Shared sacrifice

It’s so easy to get focused on the moment to moment in our lives that I think sometimes we fail to see the day as a whole or our career in the big picture.  Our day passes by in a flash and we are sitting in front of the TV zoning out. 

A day in the life:

5:00 am, it is still dark out. She awakens Gregory, age 10, he complains, she pours him some cereal. She gets Alex, age 3, out of bed, he's looking forward to day care. Her husband James is in the other room getting ready for work. By 6:15 Gregory is on the bus, James is off to work, the cats are fed, and she and Alex are off for the hospital. She drops Alex at the child care center and has time for a quick coffee with coworkers, that alone makes it a good morning. She gets report on her patients, makes rounds, goes about her duties. One of the patient care techs is home with a sick child, so they'll work short again. There are fresh post-ops, discharges, and if a bed becomes empty, admissions. Lunch is 15 minutes, just no time, and the day goes by in a wink. She picks up Alex, has tea with her Mom who has come over to meet Gregory at the bus. James is working late, trying to make some extra money, the refrigerator is on it's last leg. She makes supper, then there's homework. James gets home just in time to take Gregory to youth basketball. James will eat later. While Alex plays and watches the same DVD for the millionth time, she looks over the bills. It's tight, she's lost $5000/year because of hospital cutbacks. They eliminated her certification and longevity bonuses, decreased her weekend and shift differentials. She's had sick time and wellness days taken away too. In addition, every time her family goes to the doctor or hospital, (her hospital), she pays more than before. James is too upset to even talk about the pension plan, they froze it, replacing it with a 403B that is matched at the discretion of the hospital. Get the kids in a bath and then off to bed.  She and her coworkers have lost a lot, but it cuts them deep when they see peanut butter and Italian ice taken away from their patients, when they see the qualities of supplies decrease. She worries what might be next. She hears about the changing health care environment and about shared sacrifice, but she sees in the newspaper that her hospital is profitable, she knows about the large bonuses given to the top people. Her eyes start to close as Randy Jackson critiques her favorite on American Idol.  Tomorrow she will be up before light to do it all again. Shared sacrifice shouldn't mean that she, her family, and her patients sacrifice.....so that others can get their share.

We're all in this together

A troubled man is walking down the street, deeply engrossed in his worries. He falls into a deep construction pit. He can’t climb out. He calls for help. Soon a priest comes along. "Father, can you help me?" The priest scribbles a quick prayer and tosses it down. Next, a doctor comes along. "Doctor, can you help me out?" The doctor writes a prescription and tosses it down. Then a common man comes along, he has seen troubles of his own. "Buddy, can you help me?" The man jumps into the pit. "That was dumb, now we're both stuck down here" "Yes", says the second man, "but I've been down here before and I know the way out" "I'll be in the waiting room when she's ready!" he said in anger as he stormed out. He was picking up his 24 year old daughter from the ER for the second time this week. Her life was heading down a dark path. We had offered her help but she had refused. It was early morning, the waiting room was dimly lit, he was the only one there as I arrived. He was pacing, yelling at the person in his cell phone. I waited till he was done and then approached him and introduced myself. His fists were clenched, his shoulders raised, his face and voice tense. The triage nurse watched with her finger on the panic button. I told him I was also a father and I had once been where he is. As I shared my story his hands slowly relaxed, his shoulders dropped, his voice became soft. We sat. I had no answers for him but I shared my experience, strength, and hope. I suggested counseling and a support group. I gave him a list of meeting times. He shared his frustration and desperation. In the end he said he'd try a support group meeting in his town in two days. He said he was going to call his ex-wife back and apologize. We shook hands and he took his daughter home. Did he go to that meeting? Will he seek help? I don't know. I did what I could. I carried the message to him, I feel good that I could do my part. Often we feel that we are the only one who has ever faced a particular problem. We believe others will not understand. There are others just like us out there, they can help. But it’s not enough to know how to help, we have to be willing to jump down into the hole. We're all in this together.

Voted off the island

I was walking into work on Sunday with two LDRP nurses and one of them says, "let's hope for a good day" I replied, "I just hope no one dies." But I'm getting ahead of myself, let me take you back ..... Kim is one of our most experienced nurses, years of Med Surg, Pediatric, CCU and ER experience, great under pressure, the perfect charge nurse. But, she is a magnet for trouble! Charge, triage, on the floor, it doesn't matter, a black cloud follows her. Two weekends ago we were crazy busy.  We blamed her and voted her off the island. [Full disclosure, if Kim is a 10 on the magnet scale, then I'm at least a 7.] On Saturday, Teri was charge and Kim and I were teamed together. I know..... what was Teri thinking? The results were not good.  In our defense, you have to remember that people come to us because they are not in the best health. So, it's Sunday morning, 7:15, Kim in charge, when our first code comes in. I don't know what it is about Sunday but things don't go right on Sundays.  Before our shift was over we had another code.  Something had to be done so at the end of our shift the ED voted and both Kim and I were voted off the island. People ask me what I think will be the outcome of our union vote on May 11. I think if everyone who has said that they would vote yes comes out and votes, then we'll win. There is one thing I can be completely sure about, the nurses will get to determine our own fate, no one else, and that doesn't happen very often.

