Monday, December 13, 2010

Whispers of Ghosts of Christmas Past.....


Don't look back,

Keep your head held high,

Don't ask them why,

Because life is short

And before you know

You're feeling old

And your heart is breaking

Don't hold on to the past

Well that's too much to ask...

("This Used To Be My Playground", Madonna)


I don't work now. But not a day goes by that I remember a large part of my former nursing career....both the good and the bad...

I was an RN. And I was a certified "critical care" RN, which means you specialized in the care of patients in ICU's or else the Emergency Rooms, the "ER's". I worked the ER's. I was a certified trama nurse, a certified neurology nurse, a certified Code Blue nurse for both adults and babies, and also a wound vaccuum nurse.

And at Christmas time the remembrance of one particular Christmas in the ER always sneaks into my mind to haunt me. And I always choose to shut it out of my mind.....but sometimes that doesn't work and I have an entire flashback of the whole shift. And the the memories break my heart again. It happens every Christmas.....and the pain and feelings of helplessness return with a vengeance, flooding into my mind as if a damn broke.

In my 22 years of nursing it was the zillionth time I was working the ER on Christmas. I had come to know, during my career, that I would most likely work most Christmases, either because I was scheduled to or else I did it to allow a co-worker nurse with children to have it off so she could be with her family on Christmas.

Thus, most Christmases I worked with other sad nurses who couldn't have Christmas off, and we were usually a motley crew of those who worked simply to make a fortune in the double overtime pay rate for Christmas, single nurses with no family, or other nurses who worked for some other reasons like mine.

There is no way around it---ER work is brutal. We used to call it "dog work". By the time you got off work, you'd slogged your way through so much vomit, blood, pus, urine, and feces that it was all over your uniform. And so when you went home, you stepped into the back door and stripped nekkid, throwing the uniform into the washer before you stepped foot in any other area of your home.

Anyway, where was I?

Oh particular Christmas in the ER which haunts me.

It was a very bad night that Christmas Eve in the ER. I was running my ass off to keep up with the never-ending flow of patients, both from the endless parade of paramedic trucks who kept bringing patients with the most horrible of wounds or acute illnesses, and also from the triage area in the waiting room which kept trying to fit patients around the flow of the paramedic patients.

I was so tired and hungry about 6 hours into my 12-hour shift that I just had to eat. But there was no way I could take a break. Nobody was getting a break that night. So I grabbed a half of a sandwich and worked while eating the sandwich. One of my patients was an ectopic pregnancy and she was very nauseated. In fact, she suddenly vomited into a trash can. I patted her on the back and said (through my chewing of the sandwich) "Just get it all out, honey, just get it all out."

During that, I looked up and saw one of my co-workers at the nurse desk. She was staring at me with emotionless eyes. And I noticed that she was eating Campbell's Bean & Bacon Soup right out of the can with a spoon. No water, no heating it up. Just eating it cold right out of the can.

I knew then that she was going just as crazy and insane as I was.

As the night wore on, each way you looked patients were dying or in the throes of death. And there were the patients who were so sick that you were begging the ICU or "the floors" for beds. But there were no available beds and so some patients were simply put on stretchers in the halls. We hooked them up to heavy portable cardiac monitors and IV pumps for their medicines. Carrying the heavy monitors and IV pumps were backbreakers. But we had to keep them alive.

I knew I was in a bad mental place. I knew I was so worn out that I was not feeling any caring towards any of the patients. And then it hit me---I was close to clinical burn-out. And I didn't want to be one of the burn-outs.

A burn-out lost their empathy for nursing in general and worked on autopilot. Their eyes were dead and they rarely spoke except to exchange patient information with the lab, doctor, or other nurses.

I knew I had to change my attitude this night or I'd sink into a burn-out state and would never feel anything for any of my patients again. I didn't want that to happen to me. I knew I would have to do something to change my attitude. But what? What could I do? How could I see through all that blood and vomit? The patients were all starting to look alike to me. I was becoming less and less able to comfort them....

I didn't know what to do but I kept on working. I was starting umpteen IV's an hour. And I was so good at it that my patients didn't feel a thing. Hell, I was so good at IV's that I could slide an IV into somebody's arm in the dark with one hand tied behind my back. And, thankfully, I could still charm the little children that needed IV's so that they wouldn't be frightened too much and wouldn't need strapping down for the scary task.

I was stemming the blood flow on countless patients. I was bandaging wounds, giving suffocating patients oxygen, applying casts, helping the doctors stitch up people with deep, bloody injuries that I'd rinsed out with a cleansing fluid, and I was drawing blood on literally every patient I got.

