trauma

Overwhelm

I love the adrenaline rush of working in the emergency room at a level 1 trauma center. I walk through the doors at the beginning of my night shift and enter another world, a world where keen observation precise and clear communication and  quick decisions can save someone’s life. The majority of people leave the ER alive and feeling better, some require follow up, long recoveries and rehab.  Some leave with their lives drastically altered forever.  Some though, never make it. It is part of the reality of where we work.  We witness much tragedy and violence, as well as love, appreciation and healing.  We are with people in some of their most vulnerable moments of their lives. Of course it takes a toll on us, we walk the line between opening our hearts enough to have compassion and keeping emotions in check enough to do our work and keep showing up.  We keep each other motivated, have each other’s backs, share humor, and stories of our lives and families outside of work, cheer each other on and commiserate and vent our frustrations and even share a few tears. We see so much, our hearts break, we breath deeply, maybe cry a little in the med room, and then go see our next patient.  When I walk out the doors in the morning, exhausted, calling “sleep well” and “see you tonight”, I leave that world behind and come home to regular life.  I may share a story or two with my family, but I have learned that most people don’t really want to hear details of how we had to go on lock down again after a gunshot wound was dropped at the door, or how I had to delicately determine if the woman asking me to find her husband, is the wife of the unidentified dead stabbing victim in room 6, or how my patient who had just been beaten and sexually assaulted was being harshly questioned by the police  because she allegedly hit her assailant with a bat. These stories stay inside the ED.  Before the pandemic,  the news didn’t usually cover what we do everyday.  We have been short staffed my entire career, and short of the resources we need to take care of the patients.  We are inundated with patients who are aggressive and violent, have drug addiction and mental health problems, are homeless  and without a way to stay clean and fed let alone take care of their chronic health conditions.   It is the balance of normal life outside the hospital that keeps us going and gives us the resilience to keep doing our work.

This pandemic however has been extremely challenging, in that there is no break when we go home.  The news is full of images of nurses and doctors taking care of Covid19  patients, talk about masks and ventilator shortages, counting of cases and deaths in China, Italy, Seattle, New York.  People are anxious, and concerned for their own health as well as their loved ones.  Social media is teeming with good information, bad information, advice, and some humor. There is no getting away from it. The first several weeks I found myself reading everything, and digging into the research as it was coming out, trying to understand for myself and my practice  and to be able to answer questions for my friends and family.  I quickly became buried in data, and the opinions of all the journalists and public figures.  The anxiety level at work is up as well, our preshift huddles are longer due to the daily changes in protocols as we prepare for the surge of Covid19 positive patients, and the shortages of PPE and equipment. Right now we have enough PPE, we get one mask and gown per shift, it is not ideal; they are supposed to be disposable every time you go in and out of a room. But we have them and we are protected for now. There is a sense of foreboding as we watch the number of cases and deaths go up around the country and wonder how long before our hospital is overwhelmed.  One of my coworkers described it as being in a building with an active shooter, you know they are out there with a loaded gun, you know they are coming through the building room by room and you are just waiting for the S#*$ to hit the fan.  It is going to happen, many more people are going to get sick, they are going to come to the hospital, when will it start?  will we be ready?  Right now it is eerily quiet.  Our regular patients are scared to come in, there are fewer car accidents, bar fights and drunken falls with the stay at home order.  The patients that do come in are real emergencies, today we put 5 patients on ventilators, and our ICU is full.

The rhythm of my days has not changed, I am not home with extra time on my hands. I am not going to lie, I am a little jealous of the people who can work from home, spending time with their families, planting gardens, reading more books, getting projects done, or even meditating more. I miss hanging out with my family. I miss coffee with my friends.  I miss going out to dinner, seeing movies, going to the theater and the opera.