Conversations

My mother always says there are two sides to every story.  I hesitate to disagree but maybe sometimes there is the truth and ..... I think the difference between a conversation and a lie is that a conversation is two sided, with mutual respect and a lie is not. When I first meet a patient in the emergency room I introduce myself and ask them how they are.  In a short period of time I need to find out why they have come in, what their concerns are, what their expectations are, and what their history is. It needs to be a two sided conversation, as opposed to........ Do you drink alco....NO! The answer comes before you can finish the question. It is so common for patients to lie about alcohol intake that nurses automatically double the answer. Don't lie to me! This process of forming a union has involved many amazing conversations with people, in the hallways of Backus and in living rooms and kitchens. I have learned about their lives, about their families, about their hopes and dreams. I think I've become a better listener in the process too. I have heard the concerns of people in my department and of other departments. Some of the concerns are similar and some of them are different. I've come to know a little better what it's like to work on a different shift or a different department, and what it's like to be of a different age group or family situation. I've come to realize something very important; my coworkers are thoughtful, intelligent people who really care about what they do. Our administration talks endlessly about thier open door policy, but we're still waiting for our meeting with David Whitehead.  We have been told many things recently: We don't need a "third party ". Except Wellspring and Jackson and Lewis. "At Backus, we believe that each employee already has a voice " What kind of voice did our LPNs have? "Every other department likes the new IV catheters." Really? "If the union comes in such and such will happen." The union doesn't "come in ", we've been here all along because WE ARE THE UNION! "If you want to talk about the union you need to punch out and go in the break room." It's our right to speak freely and you just broke the law by telling us otherwise. "The union will make all kinds of promises, get it in writing ". The overwhelming majority of us have put our one and only promise, to stand together, in writing, by signing cards. I truly believe the difference is this - I and the other organizing nurses have been having conversations, and administration for all their talk of opening a dialogue has not. Just the other day, I had a conversation with a nurse in the ED.  She is not in favor of the union.  I was offering her a "Proud to be a nurse" button. I told her that I would not be offended if she covered the union emblem with white tape. She graciously accepted the button.  We had a nice conversation, she shared an experience from her past that explains her union stance.  She is a wonderful nurse, she is a great patient advocate, she is a great teammate.  We both want the same thing for our patients, our coworkers and our hospital, we just disagree which is the best course to follow. But we had a conversation! I did not tell her how to think, she did not tell me how. I don't think there is a nurse in our hospital who doesn't want what's best for our patients, our families, our selves, or our hospital.  Yet, we do not all agree on how to get there.  But we are intelligent people, we do not have to be told what to think. The hospital administration wants to make your vote between the administration or "the union" but it isn't.  Hospital administration is not on the ballot and they don't get a vote.  The election is between whether or not we want to join together as a group of nurses or whether we want to continue as individuals who happen to work in the same building.  We have a wonderful young nurse in our department, Kate, who has been active in our effort. One day we were both asked a question about our union by a third nurse in our department.  As I started to open my mouth to answer she started this wonderful conversation with that nurse.  I just sat back and observed. I felt such a tremendous pride, in her and in our profession. This organizing effort is like a micro version of our union.  There are so many people sharing the work.  We are all listening to each other and coming to a consensus.  It is not being driven from someone sitting in an office, it is driven by us.  Right now the organizing committee are the leaders, eventually each department will have representatives and together they will be the leaders. Our leaders will not sit in an office and dictate, they work with us and for us. What do I want? I want what we all want, a GREAT Backus Hospital, where patients and staff are treated with respect.  Do I have all the answers on how to get there? No, but together, we do! And we'll discover the answers though conversations. It all starts with conversations, not lies.

I am a nurse

I am a nurse A simple yet profound statement. It is more than a stating of a chosen profession, it is also a commitment to a vocation. As Connecticut Governor Dan Malloy said to us, "I truly believe that nursing is a calling." It means I have put in the long hours studying needed to survive nursing school, where half my classmates didn't finish. It means I continue my education to stay current in an ever changing world of medicine. It means I can manage ventilators and multiple IV drips, deliver babies, assist in and manage an OR, monitor chemotherapy and blood transfusions with compassion, manage a trauma patient, run a cardiac arrest code, recognize subtle changes in my patients and react, monitor cardiac rhythms, and as an APRN, independently diagnosis, treat and follow up. It also means I can listen and hold the hand of my patients and their families, be they a small child with a boo boo, an elderly person in their last hours, or a psychiatric patient doing the best that they can. I work in hospitals, SNFs, jails, clinics, and wherever I am needed. I go by the title of RN, APRN, Nurse Anesthetist, and LPN. I am a nurse. But WHAT is a nurse? A nurse is someone who places the needs of others above their own, who advocates for those who cannot, who teaches a better way to live, who places people above personal profit. These are people who engage in the activity of nursing. Then surely the parent watching over their child is a nurse. Surely the child caring for their elderly parent is a nurse. Surely the spouse of a terminal patient is a nurse. Everyone recognizes Florence Nightingale as a nurse, but so was Mother Teresa, Martin Luther King, Nelson Mandela, Mahatma Gandi, and Cesar Chavez. They all advocated for others, regardless of the trouble it might bring them. As I look around my hospital I see all kinds of nurses, not all with letters after their names. The people making the food, cleaning the rooms, protecting the staff, have all put the patients above themselves at one point. When I look at my community I see nurses: fire, police, ems, teachers, religious leaders, our brothers and sisters in the military and more, all wearing the uniform of their particular calling and all doing their part. You see, being a nurse is not a job, it is a calling. It is less what we do, and more who we are. It is a way of life. I am a nurse.

