I know we are all putting ourselves and our families at risk. From the bottom of my heart I thank you for all you do and I’m with you. I’m showing up at work. I’ll see you there. Tune out the noise and do what we do best. Heal. Tell dirty jokes. Make horrible coffee. Complain about management. And save some lives. We got this.



Top Five Most Memorable Emergency Department Nurse Moments 2/5…

Night shift changes a person.

Not only because it permanently messes with your sleep schedule and actually takes years off your life (Yes that is scientifically proven) but because, well at least for me, it made me a nurse. Not just an average nurse. But an I can handle mostly anything you throw my way kind of nurse.

Night shift is when shit hits the fan. Sometimes literally. Or maybe the wall.

I switched to nights from evenings after I had been working for roughly two years on evenings. In ED terms that’s still relatively new. I was just starting to work in triage, which significantly honed my assessment skills, and had never truly been on my own. Because in the ED you really shouldn’t be. It’s a team setting. So people don’t die.

But nursing is always a shit show. So while there are patient/nurse ratios they are more of a guideline not a hard and fast rule.

So a few months into night shift I already learned that I needed to get good at IV’s fast. I was decent but night shift made me one of the best. Because if I missed there literally might not be anyone else who could do it if there were enough call outs. And trust me, people get pissed if you stick them with a needle more than three times. Especially when it’s their kid.

Eventually I would put an IV into a child’s pinky. Literally. And the mom would request I do the IV every time they came in. She knew I could get it even if all I had was her child’s fingers.

But my most memorable night shift didn’t revolve around IVs. Shockingly. It was a night with a lot of call outs and no one would be coming in at midnight when evening shift left. Myself and two other nurses were covering a full floor of for once, medically ill, not psychiatrically ill, kids. Overnight there was only one Attending and one resident.

Midnight rolled around. Evening shift was antsy to go, so they left. The second Attending hung around charting. Thank God. It had been busy, but nothing life threatening. Until twelve thirty AM when evening shift was gone and it was me and two other nurses. For a packed floor and full triage bays.

I like being busy so it wasn’t horrible. Until I walked in the room of one of my patient’s and they weren’t breathing. It was a baby. The mom was asleep. I started bagging the baby while trying to flip the brakes off the stretcher and yelling at the mom to wake up.

Luckily our Attending was walking by and saw me bagging a patient, said, “OH!” and my team was there. Unfortunately that left the rest of the department manned with only one nurse and one attending (for some perspective day shift could have up to 14 nurses on at once). For awhile.

We had to intubate the baby and admit it to the ICU. By the time I made it to my next patient’s room an hour had passed and I walked in, it was a teenager, and for fuck’s sake they weren’t breathing. We had already diagnosed a double pneumonia. Apparently they decompensated in the last hour.

I started bagging my patient. Fumbling with the damn brakes on the stretcher again, yelling at the damn parents to wake up, and who should walk by but my Attending. She did a double take. I think she thought I was pranking her at first. But I wasn’t. We intubated a second patient.

I walked into my third patient’s room an hour later. The parent’s were pissed. I hadn’t been in for two hours. The one nurse on the floor had hung some IV antibiotics an hour ago though. I didn’t blame them but thus far he was my only patient that was breathing so he had to wait. They didn’t really care though.

I checked his blood pressure and it was wicked low. Tachycardic. Somewhat delirious. Fuck. I shook my head. Unlocked the brakes and rolled him to our resuscitation room and called a medical alert overhead. My other nurse and my Attending whom we had just intubated two patient’s together rounded the corner looking haggard and pissed even though it seriously wasn’t my fault that all my patient’s tanked that night.

He was in septic shock. Perforated bowl. Went to emergency surgery.

Now I don’t remember that night because all my patient’s were close to death. I remember that night because myself, two other nurses, and one Attending were all that stood between them and death. If that’s not absolutely terrifying and amazing and awful and awe inspiring…I don’t know what is.

That’s when I felt it. I knew I wouldn’t forget that night. I wouldn’t forget the teamwork with those two nurses and the Attending. We forged bonds in a battlefield of dying sick children that cannot be described fully.

The most fucked up part about that is how much money I was making. I was getting paid roughly 29$/hour that night plus maybe 7$ night shift differential. To save children’s lives.

Obviously it’s more than minimum wage. But is that what a life is worth to us? My work that night was solid. But in my “yearly review” my manager never brought up that night. She brought up the ED’s budget and nonsense that I had no control over. I was never thanked by management for working my ass off that night understaffed and underpaid and saving lives.

In fact I wasn’t given a full raise that year because the ED had failed to meet some of it’s budget requirements. That never made sense to me. My raises were based on objective financial data. Not the number of lives I saved or who I saved them with or perhaps more importantly who I saved them without.

Nursing makes a person jaded. It certainly made me very cynical. I saw the value large corporations place on human life. Because hospitals are just that: corporations, and it didn’t add up to me.

That night I breathed air in the lungs of patients who couldn’t breathe on their own. I sounded the alarm and helped stop them from dying. That night shaped me as a nurse. I saw the limitations to nursing and I saw my full potential starting to shine.

I didn’t feel new anymore after that night. I felt like I could handle kids not breathing. I felt like I earned the trust and respect of the nurses and Attending that night as they earned mine. I felt simultaneously like the coolest person alive and also the most underpaid.

I remember thinking this is it. This is why I became a nurse. To save some lives. And there I was doing it.

p.s. on non-busy nights when we didn’t have patients trying to die left and right…we did prank the shit out of each other certain pranks involved moving peoples cars in the parking garage pretending they were stolen while others involved body bags. As I said night shift changes people…makes you a little darker.