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Monthly Archives: March 2011

Two Traumas, Lots of Drama

11:09PM, 1 hour after getting home from a 14-hour shift

Well, I am already behind on my pledge to document this ER experience. Little did I know just how draining 12-15 hour shifts can be. Especially as a nursing student fresh off the press, I almost feel like I am being thrown to the wolves every morning at 7am when I walk onto the floor. Luckily, (most of the time) I have a very protective preceptor who keeps me close under her wing, but it’s still a lot to take in for a newbie.

Today the trauma room saw its fair share of blood, gore and more. And I saw far more than my typical allotment. First a man came in who had fallen from a 30-story building. That didn’t last long. While in my freshness I was very much distracted by the nearly-severed foot jutting out from a protruding tibia and fibula and a matching skull flap, the internal injuries were the real outcome-predictor. Seasoned nurses told me that shearing forces can cause the entire aorta to rupture. I only spent a few moments in the trauma bay on that case, but it was more than enough time to be imprinted in my memory. The second case was more hopeful. A middle-aged man came in to the ER already in cardiac arrest with CPR in progress. Lost in the hubbub of the moment was a warning from a veteran RN for us NOT to cut off the man’s down jacket. But once the presiding resident made the call, all hands were on board cutting off and removing clothing at lightning speed. Soon there were downy feathers snowing down and nestling in every crevice. In an already chaotic scene, the sight of the feathers made it even more absurd. I served as the scribe, which was an excellent way to follow the rapid-fire succession of events. From no pulse and asystole, this man was successfully revived and stabilized with a v-tach rhythm before he was quickly shipped off to the cath lab. This was a much better outcome to be a part of. Minus the bird feathers and blood that tarred the floor at the end of the code…

One sad event that really stuck with me and I need to unload before going to sleep. We discharged a young woman who came in for seizures. Since we weren’t on her team prior to discharge, we asked for a brief history. She said that she fell down a flight of stairs during the seizure. My preceptor asked if she hit her head on the way down and the patient nodded, like it was obvious. She asked how she got help and who found her, and this poor young lady said, “What do you mean, who found me?” I took care of myself.”

My preceptor tried to clarify, and asked, “Oh, ok, but who called the ambulance?”

She responded simply, “I got myself up, and called it myself.”

For some reason that really sounded sad to me, and more so when my preceptor asked how she was getting home. She had no one to come pick her up and she didn’t feel safe going to the subway because of all the stairs, and her discomfort around trains. Even though she lived less that 2 miles from the hospital, she barely knew the bus lines. Taking her out to discharge, I glanced through the glass exit doors to see a dusky sky, quickly turning black. My sadness for her was almost overwhelming. No one should both come to the ER and leave completely alone, yet too often this is what happens.

Let’s leave this entry on a funnier note. My first patient of the day was a loud old blind man with an Albert Einstein-esque hairdo, who compensates for his lack of sight by screaming all the time. Anytime a shadow of a person walked by his room, he would yell, “NURSE, NURSE! CAN I GO HOME YET?” When asked to lower his voice by my sweet and mouse-like preceptor, he would yell, “I CAN’T HEAR YOU! WHY DO YOU TALK SO QUIET?” She would reply, obviously bothered by his loud volume, “Why do you talk so loud?”

“I STILL CAN’T HEAR YOU! WHEN AM I GOING HOME?”

“Sir!” Finally reaching to the top of her internal volume modulator, my preceptor gathers all her strength and yells back, “We can’t send you home until we have your lab results. Sir, we are getting them as soon as we can!”

“OH OK! FINE, WELL WHY DIDN’T YOU SAY SO?” Exasperated, my preceptor escapes the room. Thinking it’s over, I go onto the next patient, but it’s not two minutes later that I hear him again, “NURSE, NURSE, I AM READY TO GO HOME. CAN I GO HOME NOW?”

I don’t know why this was so funny, but somehow it was, and we were all laughing. In an ER, where things are so emergent and tense for so many people, sometimes you just need to take things a little more lightly and help others see the small humor in daily things as well. I find that I say cheesier jokes in the ER, and brace myself, expecting a courtesy grimace at most, but I actually get more laughs there than I do at any better jokes that I ever crack outside of the ER. Happiness is a hot commodity in the ER and it’s in demand. I like this work because no matter what, I always find reasons to smile.

