Oh So Very Keri

the Dark Spleen Rises

Today our houses unite to remember a great man.

We will always remember the lesson you taught us - bad actions don’t make a bad man

It doesn’t matter how inevitable it was or how much was done to stop it. A patient dies on your watch, you find a way to blame yourself.

Yeah, his troponins bumped 20 points in a day and he was on multiple pressors, too unstable for the cath lab, and his transvenous pacer wire became dislodged and wouldn’t capture, and then when it would again his left ventricle was so damaged by the infarct that even a good VPR at a rate of 80 generated no blood pressure. The logical reasons for his body’s failure.

But your nurse heart says:

If I had just titrated his pressors more effectively If I had just turned him more gently If I had just noticed his decline sooner If only he had been assigned a better nurse……

…..and what? Nothing would have gone differently.

But still, the sick feeling, the unrest.

You still have to hear the distraught cries of the family over the phone, and watch them shuffle into the room in tears to say goodbye.

You still have to go to the utility room and choose the appropriately sized shroud (fancy word for plastic body bag.) You still have to put a patient sticker on a tag and tie it his toe. You still have to zip that bag up over his face in a way that seems so undignified no matter how much respect there is in doing it.

You still have to look at the lifeless body and know that you were assigned a living patient, and that patient is no longer living. On your watch.

“Reason and heartache don’t speak the same language.”

ET tubes out of stock, we’re just using Yankeurs now.

Right now, there is a baby nurse who is searching online and deep inside for an answer. There is a brand new member of the profession who is questioning her calling. There is a newly-minted graduate who wonders how school seemed to teach her everything and nothing all at the same time. There is a greener-than-grass new hire who is praying that she doesn’t kill somebody at work tomorrow, and wonders if she already did yesterday.

Dearest baby nurse, don’t let this scary new world drag you down. You’re going to have moments when you are sitting on a toilet seat for far too long, probably for the first time in your entire shift, and question why you even decided to become a nurse in the first place.

That’s okay.

You’re going to have days – many of them – when you plop down in your car after leaving work two hours later than anticipated; and you’re going to turn off the radio; and you’re going to roll down the windows; and you’re going to cry the most painful and ugly cry.

That’s okay.

You’re going to have shifts where your head is spinning and your hands are shaking and your brain is thinking faster than your fingers can type.

That’s okay.

You’re going to have moments when you clean more bodily fluids in one 12-hour day than an average person might in a lifetime. You’re going to feel that – sometimes – you’re the only person on the entire unit, because everyone around you is just as busy as you are.

That’s okay.

You’re going to have times when patients yell at you for something you didn’t know (that perhaps you should have). They will complain about you to anyone that might listen. They may even become so frustrated with their care that they threaten to leave. And this is going to bother the hell out of you.

That’s okay.

You’re gonna listen for 20 minutes and still not hear a damn murmur.

That’s okay.

You’re going to have moments when you feel like something “just isn’t right” with the patient in your care. You won’t have enough experience as a frame of reference for what may be happening, or why. You’re probably going to feel helpless in these moments – it’s a “tip of the tongue” phenomenon to the highest degree.

You’re going to feel devastated the first time a veteran nurse yells at you – even more so when their reaction is for something nit-picky and non-essential. You’re going to mumble something unsavory about them under your breath.

That’s okay.

You’re going to call a doctor to clarify an order, and she’s going to complain. She’s going to want answers, details, vital signs, and a picture of what is happening with your patient, and you’re going to word-vomit something that probably makes very little sense to an angry cardiologist at 3 a.m.

That’s okay.

You’re going to walk into a room expecting to pass your morning medications and come to find your patient unresponsive. Maybe she’s stopped breathing. Perhaps she’s lost a pulse. Either way, you’re going to bring forward everything you learned in every class, clinical, and scenario – and forget how to do any of it. You’re going to scream for help. You’re going to look like a deer in headlights. And you’re going to wonder, “When the hell am I ever going to be able to be as good as they are?”

That’s okay.

You’re going to lose that patient, on an unexpected shift, and in an unexpected way. You’re going to think it was your fault. You’re going to be riddled with guilt and feel ashamed of how you reacted. You’re going to replay that scenario in your head over and over again, and every time wonder why you didn’t see it coming. You can’t always see it coming.

You can’t always be the hero. And that’s okay. Because someday you will be.

Someday you’ll understand the subtleties and nuances that no one can teach you except for time Herself.

Someday you’ll be able to balance the full-fledged mountain emergencies with the miniature mole-hill ones.

Someday you’re going to address a patient or family member who is frustrated with a sense of firm yet compassionate care, and will know how to redirect their emotions.

Someday you will call a doctor, and she will thank you for keeping such a close eye on whatever concern you’ve already handled.

Someday you’re going to finally take a lunch break, and it will actually be during lunchtime.

Someday you’re going to do chest compressions or inject medications or ventilate a patient, and your paralyzing fear will be replaced by sheer adrenaline.

Someday, somebody is going to die on your watch – but whether it’s through blood, sweat, and heroics or a quiet and accepted end – you will have made a difference in the journey of that patient and his or her loved ones.

And while some days you may still feel like a hamster on a wheel, going through the motions just to stay afloat – someday you will realize that you are not the one sinking and needing to be saved. Rather, you’ve grown into a life raft for another baby nurse, insecure and unaware of all of her untapped potential.

Someday you will understand that the nursing profession is perhaps the hardest of them all, but in so many different ways, the most rewarding.

And someday you will stand up for yourself; stand up for your patients; and stand up to the barriers that impact your highest capacity to care – this day will remind you why you trudged through every tear, scream, and exasperated sigh.

So do not give up, baby nurse: new to the world in which nurses beget nurses; still questioning why nothing ever ends up like the texts books might have said. No matter how bad it feels – no matter how hard it seems – always turn to the nurses who can teach you that one can have a brilliant mind and a beautiful soul; one can be funny when things feel too serious; one can be tough as nails and still be softened by the circumstances; one can make mistakes and still maintain integrity. Stand your ground, baby nurse; ask questions; study hard; prioritize what matters; own up when you don’t know; and don’t let anyone beat you down – especially that little voice in your own head. If you allow yourself to do it, you’ll be amazed by how quickly a baby nurse can grow.