It’s not what we do, it’s who we are.

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Sometimes, I get inside my car, I shut the door, and I cry. I just sit there and cry, because honestly, I just don’t know what else to do.

We’ve all been there, those 12 hour shifts that magically turn into 14, 15. You’re exhausted, your feet hurt, you haven’t eaten, and you’re overwhelmed with emotion or numbness, whichever one the day brought on. You don’t want to reflect, you just want to drive…but you have to, you have to cope, nothing good can come from bottling it up inside. So, you cry. You just sit there and cry. Then you wipe your face, you put on your seatbelt, and you drive home in silence, because in our world, sometimes the absence of sound is the best therapy of all.

The last few weeks have been tough for us, our job is hard, and people don’t understand what we do. It can be incredibly frustrating. Our acuity is high, our volume is outrageous, and we are exhausted. Physically, mentally, emotionally, exhausted. The people I work with are incredible human beings, I’m not lying, these people are the cream of the crop, and they are worn out, how could they not be. I seriously lost count of the traumas and strokes we had in one shift last weekend. It’s a lot to swallow. Pumping on the chest of a teenage traumatic arrest, followed by giving tylenol to a screaming baby, de-escalating a violent psych patient, cleaning a GI bleed, and then chasing an angry lady with dementia down the hall. Only to empty your beds and start all over again. It will wear on you.

I just wish you could watch these people work, with their red faces, sweaty foreheads, loving hearts, kind hands, and tired eyes. Eating M&Ms for dinner out of the “community candy dinner pile” for the third night in a row. It’s amazing. They don’t complain when they hear the report of another trauma or incoming patient, they gown up and stand tall, ready for whatever the next challenge may be. They are inspiring. They are heroic. Each one playing a vital role, each one looking out for the other, and all of us dancing together to save lives. Never losing hope, never forgetting who we are, and never losing that spirit, the one that keeps us laughing on the darkest of days.

I don’t always know how we keep going, how we find the strength to get back up, put back on our scrubs, and walk back through those doors. I won’t lie, sometimes it’s hard. It seems as if there must be much easier jobs out there, jobs that don’t demand life or death, jobs that don’t require driving home in silence, but that’s not what we do. So we pick ourselves up, we wipe the sweat from our brows, the tears from our eyes, and we push on. We keep going, because it’s not what we do, it’s who we are.

-Melina

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Finding Peace Here

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I watched four people die this weekend, four people. Sounds horrifying right? Well, it is.

Surely these people must have been sweet little 90 year olds, who lived long happy lives, drifting quietly off into the night surrounded by family they love. Well, that is not my story, in fact, that’s never my story. My story is filled with people who woke up, got dressed, and started their day, just like you and I, having no idea that it would be their last.

The room above looks so benign, shiny and new, full of promise and cutting edge medical equipment, ready for whatever may roll through the doors. Exactly what you would want if you were the one lying in the bed. But, there is much more here than meets the eye. So many things, things that can’t be seen by those who haven’t stood in this place time and time again.

You may wonder what could hide here, what could be lurking behind the glass doors and freshly painted walls. Just what do I see when I look at this place? I see so many things. I see countless hours of hard work, sweat, and tears. I see a floor covered in blood, trash, gloves, and whatever else may land there in the middle of the mess. I hear gut wrenching screams, the indescribable sound of a weeping mother, and the words “time of death” many more times than I care to admit. I hear the pumping of the level one, the hum of a ventilator, slamming drawers, alarming monitors, and the loud sigh of relief when we “get them back.” I see gowns, trauma surgeons, confused patients, ET tubes, code carts, flushed faces, shaking hands, and countless lives, both saved and lost. You see, I have been on both sides of this bed, and I can tell you they are equally terrifying.

You may think that there is no way anyone could find peace here, or that there is any way to see beauty in this mess. To tell you the truth, some days I’m not sure either. Some days I leave defeated, I let the dark win, and I am certain there is no way I can work one more shift. Then, just when I know I can’t step back in that room, something amazing happens. We save a life, one, that’s all it takes, and you know you can pick up the pieces and carry on. I recently cared for a patient with dissecting AAA, scary shit, I don’t care how many times you’ve done it. This man drove himself to the hospital and arrested walking through the triage doors. Incredible timing right? Not only did he regain consciousness in the ED before going to the OR, he walked out of the hospital a week later, that’s right, walked out. AMAZING! How does that even happen? That shiny room worked its ass off that day and won, we won! I can’t describe the feeling. Nothing can compare to saving a life.