 
 

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Entering the Emergency Room

In the wake a devastating tsunami, the nuclear reactor disaster and all the events that have succeeded the earthquake in Japan, it seems somehow appropriate that I begin my integration period tomorrow in the Emergency Room of a bustling metropolitan hospital. When I told the director of my program that I was very interested in Emergency Preparedness as a subspeciality, I had no idea that she would take my interest so seriously and give me an eight-week ER clinical placement. I feel so lucky, and also SO nervous. I am going to try to document this experience, as I work eight weeks under the tutelage and supervision of a RN. I will be taking her normal hours which means 12-hours shifts for a total of 36 hours per week, for 8 weeks.

In my anxiety-flavored preoccupation over what tomorrow will hold, I called my grandfather, for some sage words of advice. In typical fashion, he proffered a few more that I initially asked for, but absolutely helped to assuage my fears. When I told him I was afraid, he reminded me that it was normal to feel scared in a setting where everyone is having personal crises. Nerves run high, but he told me that among emergency personnel, calmness and composure are paramount. He reminded me that people work together in the ED like a well-oiled machine, and that I will never feel stranded. I hope this last part is true. He also told me something that I know: I will feel uncomfortable. I will not feel proficient. I will make mistakes. But then, I will ask questions and I will learn from these mistakes. If I don’t ask a question when I have one, that is the biggest mistake I can make. This is my time for learning, and I will learn.

He also told me that he knows I will be calm in the face of a crisis. I don’t know how he can be sure of this, since I am certainly not sure of myself, but then he told me about the night when my grandma took his own hypertension medication accidentally, and how terrified he felt. In response, he called his cardiologist at home (ah, the benefits of having doctor colleagues) who told him that he could manage the situation on his own, rather than bring her into the ED so late at night. So, my grandpa pushed his fear back and kept it at bay throughout the night while he stayed awake and cared for the love of his life. He told me that he fed her so much coffee, that by the morning he had induced hypertension in my grandma. Not exactly the most settling story for a granddaughter to hear, but very sweet all the same especially since the outcome was good.

My goal for these few weeks is to chronicle my experience, writing down the wisdom of veteran nurses for my future practice as well as the more fun and interesting cases that I run into. Now I just have to wait a few more hours to see what tomorrow has in store…

 
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Posted by on March 21, 2011 in Hospital, Memoir, Nursing School

 

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Bearing Witness

Beyond the overt medicalized interventions that drive healing, I see a role in nursing that now seems so obvious, but was completely elusive to me until recently. The far more abstract responsibility of “bearing witness” serves a number of purposes in this profession. My fresh eyes as a novice student nurse have already witnessed both ends of the spectrum, from a wasted young man’s body ravaged by AIDS to the most beautiful and awe-filled hour of my life: childbirth. Both hold their own meaning and purpose and both have a story to tell. Meanwhile, I have also struggled with my own friend’s disease process, faltering when trying to define my role in the difficult contours of her illness as well as in coming to terms with its unfairness.

In the realm of my friend’s illness, I have realized that right now I can’t be both her nurse and her friend. I live too far away to stay constantly updated on her care. I simply cannot travel to her hospital every weekend, because I have my own health and well-being to tend to as I wade my way through this strenuous program. It has taken a long time for me to fully appreciate, and believe, that I can only give what I have to give. Right now, I can be her friend. I hope that’s enough.

In difficult moments in nursing, I can do more than be a compassionate nurse. I can write about it, a catharsis for me and hopefully an advocate for someone. I can bear witness to the pain, suffering and disease. This is something I first started thinking about when listening to a presentation from Doctors Without Borders (MSF). I used to believe, incorrectly, that they were an organization that just ran into a country in crisis and provided brief, unsustainable interventions. Good first aid, but not long-enduring change. My opinion is beginning to change, especially after listening to an incredibly thought-provoking discussion on bearing witness. Do we provide humanitarian aid to the victims of human-devised tragedy like genocide without taking a political stance? Where do we stand? Who do we treat? I can’t answer these questions for MSF (nor would I even remotely want to try) but I like the concept of retelling the stories, bearing witness and trying to be ethical. I think that some of the “psychological first aid” that they provide in crises actually comes from the re-telling of the stories afterward, in words that reverberate across headlines, blogs and lectures like the one I attended.

 

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