I thought I knew.

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I thought I knew. Really, I did. I mean, I’ve seen it all right? I know how it works. I have directed more people than I can count to this very room. You know the drill. “If you will have a seat right in here, I will make sure the nurse knows where you are and they will come get you after they get them settled in the room” and then they wait, that’s it. That’s why they call it a “waiting room” but, I was wrong. I had no idea what happens in here.

This room is nestled right outside our biggest ICU, and houses the family and friends of all the patients in our neurotrauma and medical/surgical intensive care units. The sickest of the sick. One of those places where the nurses speak a different language, one of drips and art lines, and know their patients more intimately than some people know their own families. A place where full recovery is rare and the ODA staff have pictures hanging on the “ICU family wall.” I am sure it can be a place of laughter and celebration. A place where people survive, pull through, and do miraculous things, but I think more often than not the outcome isn’t rosy, and the patients either die or move on, there just isn’t a time to see them walk out of the hospital. A place where quickly learning how to leave “work at work” is a survival technique, and being off your game is just not an option. These nurses are awesome, plain and simple. Seriously, they rival my ED staff, and you all know how I feel about them.

I had the honor, and I do mean honor, of spending some time in this space just a few months ago. Not as a patient, but at my grandmothers side as she spent the last few days of her life having every little need met by these incredible people. They adjusted her drips, combed her hair, monitored her CVP, intubated her when she lost her respiratory drive, watched for trends in her serial blood gasses, gave her bed baths, held my hand, laughed with me, cried with me, fed me, rubbed her feet, paced the halls with me, problem solved with me, covered me up when I fell asleep, controlled her pain, put lotion on her face, called the doctor, and stood by us as we made the hardest decision I have made to date. Then they extubated her, turned off her drips, reassured me, and helped me cope, when I just couldn’t take another breath. They were flawless. I’m sure they may not have felt that way, because we didn’t save her, we couldn’t, but they were flawless. Everything that I could hope someone would be to my family if I ever found myself on the other side of this bed.

In the days I spent here I watched people come and go, some only stopping by for a moment, just a visit, and others who never left. Wearing the same clothes for days and sleeping in chairs with a pillow propped on the wall. Parents with small children who just wanted to go home, but were afraid if they left they may miss that final moment. Young girls sitting in the floor making “get better” and “we’re praying for you” poster boards, complete with glitter and glue, at 3am, trying to convince themselves the person on the other side of the door was going to survive. Whole families, I mean 20-30 people sobbing in each others arms at the news their young daughter would not ever awaken, and watching her father as he gasped for air. Feeling such real pain for people I had never met. Mothers, sisters, wives, brothers; crying, praying, cursing, wishing, anything to ease the pain. Tired eyes, throbbing feet, and exhausted hearts. People at the end of their rope holding on for dear life. Pacing the halls with their cold coffee and tear-stained shirts.

I hadn’t ever really given much thought to what happened inside that pretty little room with the frosted glass windows. How many hearts had been broken, how many unheard cries for help had bellowed down the halls, and how many people had cursed the sky, or lost their ability to breath, to speak. Hurt so bad you can barely feel. Once you have been there, once you have seen that place and the faces that come and go, you can’t ever forget. There are very few times I can remember witnessing pain that intense. I mean I knew, but I didn’t KNOW.

Being an ER nurse is a hard job, we see a bit of everything, the good, the bad, and the ugly; and often times we taste this pain, this palpable anguish of the ICU, but this is a different world. One where not only the patients, but everyone you meet is fighting for their life. Everyone is holding on by a thread, praying for a miracle, and hurting in a way that you can’t describe until you have lived it. It’s intense, it’s incredible, and it’s beautiful. The will to survive…Now I know.

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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

Somewhere There’s A Nurse

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Nursing, the most trusted profession in America. We don’t think about it often in the hustle and bustle of our everyday, but that’s a pretty intense statistic. People trust us, exclusively, with almost every aspect of their lives. Through the good and the bad we are who they turn to. They expect us to be on our game, present, and know all the answers, at any given moment. We don’t get to have an “off” day, or someone may die. We must sift through the mess, dig to the bottom, and give every ounce of ourselves to anyone who walks through the door. We learn to watch for trends, patterns, or any subtle clue that may tell us something is about to go down. This isn’t bad, in fact, it’s pretty awesome, and I am most certainly not complaining. This is my job, my calling, and huge portion of who I am. It’s an honor to care for these people, even in their darkest moments.

I was thinking about Nurses Week, how one week a year everyone tells us how great we are, and how thankful they are that we, “do what we do.” Regardless of what your calling may be as a nurse, this is your time to shine. Truth is, I know they appreciate us all year-long, even if they don’t vocalize it, but it’s easy to forget about the daily sacrifices we all make if you’re not on the ground running. Now don’t get me wrong, I like Nurses week, I think it’s a nice gesture, and I am always happy to receive my new cup, tote, flashlight, or whatever the gift of the year may be. Just a token of appreciation for our hard work; but to me, being a nurse is so much more.

I have had the honor of knowing and meeting so many amazing nurses in my life, not just in the ER, but all over the place. Though we all have vastly different jobs, they are equally as important. We all play a vital role in the health care system and overall well-being of our patients, and not one of us could function independently. We need each other to get by.

