Tag Archives: emergency room nurse

Return of Spontaneous Circulation

7 May

It’s a random shift in the middle of the week, a week I’m barely getting through. But I do my best to sleep all day and prepare for the night shift. I put on my uniform, manage to eat a couple of bites of peanut butter toast, force down a tall cup of coffee, place a cold washrag on my eyes to bring down the puffiness.

“Let’s do this,” I say to the mirror and listen to pump up music on my way to work.

At work, I’m told that I’m floating, which means I don’t have a patient assignment, I’m supposed to go around the department and help out any nurses that are busy. Not ideal for me at the moment as I’m truly looking for something to distract me, to keep my mind busy and away from the cyclical thinking that has been torturing me. But I do my best to find things to do. I see a doctor who is going to be discharging a patient with crutches, and she asks me to come help her apply the splint. We stand outside the patient room while he’s changing out of his hospital gown. She looks at me for a minute before saying…

“Are you pregnant?”
“No, I’m not.” I say loud and angry. I’m a firm believer that unless someone is very very visibly showing (6/7 months at least), you should never ask someone if they’re pregnant. Maybe they’re slouching a bit. Maybe they ate a big lunch. Maybe they’ve been lying in bed crying for days. No matter the case, don’t ask, don’t be an asshole.
“Oh,” she pauses. “But were you recently pregnant?” She had the nerve to double-down on the assertion that I look pregnant.
“Nope. Never been.”

I help her in the room with the patient, and as soon as she seems like she doesn’t need me anymore, I rush out of the room and head straight to the pantry, tears burning in my eyes. One of my co-workers that I’ve become friends with sees and follows me. She knows I’ve been heartbroken lately. I tell her what happened with the doctor, and she comforts me as best she can.

“She’s crazy!” she says. “I would kill to have your figure. You don’t look pregnant at all.”
“I just didn’t need this right now, you know.” I cry as she rubs my back. “I already feel so low, so alone, and I didn’t need this tonight.”

The radio I wear around my neck announces that a cardiac arrest is en route to the hospital. A second or so later, the charge nurse radioes me directly to say the patient will be assigned to me.

“Okay. I’ll be there,” I say as I wipe my tears on a rough paper towel and take a deep breath or two and tell my co-worker thank you, but I guess I have to go do work now. She’s an ER nurse too, she understands.

I run out of the pantry, my eyes still blurry from tears. I throw all my PPE on, the gown, the goggles, the extra face shield, grateful that it can cover my blotchy, mascara stained face to some degree. I run into the resus room as the patient is being wheeled in, a pretty large man who is intubated but the cardiac monitor is not showing activity. The doctor in the room says to start CPR. There are large EMTs present, and they’re usually the ones that do the chest compressions during CPR since it takes a lot of strength and stamina. I see a couple of them rolling up their sleeves. But I know this one is meant for me. I grab the stool, put it beside the patient, elbow my way past my co-workers and start my compressions.

These are the best chest compressions of my life. And unlike other CPR I have performed, I feel like I could keep going indefinitely. I look down at my criss-crossed hands on his chest and lose myself in the beat of “Stayin Alive.” My compressions are deep, even, perfect. I think only about hearts about how there’s one heart out there, somewhere in Brooklyn that I would particularly like to pound on, to beat until it hurts as much as mine. But this one will do, so I just keep going.

After a couple of rounds of CPR and medications, we do a pulse check and find that he has ROSC, return of spontaneous circulation. The meds worked, and he lived. This is rare. This almost never happens. Every time I’ve been in a code and performed CPR, the efforts were futile and the patient didn’t make it. Who knows why this guy did. Maybe he was young enough. Maybe the meds and CPR got to him quick enough. But he lived. It was another hour or two of stabilizing him and preparing him to be shipped off to the ICU.

A week later, I’m at drinks with some friends, going over and over and over my heartbreak, how I feel so confused, so hurt, still so low.

“Anything good happening, though?” one of them kindly jokes.
“I did CPR at work and the patient lived. I’ve never had a patient live before.”
“Woah, that’s incredible. Do you hear yourself?”
“I guess. I did the cardiac compressions. It felt good to pound on a heart like that.”

