“Are you crazy?” This was the response—replete with an equally stunned face—I got when telling people that I was thinking of taking a new graduate emergency department nurse residency. “Um, I guess so,” was my pathetic shy response. Inevitably, second guessing ensued.
Nothing about the ER is easy. Now, I would venture to say nothing about any kind of department or nursing is easy. I remember watching the TV show ER as a kid. I always kind of imagined the TV show…“ER.” Cue theme music. Cue fast screens of each actor looking serious, looking concerned, looking medical-ly. Wait. Where is sexy George Clooney with medication on hand, and that stethoscope placed precariously, but oh so perfectly around his neck? Nope. Not here. I’ve looked. No Clooney, no Noah Wyle.
I can remember it vividly. The moment I decided to tackle nursing. I had been sitting next to an elderly blind woman. I was a volunteer in the ED, the lowest on the food chain, and unbearably shy and awkward. I was asked to help feed this woman her meal. I approached the curtain, and with a feeble, “hello?” I walked in with trepidation. The woman was as sweet as she could be, with a southern accent and manners to match. She asked, “Well, hello there…Do ya have my Jello?” With this I felt at ease, and with a smile I sat down next to her and proceeded to have a long conversation about Jello, Southern food, and the smooth moves of James Brown.
I would not change my choice for the world, and working in the emergency department has been the most rewarding, challenging, and enlightening experience of my life. And, without a doubt, I have learned some of the most about nursing and myself during trying times and harrowing situations.
This brings me to Room 20.
We have all heard it. The stories, those patients that stay with you the rest of your career. The ones you never forget…you can be anywhere, doing anything, and BAM! An immediate recollection of the event. It is like a memory frozen in time that is destined to stay with you the rest of your life. I must admit I had not had mine yet. As a busy, task-oriented new graduate nurse with spankin’ new scrubs on (and a shiny pen light to boot) I was unaware of the fateful day I would encounter my moment. But then again, who is really ready when that moment strikes?
I was on top of things this day, I had my rooms prepped, my monitors ready for whatever may befall me. I looked over to the charge nurse desk, and saw a patient on a stretcher. Oh lord, I thought to myself, this one looks like a challenge. He was talking, more mumbling, and at first glance anyone could have mistaken him for just another guy who had had too good a time out on the town. Boy, was I wrong. “Put him in that room, room 20.” They were pointing to my assigned room. My breath quickened, I picked up my pace, and I steadied myself for my new patient.
“He’s responding, but just barely.” I looked at him; he looked like someone in crisis, not at all as he first appeared by the charge nurse desk. And I knew then we had to work quickly before he deteriorated even more. “I’m starting IV access.” My hands fumbling, shaking, I tried to keep his hand steady. I missed. The other nurse missed. Another nurse and a nursing assistant were getting the patient on the monitor and performing all other duties. I called for the code cart. “We need IV access…And quick.”
“I know,” I exclaimed, attempting to keep my calm despite a steady surge of butterflies and terror creeping up on me.
“Hey,” the other nurse looked me squarely in the eye and said one of the most haunting things I have ever heard. It was not so much what he said, but the way in which he said it that really struck home. “This guy is going to die.” I swallowed hard. This stirred in me more fight than anything. The attending physician and respiratory therapy were at bedside as we furiously wheeled him into the trauma bay. Multiple rounds of epinephrine, a failed pericardiocentesis, a chest tube, you name it. We couldn’t save him. In the end, we all settled on a brain bleed. The ultimate diagnosis: fatal and sudden bursting bilateral cerebral aneurysms.
Despite knowing we did everything we could—we worked as a team, we poured sweat and tears into this case—it was not enough. Perhaps his fate was sealed before he entered our ER. But, I still recall staring at his lifeless hands, hands that one time held coffee, high-fived a friend. He was in his 20s. I cried all the way home. Like a baby. The stress of the whole day just releasing into my steering wheel.
As a new graduate nurse in such a demanding environment, with equally demanding patients and tasks, I learned I can never get used to seeing a dead body. But I also learned I never want to get used to it. I try and treat every patient with as much respect and dignity as possible, and more often than not I choose to not know the backstory unless necessary. Death in an emergent setting can be harrowing, but there can also be moments of calm sadness, if not even serenity.
What Can a New Grad Do?
1. Breathe. My biggest advice: BREATHE. Really, you would be amazed at what an inhale and exhale can do for one’s nerves and clarity of thought. In retrospect, I know that as a new graduate nurse just the simple task of breathing in such stressful situations is immeasurably beneficial.
2. Decompress. Does nursing school prepare you for all of this? No. I say a silent prayer for each zipping of a body bag. It is hard to tell others of such morbidity, and to this end, self-care and decompression at the end of the day is both healthy and necessary.
3. Reflect. I think back to that situation often, and realize, more than anything, the worth of reflection in clinical practice—for improvement, for your own sanity. I personally like fitness or long walks, but it should be something fulfilling for both your body and soul.
4. Forgive Yourself. Fast, critical thinking is needed, split-second task performance, and impeccable teamwork. Will this always happen? Hopefully so, but honestly and unfortunately, it isn’t always possible. If this is the case, then learn to forgive yourself, and know that all your heart, effort, and knowledge were put into the case. After all, nursing is both an art and a science. And taking care of others is one of the most beautiful of arts.
And still, at the end of the day, I make sure to always try and reflect on two pivotal questions: Am I happy? Am I a good person? What are your answers? I know that as a nurse I am happy, and I know that I strive every day to be the best person I can be—for my patients, for their families, for my coworkers. As for the art that keeps on giving? Maybe it can be said that nurses are medicine’s Monets.