I worked triage this past weekend, and for anyone that is an ER nurse, you know what an interesting group you can encounter in just one shift. You are literally the front line, the face of the hospital, and the catch-all for whatever stumbles in. Talk about being on your game, this is it. Every person has the potential to crump, to leave out a minor “detail” that could change everything, or to be “that patient,” the one that teaches you a lesson you will never forget. This is not a solo job, there is so much work that goes on behind the scenes, but even so, it’s a pretty scary place to be. My biggest fear sitting in that chair? That someone will run in carrying a blue, limp baby. It’s happened, more than once, but it’s never fun, and it takes days, sometimes weeks for me to shake. You see, I have been that mother, the one whose tiny babies weren’t able to breathe on their own and were born that scary shade of blue, the one your gut just knows is bad, and even though we like to think that as nurses we are prepared for anything, we aren’t. We are human, and we get terrified just like everyone else.

Scared does not adequately describe the way I felt the day my girls were born. They were early, and I knew they would be, so I thought I was ready. Ready for whatever they could throw my way. Well it turns out I wasn’t ready after all, but you know who was? Their nurses. Those NICU nurses are incredible. I trusted them with my heart and soul. Not that the neonatologist weren’t great, because they were, but they spent minutes a day with us. The nurses were there every single second for weeks on end. They laughed with me, cried with me, understood me, and didn’t judge me when I was losing my mind over spilt milk, bradycardia, and grams of weight. They trusted me, they helped me feel like a mother, even though I couldn’t even carry my girls more than 2 feet away from their isolettes. So incredible the relationship I created with these people. I may have just met them, but they loved me and my girls like family, that was the only thing that got me through those long sleepless nights.

A couple of years ago my grandmother called to tell me she was having a hard time breathing. I sent my husband (who is a paramedic) to check on her. He found her ashen, gray, and diaphoretic, with a heart rate of 12, yes 12. EMS paced her in route and she made it to the ER, to the ICU, and then she arrested. I trusted those ICU nurses and the cath lab nurses without ever thinking twice. They are incredible at what they do, and I knew they would treat her like one of their own. They did, they saved her. She slowly got better, and walked out of the hospital a few weeks later. She is still alive and doing well, I couldn’t be more grateful to all the nurses along the way, I credit their hardwork and dedication for the joy I feel knowing she will attend my girls third birthday party tomorrow. So many moments we almost lost.

It’s easy sometimes to forget the importance of the all the nurses around us. We get focused on our field, our work, and the guts and glory aspect of our job. Is it awesome? Yes. Do I absolutely love it? Yes. But it’s not for everyone, and that doesn’t mean their work is any less meaningful. Right this minute, all around the world, there are nurses working tirelessly to save lives and help others.

Somewhere there’s a nurse compressing the chest of a 40 year old father who just arrested in front of his family. Somewhere there’s a nurse reminding sweet Mrs. Jones for the 460th time today where her room is. Somewhere there’s a nurse who’s hungry, hasn’t peed in 8 hours, and is trying to pass evening meds before the end of her shift. Somewhere there’s a nurse consoling a parent whose whole world just turned upside down with the loss of a child. Somewhere there’s a nurse being berated and belittled by a doctor. There’s a nurse rocking a crying baby, emptying the tiniest chest tube you could ever imagine, and measuring urine output by weighing a diaper no bigger than your palm. Somewhere there’s a nurse taking vitals, giving shots, and holding hands. There’s a nurse intently watching as the 17 year olds ICP creeps up, 3 days after he crashed his motorcycle. There’s a nurse preparing to intubate a 10 year old who is having an anaphylactic reaction, placing a COPD’er on rescue Bipap, and cracking the chest of a stabbing victim as a last ditch effort.

There are nurses who quit their jobs, sacrificed countless hours with their families, and lived at school for years to be able to put you to sleep and keep you safe during surgery. Those nurses eyes can’t leave their patient, not for one second, they hold your life in their hands. There are nurses who function as practitioners, making decisions and placing orders just like doctors, but yet still battle the “just a nurse” mentality. There are nurses who come into your home, to help you when you can’t help yourself. There are nurses helping young healthy people, learn to walk again after the traumatic loss of a limb. There are directors, managers, and CNO’s, who have attended more meetings this week then I probably have in my life, crossed T’s, dotted I’s, and gone to battle for us, day after day. Their work never really ends.

There are nurses on helicopters, landing in the middle of the interstate to rescue a family after they were hit by a drunk driver. Those guys have seen some unimaginable things. There’s a nurse charting, charting, charting, because the patient was so sick that they haven’t charted a thing in hours. Somewhere there’s a nurse administering chemo to a 4 year old girl, who has lost all her hair and is dressed as a princess. Just typing that makes me feel like someone kicked me in the gut, but it’s true.

There’s a nurse crying, a nurse laughing, and I can almost assure you there’s a nurse telling an inappropriate joke. There are nervous nurses who are studying for the biggest test of their lives, tired nurses who spend every extra minute working on school work, and burnt out nurses who can’t take it one more day, they’ve just seen too much. There are happy nurses who just witnessed true strength as new life entered the world, and proud nurses as they watch their rehab patient finally get in the car for the long awaited ride back home.

All around us are nurses, silent superheroes, who do and see the unimaginable. Some of it is amazing, so incredible that it would bring tears to your eyes, and some of it so horrifying that just thinking about it brings intense pain, even to the most seasoned of nurses. The best part of it all is that we have the ability to change lives, every single day. Our job can be thankless, but it can also be beautiful and consuming. The kind of consuming that changes who you are, makes you cherish the sunshine, and gives you the strength to be a better person, a better nurse, one patient at a time. It’s what we do.

Happy Nurses Week to the most complex and amazing individuals on this earth. I am honored to be part of this with each one of you.

-Melina

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