The lab was pissing me off. They'd call me up and say: "Your blood draws on so-and-so hemolyzed---draw us some more." And then I'd have to waste valuable time to go draw blood again on the patient. And then after a few more times of this, it hit me---the lab was lying to me. I thought maybe they wanted to take breaks against the constant flow of tubes of blood. Actually I don't really know why they did this. But I knew it was for an unacceptable reason.

Upon this realization, do you know what I did? On every patient that I drew blood on, I'd draw a second set of tubes of blood---from the same stick. And so when the stupid lab called me up to ask me to draw another set, I'd send that second set I held in reserve--and the lab was just fine with it. Hah. I had fooled the lab and saved myself valuable time.

Then I heard the radio crackle with a paramedic calling us. I answered it and he said: "Bo, it's Miss Emily again....and we're bringing her in."

I swore in anger.

And I was that much closer to admitting defeat of my attempt at a better mood. I was approaching the dark abyss....

Miss Emily was one of the most aggravating patients in the world of our ER. She was a widow woman, and she never really had anything wrong with her. And so she wasted a lot of our time. She always chose the most busiest times to call the paramedics---and, as usual, the doctors never found anything wrong with her. But I knew that all she really wanted was some attention, as she was all alone in her life, and she wanted a validation that she actually had something wrong with her. I also knew the doctor would be irritated that she was coming in, too.

And at that moment, it struck me!

Miss Emily would be my Christmas project for regenerating my horrible attitude into something positive! I would save myself from my dark depression and mean thoughts by using Miss Emily! So--- I decided right then that I wouldn't be irritable with her like I usually was. In fact, I decided to be as nice as I could. So nice that she would get the attention and validation that she was so desperate for.

So when the paramedics radioed that they were pulling up at the Ambulance Bay doors, I was there......and I had open arms and a big smile on my face! "Oh there you are, Miss Emily!" I said. "I've been waiting for you! I want to make you feel better!"

And, as they pulled her out of the paramedic truck on the stretcher and she saw and heard me, she started crying and said: "Oh, Bo! Thank God for you!" And I hugged her. I told the astonished 'medics to roll her in a certain room and I hung onto her stretcher as they trundled her on the stretcher, patting her hand all the way to the room.
"Now don't you worry, Miss Emily," I told her. "We'll fix it. I want my favorite patient to feel better!"
Miss Emily kept crying tears of gratitude, and I saw a peace come over her face. That look was worth everything to me.

And I treated her like a queen for her whole stay. I quietly told the doctor that all she wanted was a pain shot for her arthritis and some attention---and so the doctor did just that. (ER doctors love it when a nurse tells them how to treat a patient to make their job easier.) The doc was one of my buddies and trusted me for whatever advice I gave him. We made Miss Emily's Christmas Eve a good, wondrous experience. And when she was loaded into the paramedic truck which was going to take her home, I stood in the Ambulance Bay and waved goodby to her.

And you know what?

Miss Emily did save me. She had saved me from becoming a dead-eyed "burn-out", a nurse devoid of empathy for patients that happens to so many ER nurses. I once again had enthusiasm for my job. And I knew, as I waved Miss Emily goodbye, that I would be able to make it through the nightmarish shift that Christmas night with a new heart and re-newed courage.

No matter how bad it got......

Somewhere close to the end of my shift, and I was feeling hope that the clock would show quitting time, there came a 40 year-old girl who said she was having chest pain. Nobody paid much attention to her since ER's don't respect chest pain under the age of 50. But I had a feeling. So I hooked her up to the portable cardiac monitor with the help of my charge nurse, Gregory. As soon as we hooked her up, we noticed that she was in a godawful heart rhythm. It was so bad that we literally had to struggle to keep our faces straight so she wouldn't know that we were panicking inside.

I said: "I'll go get the doctor"..... but then it happened all of a sudden.....

"Bo!" Gregory shouted. "She's gone into V-Fib!"

I turned around and saw that the patient had turned the "death color", a deep purple. The "won't be able to be brought back" color every ER nurse knew and dreaded. Gregory had hit the "Code Blue" button to alert the hospital and he was already following the V-Fib protocol of shocking her with the defibrillator her by the time the helper co-workers began streaming into the room.

"CLEAR!!" he'd yell and we'd all step away from the bed. And then he did it a couple more times.

But the patient was not responding so Gregory opened the drug drawer of the Crash Cart and threw some reviving drugs over the bed to me. I caught them and opened them quickly, and then I screwed the huge, two-piece syringes together---and then I hurriedly pushed the drugs into her IV. Finally the doctor ran into the room and started giving orders. But still, nothing was working. She was still that deep purple. She was dead on the table. All of us knew it but kept following the reviving protocols as a last ditch effort. (Actually, all Code Blues are the last ditch effort.)

Her husband, who was at her side, started praying loudly to The Lord.