The last couple of weeks, I keep finding myself saying “There’s gotta be a metaphor in there somewhere.” Weird things that happen, things I notice in nature, the return of spontaneous circulation. What does it all mean? But I guess I’m not supposed to know. Not while I’m deep in the thick of it, trying to keep my head above water. I think the meaning, the metaphors are only supposed to make sense in hindsight. But for the couple of hours where I worked on that patient, did my job as a nurse, all my other problems and heartbreak felt so insignificant and unimportant and weren’t even on my mind. So while I keep thinking of metaphors, maybe it wasn’t that I was trying to push on someone else’s heart, maybe it was my own, maybe it was something about bringing myself back to life.

I don’t know though. Those answers aren’t here yet. I just know that my patient lived, and I guess I will continue to do so as well.

March 30, 2020

30 Mar

Working in healthcare right now is full of a lot of highs and lows. I feel lucky that I’m working in a facility in Manhattan that hasn’t been overwhelmed and that my healthcare organization has been able to provide us personal protective equipment thus far. But we still work with the stress of the situation we are in and for what is coming. My nursing union sent an email yesterday to tell us that projections look like we are at “the beginning of the middle” with patient numbers growing rapidly and reaching their apex in about 10 days from now. The hospitals are already overwhelmed, and we don’t know what life will be like in 10 days. We do expect to run out of the supplies that protect us. We are currently required to reuse our mask for 5 shifts. But even as the rubber bands of the mask carve sores into the tops of my ears and cause bruising on the top of my nose and cheeks, I’m grateful for my little mask, because I don’t know how much longer I’ll be able to have one.

I showed up to my ER the other day to find a giant truck parked along the side of the building, about the size of the back of a long-haul semi. It’s a refrigerated space to hold dead bodies, and it sits outside of the building as a reminder of how dire things are becoming. Also, outside the ER, scribbled on our sidewalk, are messages of encouragement and love from the neighborhood. I’ve seen videos of people cheering for healthcare workers out their windows. News of the deaths of nurses and doctors in New York City have stricken us with a cruel uncertainty of our own fates. My co-workers and I talk in somber tones about the 28-year-old who had to be intubated in our ER. One of our doctors who had the Coronavirus is recovered and visited us yesterday, warming our hearts to see how healthy he looks after 2 weeks of being home and now Covid negative. We gathered around him like children at story time. Tell us what it’s like. Tell us you’re okay. “Every single breath I took was painful and burned my lungs,” he told us.

It’s dizzying highs and crushing lows. Historically, there is animosity between ER nurses and med/surg nurses. They don’t like us, because we send them our sick patients, and we get frustrated when they give us push back. Calling report to a floor nurse is usually a snarky experience with a lot of sass thrown back and forth. All that is gone. When I call to give a floor nurse report the conversation now starts with sincere “how are you guys doing?” and sharing of compassion and care for one another. My friends from nursing school keep checking in on each other since we all feel so lost to be caught in this storm during our first year of nursing.

I woke up at 3AM t a couple of nights ago with my heart pounding, and I started crying, heavy long sobs born out of anxiety. I’m frustrated that I can’t do more. I’m angry that we are running out of protective equipment. I’m scared for myself, my friends, and my family. I’m nervous about what the next couple of weeks are going to look like and what I’ll be asked to do. And it all hit me in the middle of the night, because my days are spent trying to help people stay calm so that they can breathe a little easier.

Governor Cuomo put a quote on Instagram that struck me.

“Courage is not the absence of fear, but rather the assessment that something else is more important than fear.” -Franklin D. Roosevelt

Healthcare workers are just as scared as everyone else, if not more so, because we first hand know what it looks like to not be able to breathe. But we have to keep going. That’s just all there is to it.

A Post from the Frontlines

23 Mar

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The world is a different place from the last time I was able to write a post. That is an understatement and obvious enough. It’s a time when we are all reaching out more than ever to the people we love and care about to check in. But I find myself reminded that I am in a different position in this global pandemic than most. I’m a registered nurse working in an emergency room in the heart of one of the most affected places on Earth, New York City.

It’s humbling and encouraging and strange to receive messages from family members and friends saying how grateful they are and how “heroic” me and other medical professionals are. I think it’s an odd thing for us to comprehend, because our worlds are still operating. I still go to work, clock in, do my job, eat my lunch, clock out, go home, and rest up for my next day of work. I understand the curiosity and interest in life at the frontlines, and I hope to give some insight into it.