In the middle of the chaos it’s hard to see the significance of the work we do. We just power through whatever the task is at hand. Lines, labs, intubation, compressions, chest tubes, splints, the list goes on and on. It isn’t until after the event that we can step back and look at what we have done. What went well, what could have gone better, and come to grips with the fact that the person we just cared for was in fact a person, not a job, not a task, but a human being. Someone with a life, and a story of their own. For me, it’s in that very moment I find strength and peace in what we do. There is always something beautiful, even in the worst of situations. The pure will to fight, to live, and to carry on, even when it hurts to breathe, is what keeps me coming back for more.

So yes, that room can be a horrific place. It can be scary and lonely, but it can also be amazing and inspirational, a place of love and triumph. Each day, each patient, brings a new chance to fight, to win, and to find beauty in unthinkable circumstances. Behind those glass doors are many hidden things. Many things that most people will never see or feel. Things that have made me laugh, made me cry, built me up, and knocked me down. Most of these things can’t be shared, and that’s ok, they don’t really need to be. If you live it you understand why, and you also understand how it’s possible, to find peace here.

-Melina

Photo credit: MCR trauma room in Loveland, Colorado

Extraordinary

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As I sit and reflect on my life, I find myself humbled. Humbled by the business that takes place all around me, the real fight for life and struggle against death, the palpable emotions of situations I often find myself in, and the incredible strength of those whom I work alongside. It’s the stuff movies are made of and it is truly amazing to watch.

Working in an Emergency Department creates such an interesting outlook on life. One that knows and understands all to well the fragility of every single breath and the vital importance of embracing all aspects of living, even the scary ones. We are the truest definition of realism. Would I like to wrap my kids in bubble wrap and never let them out? Yes. Do I? No. Instead they can be found jumping on the bed, because let’s face it, it’s awesome. Riding their bikes outside, because nothing is better than the wind on your face, and occasionally, get ready for it…eating cupcakes for breakfast (I know, I’m out of control.) Simply because life is often cut way to short, enjoying the little things is what matters, and in the end all of these things are little.

I think about my day, nothing out of the ordinary happened, nothing note worthy, nothing that any of us will probably ever remember. Just a typical shift at work. It was the normalcy of this day that in the end took me by surprise. You know, we all feel accomplished when we give TPA and watch as stroke symptoms improve before our eyes, when we catch sepsis early knowing that a mother will now one day leave the hospital and return home to her children, or we save a precious life after restarting a tiny beating heart. Everyone knows the importance of that work, it can be seen and felt by anyone around. It’s everything else that most often goes unnoticed. The real behind the scenes work that happens every minute. The little old lady with dementia who is fighting like hell, the intoxicated man in the hall who shouts obscenities at anyone who passes, the appendicitis, bowel obstructions, broken arms/legs, screaming babies, the dysfunction and frustration of the psychiatric service system, the list goes on and on. This is the bulk of what we do. These people are scared, sometimes we are too, and they come to us for some sort of relief.

Sometimes I like to just watch , like a fly on the wall, as my co-workers buzz around tirelessly caring for others. Crying, laughing, talking, singing, telling stories, sharing our lives with these people, these people who are in crisis, doing anything to ease their pain or their mind, whichever is in need. I was walking through our department yesterday and noticed a nurse standing at the bedside of a critically ill man. He was alone, intubated and sedated, but yet there she stood, just holding his hand. Reassuring him quietly that we were going to take good care of him and that his family was on the way. No one was there to praise her, the patient most certainly will not remember this gesture, but she was still there in that moment of need. Amazing. These fragile yet resilient people who are all around me.

For those of you who don’t do what we do, who haven’t seen things that can not be unseen, be thankful. Be thankful that you don’t have to know what we know, and that you live in a world where there are people who are able to internalize all of this. People who can go to work and do things that most simply can not fathom; and for those of you who find themselves beside me in the trenches, thank you. Thank you for being selfless, for giving and giving when I know sometimes you feel like there is nothing left to give. Thank you for doing what is right, even when no one is watching. I saw you rock that crying baby to sleep. I saw you walk that little old lady to the bathroom after you clocked out because she seemed unsteady on her feet. I saw you buy that man whose wife was dying a cup of “good” coffee from the cafeteria, out of your own pocket, because after today, he just deserved it. I saw you silently shed a tear as you left the room of a pediatric cardiac arrest, then go call and check on your own little ones at home because the pain was too much to bear. I heard you clapping and cheering with the family of a patient who just found out that there was no brain tumor after all.

I know sometimes you laugh when something is going wrong, and people think you are crazy, but the only other option is crying and if you start you may never stop. I know you’re tired, I know you hurt, and I know you love your job so much that you can’t imagine doing anything else. I am so proud to be a part of this with you, you all amaze me, and even the days that don’t seem extraordinary, are.

~Melina, ED RN