Insights from a Girl Who Knows Better

Mar. 30, 2020

This is the calm before the storm. We are on Day 20 since the area’s first case of COVID19. Our emergency department has been working diligently attempting to get into a new routine. PAPRS and gowns...wear this mask today but not tomorrow...hold onto this mask for 7 days...it’s airborne...it’s droplet...it needs a negative pressure room...a neutral pressure room is fine...did the patient travel recently?...travel no longer matters...did the patient have fever?...not everyone has fever...the list goes on and on...

 
I am a girl from West Texas, the Panhandle actually but most Texans group us together with West Texas.  I love so many things about that part of the world but one of my favorite things is watching a storm roll in. It’s different out on the plains than it is here in the metroplex. In West Texas, you can literally see the storm for a hundred miles before it gets to you. It grows and it changes as it moves nearer and nearer to you. You can actually see it building. You can see it getting taller and more powerful. You know it’s coming and you can see how bad it is going to be. It’s mesmerizingly beautiful and yet terrifying at the same time.  You know without a doubt when it’s going to be a bad one. 
 
That’s exactly how I feel about COVID19. It is definitely moving in quickly.  On March 10 we had our first case in the area. It has been chaotic since that day to say the least. Our daily census is down but we don’t really feel it. All of the donning and doffing takes extra time and extra effort. What used to take 5 minutes now takes 20. Even a simple IV start takes triple the amount of time because you are trying to do your job through protective goggles that are fogging up with every breath you take. It’s uncomfortable. It’s hot. You feel disgusting and dirty...contaminated. You are scared that you will contract it and either die from it or give it to someone you love and then they will in turn die from it. You are scared that before this is over your hospital will run out of PPE leaving you vulnerable while
fighting this war against an invisible enemy.  Some days you cry at work. Some days you cry after work. Some days you cry on the way to work. This pandemic is already taking its toll. We read about the horror stories from China, Italy, Spain, New York, and New Orleans. We know it is coming. We can look at their numbers and know that any day now we will be seeing double the number of patients that we are used to seeing. That is what every ER is facing right now. I cannot imagine seeing 600 patients per day. Many of which will need to be intubated and admitted, to where I’m not really sure. Who will take care of these patients? Logistically, if we normally see an average of 300 patients per day we will need another entire ER staff (days and nights) to care for the number of patients that are getting ready to walk through our doors. We will also need another entire ER. I can tell you 100% without a doubt we aren’t ready. Please don’t misunderstand me. I truly believe the administration from my hospital is working around the clock trying to solve these issues. They know. They, too, read the headlines. They can see the storm coming. They have been present and accounted for.  In my entire career, I have never been able to more easily identify the face of the president of my institution before now. Multiple times a day he is in our department and interacting with the staff. He is worried. We all are....Even scared. We are scared because we see the storm coming. I look into the eyes of my coworkers and wonder which of us will lose our lives in this battle. It will happen.  We all know it will happen and yet we continue to show up...shift after shift...This isn’t political. This isn’t a hoax. This doesn’t discriminate.  If you have the luxury of staying home, please do so. Keep yourself safe. If you work in healthcare, wear your PPE. Conserve your PPE. Save your masks. While right now wearing a mask for 3 weeks might seem disgusting, a dirty mask will be better than no mask at all.  Listen to those who have already been fighting. They know. And for God’s  sake,  look up from your phone...glance up to the horizon and look for it. The storm is coming. I can see it rolling in and trust me...it’s a big one. 
 
May. 31, 2017

One of the funny things about trauma nursing is the fact that we are always there at the beginning of a crisis.  We swoop in like a swarm of bees, working together in critical situations.  We can literally start IVs, calculate critical medications, put tubes in every orifice… all within minutes…sometimes even seconds. What we do can literally determine whether a patient is given a chance of survival or not.  We are irreplaceable.  We are fierce.  We are masters of time manipulation.  We are all of those things and all of those things are imperative in the beginning of a crisis. 

Moving forward, patients are often rushed off to the OR and then the ICU where they will spend weeks healing.  It is during those weeks that the patients and their families form a bond with their doctors and nurses.  They don’t really think about the ER and what happened there.  Most likely, the patients don’t even recall being in the ER. Their families don’t either.  You can’t really blame them.  People are in shock in the ER.  The patients are in shock…  The families are in shock… 

When a trauma makes the news, you will hear the patients and their families thank the first responders, the doctors, and the ICU nurses.  Rarely is the ER even mentioned. I often joke and say that the ER is like the ugly girl in the movie who decorated for the prom but didn’t get invited to go.  It’s sad but true.

Having said that, you should know that ER nurses are built a little bit differently than most people.  For the most part, we don’t need recognition.  We do our jobs because we love it. We do our jobs because it’s our passion.