We nurses knew that purple color meant she was dead. Dead as a doornail. She wasn't coming back. In all my experience I'd never seen somebody that death color revived by a Code Blue. Code Blues are not like they are presented on television where the patients are always brought back. In real life 75% of people do not survive a Code Blue. Only 25% make it. And this girl most definitely wasn't going to survive. And yet her husband kept loudly praying to the Lord. We just worked around him.

And then doctor suddenly had an idea.

"Hey Bo," he said. "Let's try that new drug protocol for Code Blues's---Let's try the drug Amiodarone! Go get an IV of that going after a starting bolus." (A bolus is a large loading dose, done before the IV starts.)

I turned to go get the Amiodarone IV bag........and then I heard something which made the hair stand up on my arms and the back of my neck.....

The patient suddenly "pinked up", looked up at us, and said, clear as a bell: "I'm back!"

All of us nurses (and the doctor) were so in shock that all we could do was stare at each other. If I hadn't seen it myself I wouldn't have believed it. Because we knew. We all knew that patients who have been coded and "wake up" don't even know they've been gone---much less that they CAME BACK!

"Praise the Lord!" her husband hollered.

Came back from where? I wondered....

They ended up calling the helicopter to fly her to a cardiac hospital after we stabilized her. I got her ready and then when the flight crew arrived, I helped them roll her stretcher up the elevator to the helicopter landing platform. It was scary up there because there were no side rails. I swallowed hard because we had to follow a narrow pathway to the actual landing platform which was at least 200 feet above the ground outside. And then I helped the flight crew get her into the helicopter with all her IV's, portable cardiac monitor and IV tubings intact---and all while giving "report" to the flight doctor and nurses on just what happened to her, what drugs we'd given her, and how we coded her----and then how she'd woke up saying "I'm back". They were just as shocked as we were.

While I was there, on the landing platform, I looked with envy at the flight crew's pins. Every ER nurse attaches pins onto their employee badge from various certifications they've earned. Bit the helicopter crews' pins were especially coveted but it was a rare nurse who had one. The flight crews only gave it to the people they considered exceptional. I gazed wistfully at the flight captain's pin.

As I stepped back to allow them to take off, the captain of the helicopter stepped towards me. He slowly took his helicopter crew pin off his own badge and handed it to me. I got tears in my eyes and said "Thank you so much....." He sid: "You're good, Bo. Don't ever change."

I cried when he said that. But he understood. And he gave me a big smile---and then they all got into the helicopter and flew away towards the cardiac hospital.

A day or two later I talked to the doctor about her. I asked him about why she said "I'm back" after being dead.

The doctor said: "She told the helicopter crew that she had gone to a really nice place where all her dead relatives were. And she loved that place so much that when they told her she had to return to being alive, she said she didn't want to leave. But her relatives told her she had to come back to earth to raise her children".

I got goose bumps and tears in my eyes when he told me. And I believed it--I believed it because I'd seen her DEAD on the table. And yet she came back and knew she was back instead of being confused or in a coma like most patients who've been coded.
When it had happened, and the patient was successfully coded, the nurses had all congratulated each other and the doctor on a successful Code Blue. Greg looked at me and said "Whew..... that was a close one." But I don't think it was our measly drugs and defibrillator shocks that brought her back. I knew it was her husband, who had invoked The Lord.

That night, when my shift was over and I was allowed to go home, I stopped by the ER's Christmas Tree. Because every person is granted a wish on the Christmas Tree on Christmas Eve. (So be sure and get yours.)

And I won't tell you what I wished for---but I felt renewed and and motivated for my work with patients after that......

And I went home with a lighter heart...




Charlotte said...

Bo, I know you say this is a nightmare memory for you but I think it is a very heartwarming story. Thanks for sharing it.

Deb said...

Wow! What a great true story. Thanks for sharing.

Sue said...

Oh wow...

Thanks for sharing Bo. I'm in awe of the story. You do such a good job of making it real for us readers.

Btw, great job on your shopping adventure!

Bo... said...

Thank you so much--Charlotte, Deb and Sue. In the last couple of days that episode kept playing over and over in my mind, driving me nuts, and so I wrote it down as a blog post. That helped me, I think (hope). I feel better now that's it's out of my system.

Susan said...


This story was a shot in the arm for me! Thanks for your magical way of writing, your way with words puts us right into the story. I still think you should write a book on your nursing adventures.

Merry Christmas!

Bo... said...

Susan, thank you so much! I do have a manuscript in the making, but I'm so busy (or procratinating) that I haven't cleaned it up for a literary agent to read. But I will get it done one day!

Cindy/KS said...

What a heartwarming, but emotional story! I love the way you have of telling them also. You just draw people into the story with you.

Bo... said...

Thank you, Cindy! Your comment brings a bright spot to my day!