***Note: This post was written over a number of days, so I apologize for any non-linear parts that don’t quite make sense. And if you’ve read part of this post before, stick with it for a second time because it is much better now and I actually finished it – five days later.
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My bad days in the E.R. are generally a misery trifecta composed of: 1) Excess “We’re all going to die alone” moments, 2) General feeling of uselessness, and 3) Mean nurses.
1. We’re-all-going-to-die-moments
Ok – clearly this is an overly dramatic way to describe this feeling, but really, I have no other way to describe this particular aspect of the trifecta.
On my bad days, We’re-all-going-to-die-moments tend to follow me around. And sometimes, like last Thursday, I have four or five of these episodes and I leave the ER wishing I had never, ever shown up and knowing I didn’t make one bit of difference in people’s lives.
On a scale of 1-10 on the Fear of Mortality scale (1 being never afraid of death and 10 being incapacitated by fear) I probably waver between 3 and 7, depending on the day, hour, moment. This may be a personality trait that makes me unfit for nursing – I don’t know. Maybe just unfit for anything besides midwifery?
Thursday, I started out with a patient in her later nineties, in the ER because she had fallen at home. She actually walked herself into the ER (no cane, no walker) with her home attendant, but was triaged and put into a C-collar (one of those neck-stabilizing collars that looks really uncomfortable and that patients are constantly trying to wiggle out of). She couldn’t hear me because her hearing wasn’t great anyway and the C-collar was blocking her ears.
As I took off the top of the patient’s nightgown to do an ECG, her home attendant told me that she stuffs the patient’s bra with tissues so she feels more womanly (that patient had one breast removed from earlier breast cancer). I told her that was a very nice thing to do and that I would be sure to put her bra back together when I was done. Which I didn’t – because she ended up in a hospital gown anyway. And later, I felt badly about that conversation and saying I would do something that I didn’t.
The patient was getting more and more lethargic as I did the ECG and dozing off. I asked her home attendant if she was normally like this, and she said yes, but she was still making me a little nervous. As a very green nurse, the slightest deviation from “The Normal Limits” makes me a little jumpy. I presented the ECG to the nurse, who presented to the doctor, and they made the decision to take her to the Cardiac Room. Generally, this is a pretty serious thing, because beds in the Cardiac room are limited (only 4) and a move there, after looking at an ECG, generally means some sort of unpleasant arrhythmia.
***Note on the ED layout: In our ED, we have a large “A Area” for general medical patients, a smaller “B Area” for non-emergent surgical patients, a four-bed Cardiac Room for MI’s, strokes, DKA – and other real medical emergencies. We also have a four bed Trauma Room for surgical sorts of traumas (car crashes, air conditioners falling on your head, assault, gun shot wounds, etc).
So, this particular patient was transferred from the A Area to the Cardiac Room where her home attendant was asked to wait out in the hallway. This is where the story becomes VERY anti-climactic – at least I warned you.
The doctor tried to interview the patient and the patient either couldn’t hear the doctor at all or was having some changes in mental status. Either way, she just looked around, lost, with very misty eyes and called out, “Where’s my girl!?” referring to her home attendant.
The patient looked so alone and sad and now, this non-relative, Indian woman – the home attendant – was the only person she trusted and she was calling out for her. I don’t doubt the sincerity of the home attendant, but it struck me as so sad that the only person now caring for this woman was paid to do so – and that was good enough for the patient. She just wanted “her girl.”
I didn’t realize I was crying until a few seconds of staring into space in the patient’s general direction. Thankfully, in the ER, absolutely no one is ever paying attention to anything but their task at hand, so my tears always go unnoticed. This was one of my “We’re-all- going-to- die- alone- moments,” which are only amplified by the Cardiac Room environment – where family members and caregivers are generally asked to wait outside and lots of strangers, beeping machines, tubes, and needles usher people out of this world.
2. We’re-all-going-to-die-moments, but worse.
Another patient – a contracted 50-something man came in for pneumonia. He had some pretty severe brain damage from a year earlier and was very, very contracted from a year of inactivity. I remembered my contracted patients from the nursing home (another place that left me wrought with anxiety) and immediately felt uncomfortable.
I helped put in a Foley catheter and hoped to get out of the room before I saw much more – I was feeling very fragile that particular day. Mind you, some days, I can watch horrible things with very little emotion (look for an upcoming story about truly horrible thing and a needlestick injury)- it just depends on the day.
So, before I could leave -I had to face my worst fear – his wife came in. His wife who loved him, very, very much. And she came over, put her arms around this prematurely aged, contracted little man and cried while she whispered in his ears about how much she loved him and would get him home soon.
This sort of family interaction leads me to a We’re-all-going-to-die-alone addendum which is one step worse. Family interaction like this – when you remember that you are going to lose your loved ones eventually – while you listen to a family member cry over their loss – it’s too much.
So I just snuck out and sat in the bathroom for awhile collecting myself.
2. General feelings of uselessness
Thank goodness this part of the trifecta is very simple. No more depressing stories for now. Plus, my uselessness is improving every day. When I started my job, I was limited to ECG’s, finger sticks (to test patient’s glucose/sugar), cleaning up, and moving patients/empty beds from room to room. One day, I wandered around for 30 minutes without anything to do, pacing from area to area.
Our emergency room has almost more Corrections Officers (CO’s) than patients sometimes, and generally they just sit in chairs, along the walls, watching the ER goings-ons. So, during this 30 minute period when I had nothing to do, I got very paranoid that the CO’s were all watching me and laughing to each other about my general uselessness.
“Ha! Look at that nursing student – she is totally just staring blankly at patient’s beds, hoping that no one notices that she is doing NOTHING! Oh, now look at her go, pacing to another bed. Bet she is going to go untangle some cardiac monitor wires while she hopes no one notices that she has NO IDEA what else to do!! There she goes, pacing again.”
Damn CO’s – always watching.
Clearly a delusions since they are all busy chatting, comparing tattoos, talking about how many more years they have until retirement, and occasionally escorting shackled patients to the bathroom. A delusion yes – but added stress for me when I am in the throes of a very-bad day?Yes!
I’m up to printing labs, looking at charts, drawing bloods, setting up medlocks, and sometimes helping the nurses with meds, so my hope is that this chapter of my bad days will soon be a thing of the past.
3. Mean Nurses
I started this post a few days ago, and, right now, happily, I can’t think of any really mean nurses that I work with. Even Nurse Q – who NEVER smiles, has ZERO affect, and a monotone voice – was nice to me today. I mean, as nice as a person can be who appears to be made of stone.
So, I can’t comment on the nurses for now.
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