Today, I watched in awe as someone near and dear to my heart was being discharged from the hospital.  I think I have been holding my breath since the day they were admitted.  The nurses who cared for that patient didn’t need pomp and circumstance.  They didn’t need to be remembered.  What they needed was to see their patient live…and that’s exactly what they got. 

Jan. 16, 2017

Today, when you came to me after being involved in a motor vehicle collision, I was there for you.  I made sure you were going to make it.  I followed my algorithms, I started your IVs, I pushed your bed to CT scan…I wasn’t thinking of me, I was thinking of you.

Today, when you had lost so much blood and were still bleeding, I was there for you.  I made sure your bleeding stopped.  I monitored your blood pressure and your labs.  I transfused so many units of blood.  You were so grumpy, but I didn’t lash out. You smelled so bad, like rotten flesh, but I didn’t leave your side until after I pushed your bed to the OR and handed the baton to another nurse that would continue what I had started.  I wasn’t thinking of my father, I was thinking of you.

Today, when you had been driving a car that was smashed by another, I was there for you.  While you were laying there in pain from injuries that could potentially take your life, I bent down and I told you it was going to be okay.  I watched as your blood pressure dropped and notified the doctors.  I didn’t waste time, I ordered your blood, the blood that you desperately needed.  I held the hand of the doctor who was learning to be a doctor and told him what we needed to do.  I knew we had to act quickly, with not a minute to spare.  I wasn’t thinking of my mother, I was thinking of you.

Today, when you were alone after almost a century on this planet, I was there for you.  When other patients needed me, I took one look at you and knew how sick you really were.  I made paramedics wait for me to take over their patient until I knew you had the care you needed.  I stayed in your room, collecting the pieces to the puzzle because I didn’t believe that you were over-medicated.  I knew you were on the verge of sepsis.  I knew that at your age you wouldn’t be able to wait the 2 hours it would be before I could return once I had left.  I respected you for being my elder and for being gifted with so many years on this planet.  I wasn’t thinking of my sister, I was thinking of you.

Today, when you had left so much of your flesh back at the scene of your crash and you were writhing in pain, but scared and wanted your family, I was there for you.  I called 5 different phone numbers on a wild goose chase but didn’t stop until I found your mother.  When she arrived, I hugged her and I held her and I told her you would be fine.  I made sure you both had the emotional support you needed.  I wasn’t thinking of my second family, I was thinking of you.

Today, what you didn’t see was the text that I received from my mother at 1258.  What you didn’t taste was me choking back the bile from my urge to vomit as my heart broke.  You see, in that text, I found out that my “second dad” was found dead in that very moment.  What you didn’t hear, was my screams inside of my own head saying, “NO NO NO NO NO NO NO NO”.  What you didn’t feel was the pain in my chest knowing that the people I love, MY PEOPLE, were 6 hours away.  What you didn’t know, is that in that very moment, at 1258, my world had changed forever.  What you couldn’t know is that today, the whole world became a little darker. Jokes won’t be as funny because he won’t be here to tell them.  Fish will never be quite as big because he won’t be here to catch them.  Mischief will be lonelier because he won’t be here to instigate it. His wife will be second-guessing herself for years, wondering if anything she could have done would have made a difference and how she can ever move forward without him.  His daughters will feel a little lost wondering what “daddy” would have told them to do when their life is in a slump or how happy he would have been to see them in times of great joy.  His best friend will pick up the phone to call him for God knows how long and wish with all of his heart he could get him back. A piece of our family is gone forever and he has taken a part of my heart with him…a part I won’t get back.

But you didn’t know this.  You simply saw me as your nurse.  You needed me to help you on what you believed to be the worst day of your life, never knowing that it was one of the worst days of mine. You didn’t know any of this…because for the last 6 hours of my shift, I wasn’t thinking of me, I was thinking of you.

 

Dec. 31, 2016

I have never been one to make New Year's resolutions.  Instead, i prefer to choose a mantra...one that helps me find a new perspective.  This year has been an interesting one for me. Somewhere along the way I let my spirit go. Literally, I let it go. I lost myself somewhere in between negativity and feelings of inadequacy. I'm not telling you this to gain support or affirmations. I'm telling you this because I know that some of you were probably guilty of this, too.  

 
I have been extremely pensive for the past few weeks attempting to choose a mantra for the upcoming year. Unfortunately, the most uncomfortable part of this process is attempting to determine which area in my life needs the most improvement...where I can make the biggest impact on my own personal path to inner peace. 
 
I love my marriage. I love my kids. I love my profession. However, in 2016 I feel like I wasn't the best wife, the best friend, the best employee, the best mother, or the best anything that I could have been. I lost my magic. I lost my drive. I couldn't even find my happy place IN my happy place. 
 