I was told that the first year of being a nurse is the worst and the most difficult. I was obviously not expecting this on top of everything. My biggest frustration at the moment is the very fact that I’m still considered a “new grad” nurse with under a year of experience. I’m technically still in the training phase of my fellowship, and I’m not supposed to pick up shifts. I asked management if maybe we could work around that since these are extraordinary circumstances. They are still on the fence and leaning toward no. So even though I have a nursing license and 8 months of experience, I’m not allowed to pick up shifts within my hospital system. I’m not sure if that will change, but I’ve been in talks with other hospital systems and the state of New York about being on emergency surge lists. Right now I’m trying to use the days off that I have to rest, eat healthy, and exercise. Working on getting my immune system in the best shape it can possibly be in.

When I think about how this thing has unfolded over the last couple of weeks, I know that everything changed for me when I started hearing the stories coming out of Italy. Like most Americans, I had heard of Covid-19 and didn’t want to buy into the panic of it. The panic didn’t make sense. There’s only a 2% mortality rate, so why are we so nervous? I’m a part of a couple of different nursing forums online, and I started to see desperate pleas from Italian nurses. Their healthcare system was collapsing beneath the weight of this virus. Doctors were having to choose which patients could live or die due to the lack of resources, and cities were unable to find space for the dead bodies that were piling up. From across the globe, nurses were begging us to take this seriously, to prepare for what was coming, to avoid their mistakes. It was the first time I realized this was going to get bad and fast.

The cases started to pile up at my ER. Not confirmed cases, of course due to the unconscionable lack of testing, but patients were showing up with tell-tale stories. “My chest just feels tight.” “I felt better for a couple of days, then everything got worse.” “I just can’t seem to get better.” The news articles I read on my phone began speaking of social distancing and working from home. In Italy, people were locked down in their homes, and I wondered if it would come to that. About a week ago, on my lunch break, I left the chaos of the ER to grab some food and saw the park across the street teeming with people. Everyone was smiling and laughing and enjoying the warmer weather. I stared in disbelief. After an exhausting shift, when I got on the subway to go home around 8pm, the train was packed with people in their 20s, most already a few drinks deep. Their laughter caused them to throw their heads back and whoop. I thought of the petri dish of a train car we were sitting in.

The next day was when they began shutting bars and restaurants down. I felt as sad as anyone to watch my vibrant city be shuttered, but I also knew it was the only way. Something horrible is coming. Or more accurately, it’s here. It’s likely on most surfaces, in most bodies, in thousands of homes, and it has the capability of crumbling everything down. I still look to Italy and hope we’ve done enough to avoid the horrors they are seeing, but only time will tell. As I write this, the country of Italy has 63,927 confirmed cases. My city has 12,305.

The spirits among my co-workers are mixed. Some are in a panic, frustrated and stressed about our lack of PPE (personal protective equipment) and dizzy from the hourly protocol changes from the CDC. Some of my co-workers shrug their shoulders and say that we have to keep going and just get through this, and we will be okay. Regardless of reaction, everyone still shows up every day and puts on the masks that we have, the gowns, the gloves, the goggles, and we do what we can. It’s not an ideal position to be in, but it is our job. I think of my professors from nursing school who talked about working through the AIDS epidemic. I think of nurses of the past that treated typhoid fever, tuberculosis. I think of the mother of modern nursing, Florence Nightingale, who founded nursing as profession by volunteering to go to Crimea and help treat the wounded soldiers in a war zone. It’s the legacy of our profession, and I’ve always felt deeply honored to get to do it, especially at a time like this.

I fear for my city. I fear for my fellow nurses. I fear for my friends that no longer have jobs. I fear for all the small businesses that I love in my neighborhood who now have an uncertain future. I fear for what my life will be like in the coming weeks, the uncertainty of what I’ll be asked to do. While I know things are going to continue to get worse, I also know that things will eventually get better. I’m looking at Italy as a worse case scenario of what comes next, but I’m also looking to China as to how to get through. The number of new cases there has dramatically dropped off, and they’ve begun to close their emergency hospital facilities. Our time for that will come too.