I know I have been exposed to the virus, but I am more worried about bringing it home to my partner or kids, than I am about getting it myself. I have a pretty tough immune system, but my partner does not.  At this point we are not  quarantined from each other at home but it may come to that.  We all handle anxiety in different ways and I have had to learn to be more vocal about what I need to replenish during my time away from the ED.   What helps me is SLEEP!  Walks outside in the sunshine, playing my guitar and singing, watching sappy funny movies, talking on the phone with my friends and my kids. Just seeing my kids on a screen, live, in real time warms my heart and settles the protective mama bear in me.  We are lucky that we have some amazing technology to stay connected in so many ways. For this I am grateful.

Some links if you are interested:

How COVID-19 Actually Spreads (w/Dr. Gloria Hwang)

https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief

The Four Possible Timelines for Life Returning to Normal

 

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stay home stay healthy

We are 10 days into our local stay home order, and a week into our statewide order.  I had to cancel my trip to the midwest to visit my mom, who is elderly and 2 years out from open heart surgery.  She lives alone with my sister nearby and is doing great by the way.  This meant I had 6 nights off before going back to my ED nursing job.  I was faced with a choice; do I pick up extra shifts because our department always operates short staffed even before the pandemic started, or do I take advantage of nights off at home, to rest up and eat well and get outside in the sunlight. I spent time reading the emails from my manager and the hospital administration, I read posts from colleagues about nurses being quarantined, I read about the PPE situation in the department and, the posts from my union rep about actions to take and I realized that this pandemic is going to be a marathon so I decided to take the time off as a gift.  I rarely stay home when I am off from work more than a few nights, we usually travel somewhere, so this time at home feels like a gift.  I have been spending the time doing spring cleaning and reorganizing the kitchen. I am working on a project clearing out 32 years of stored stuff that I have been avoiding for the last 5 years.  I have had time to snuggle on the couch in front of movies, do a little cooking and play my guitar.

I find myself reading studies about SARS trying to understand the truth about what we actually know.  Nursing is my third career and my first one was as a research microbiologist.  I know how to look at data, and read research studies, and I understand infectious diseases and how they spread.  I question every headline and statement I see in the news or on social media, how do they know that? what studies are they basing that statement on?  I follow the CDC, WHO and other data driven websites and make my own conclusions about what the data seems to be telling us.  I try not to post statements that I can’t back up with facts, and I don’t apologize for being a nerdy science type. Because of this background I am usually  calm and don’t freak out at every little thing because I can look beneath the sensationalism and find the facts.  This virus is new however, and we have little history about it’s behavior.  We can extrapolate and predict based on the behavior of similar viruses, we can model systems of transmission and study how to protect ourselves. The truth is, we are not far enough into this pandemic to have the data we need to make some of the decisions we need to make.  It is going to take time and trust in the scientific community (not the political or corporate community) to do the experiments; studying the epidemiology, developing a vaccine, and developing antivirals that can mitigate course of infection and maybe even act prophylactically.  We have not seen anything like this on a global level before.  Other novel infections have been contained in certain locales long enough to develop ways to fight them with vaccines or medication protocols. The time for containment of this virus is long past; we must self isolate, be meticulous with hand washing and take care of our immune systems.

So what is the good in this?  Many people get to spend more time with their families, focused on each other and what is important to them.  We as a community are finding ways to help each other with errands, check ins, and support.  We are all learning more about technology and how we can connect virtually.  There has been an outpouring of music on the internet from artists all over the world.  In the long run our healthcare system will have to improve, as this pandemic is exposing lots of places where we are grossly unprepared for a pandemic or other kinds of disasters.

I tend to look at the world though a healthcare and science lens, and rely on others to take care of the economy.  I don’t have talent or much interest in deeply understanding how the economy works, however, I  have been forced to learn a lot in the last five years  since becoming a single parent and putting a child through college on a single income. I am grateful that I have a good, stable job (that I happen to love) with great benefits. But not all are so lucky. Two of my 3 young adult children are without income right now. I am supporting one and the other is managing on savings and scrambling to create new income streams. It is a scary time for everyone,  and I am quite aware that my family is privileged. My kids will be ok in the long run, they are resourceful, smart and generous, and I am in a place to help them if they need it.

My heart aches for those without safety nets.  Without income, or most of all without people to lean on. I try to end each day with gratitude.