There is good news, though. After much thought, I figured it out. I know what happened. My focus was out of focus, so to speak.  All of my life, I have focused on what I could do for others. I have focused on a life of serving my fellow man...not just on the clock at work, but constantly serving. That's not what happened in 2016. This past year, I focused A LOT on myself. I focused on the things I don't have. I focused on all of the changes that I viewed to be negative. I focused on what WASN'T happening in my life instead of what I was giving to those around me.  And through all of this negativity, I lost my ability to dream. (Not the kind of dreams you have at night, but the kind of dreams that give us purpose.) I'm tired of this inner-me that has developed and so here it is...my mantra for 2017:
 
Focus on others and learn to dream again. 
 
I will admit, it's not a hallmark card. It lacks the poetic finesse of my mantras of prior years. However, this one is the most important one I have had in a very long time. It's time to find myself wrapped in happiness and inner peace again. 
 
So Cheers and Happy New Year! 
 
Here's to the ones who dream
Foolish as they may seem. 
Here's to hearts that ache. 
Here's to the mess we make. 
     -Mia, lala land
Sep. 21, 2016

I remember a time when ER medicine was the most amazing career known to man.  Fast-paced problem solving is purely addictive.  It’s an adrenaline rush matched by no other.  I also remember a time when ERs felt like a gigantic team.  Working together to solve a problem in an opinionated, highly charged environment…ahhhhh, the good ol’days. 

Now, ER nurses and physicians feel like baby birds in a nest, their necks stretched out as far as they can go, just waiting on someone to force the food of information down their throats.  There is no more collaboration.  There is no more opportunistic think-tank.   

Management teams are at their wits end trying to solve problems when the easy answer is right there, within their reach.  Here are a few simple ways management can improve a department:

  1. Truly give ownership to the staff.  (Physicians, Nurses, and Techs) That is all it would take.  No more threats of being sent home without pay.  No more threats of being fired because we work in an At-Will Employment State. Employees who are paranoid are less productive and have bad attitudes.
  2. Make them BELIEVE that you BELIEVE in them by trusting their opinions.  Don’t belittle them by poo-pooing their concerns behind their backs.  It always gets back to them.  ALWAYS.
  3. Make them feel valued by listening to them.  Show that you have listened by making change. Nurses, Techs, and Doctors are in the trenches. They know the truth about the issues.  Managing by metrics can only get you so far.
  4. Make them feel like a part of the team by keeping them in-the-know, instead of in the dark.  The most effective management teams I have been a part of have been truly transparent.  It may not be your preferred management approach, but type-A personalities generally need the “Why” attached to changes. If a rule doesn’t make sense, it will not be welcomed with open arms.
  5. Avoid the terminology EFFECTIVE IMMEDIATELY.  This is a dictatorial approach to change that is rarely perceived in a positive light.
  6. Do everything in your power to make it feel like a light-hearted place to work.  Laugh, be honorable, allow friendships to build.  When people feel loyalty to each other, they will always go the extra mile.
  7. Stop managing one by managing all.  Seriously.  Remediate those who fall short and leave everyone else alone.
  8. Build an environment of trust. Keep your word.  It’s that easy.

The problems in ER Medicine aren’t just problems with the mismanagement of its employees. It is time that staff members begin to hold themselves accountable for what they are contributing to the disease that is overtaking our field.  We, as staff members, need to understand that we are often times part of the problem. Here are a few things that bedside staff members can do to improve our departments.

  1. Bring a positive attitude with you to work.  Sometimes in life we have to “fake it ‘til we make it.” If you are having a rough time, don’t poison the rest of your team.  Chances are that if you simply focus on the good, by the end of the shift you will be smiling, too.
  2. Choose your battles.  Don’t buck every change that comes your way.  Doing this only makes management perceive you to be negative and unwilling to change.
  3. Do your best, every single day. A systematic approach to the care that you give will make this task an easy one. 
  4. Stay the course.  Don’t be an employee who lives with “one foot out the door.” Be dedicated.  Commit to stay to endure the ebbs and flows that your department will undoubtedly experience.
  5. Get involved. While often times it can feel that you aren’t being heard by management, sometimes it’s just a battle of wills.  Don’t be afraid of retaliation.  If you are handling yourself in a professional manner, things will go your way. 
  6.  Focus on your patients. They are the real reason you are there.  You love helping people in crisis.  If you didn’t, you wouldn’t be in the field of ER medicine. 
  7. Be the kind of team member that you would choose to work with.
  8. Don’t tear people down, build them up.  It doesn’t matter if you have been in this field for 2 months or 20 years, we all still have things to learn.  Embrace each other.  Acknowledge the special gifts that we all bring to the team.

I cannot imagine my life without ER medicine.  It is because of this, that I am committed to making it better.  Leaving isn’t an option for me.  I hope that you feel the same.  I look forward to walking this path with each and every one of you. Together, the future of ER medicine doesn’t have to seem bleak.  Together, we can heal the world.