Imagine

I have been accused of being a dreamer at times so please excuse me if I once again dream. I have these visions. As a nurse I imagine patients who see their doctor and dentist on a regular basis, who interact with their caregivers and develop a plan to keep themselves healthy and then follow out that plan.  Patients who eat right, exercise, don't smoke, don't drink to excess, and who accept responsibility for their own life style choices and don't blame others. As a person of faith I dream of a world where we take care of each other, where love, not greed, is our guiding principle. A world where all people, regardless of their ethnicity, social status, race, color, or creed, are treated with respect.  A world where, if a man owns two coats, he shares one with the person who has none. I have a vision of a Hospital where patients come first, where the staff is given the tools they need to do the job right. Where people are listened to, respected, and their ideas count. I imagine a place where the staff aren't burned out from working short. I want a hospital where people start their careers and stay. Are these pie in the sky goals? I don't think so. They won't happen overnight, but they are possible. I know what it will take to get there. It will take all of us working together, everyone in the trenches, at the bedside, getting together and sharing ideas, sharing strength, coming to a consensus, and acting as one. John Lenon sang: You may say that I'm a dreamer But I'm not the only one I hope someday you'll join us And the world will live as one I hope you will join me and the others who dream as I do, we are many, but all are invited to join us.  Do not get discouraged by the naysayers, the people who say things can't get better, they can, but not if we don't take that first step to making it happen.  Believing it can happen is that first step. Imagine!

We Cope

As I came around the corner I saw a code cart outside my patent's room.

I had gone to lunch 30 minutes earlier, my patient was fine I thought, they had come in with lower abdominal /pelvic pain, a report of constipation. I thought- urinary retention and placed a foley catheter that drained about 250cc. 

Well. that's not it. 

I started an IV, drew labs, medicated per protocol.  The doctors were backed up so the labs came back first.  When the doctor saw the patient and saw normal labs, he ordered at CT scan.  The scan had been done and we waited for the results.  The patient was slightly more comfortable, able to fall asleep, but easily awakened.  One of our bright, young nurses, Kellie, asked if I wanted to be relieved for lunch, and I was ready.  So I gave report on my 4 patients and away I went.

While I was gone the CT report came back for acute appendicitis. Kellie got an order for an antibiotic and started administering it and preparing the patient for the OR.  She was getting ready to do an EKG, she had just told the patient they had beautiful blue eyes which pleased them, when the patient started having difficulty breathing.  She called for help, a code cart and help was there in seconds, the family led just outside the room so everyone could fit.

When I rounded the corner and got to the room CPR was in process.  There were 2 ED doctors, 4 nurses and medic and a tech.  I applied defib pads.

After about 20-30 minutes of CPR, medications, and multiple defibrillations, the patient was pronounced.

So many things run through your mind, mostly, did I miss something. 

We cleaned up the patient, moved them to another room, and brought the family back in.  They had watched the code and the doctor had spoken to them.  They were in shock, hell, I was in shock and I live with this every day. 

What can you say?

I expressed my condolences, I told them to take their time and tell me if they needed anything, and I went back to work.

I WENT BACK TO WORK!

What kind of a twisted job is this?  I went back to work?  After that?

Yes, it's what we do. What else can we do?

I spoke with Steve, my partner that day, about what happened, he said Kellie did everything right.  I spoke with Kellie about it, she seemed to be OK, considering.  I worry about the young nurses.  I mean, it affected me, and I was doing this when they were 5 years old.  I'll speak with her again in a day or two.

Cassie walked over from convenient care to make sure I was OK, Cassie and I have been working together the last few months on the union organizing thing.  As I was worried about Kellie, Cassie was worried about me.  I guess that's how we cope, how we go back for more.

There are no good answers, for the family or for us.  It does affect us, and it's important to recognize that it does.  These things happen often in the hospital, even more often perhaps, in the ED.  They happen too in the field, to our EMS brothers and sisters. 

We cope.

We have to.

If we don't cope, we don't last.

If we don't last, we're not there for the next patient.

To cope, to last, requires us to understand that we are not super human

But we are not alone.

We lean on each other, we gain strength from each other, we are stronger together than alone, we are a family.

And we keep moving.

Teamwork

It was change of shift when the Med phone rang. The ED was already full, as it usually is at 3pm, and now a "stroke alert". A stroke is labor intensive so a few of us stuck around just in case. Second shift had it under control and then, just as we're getting ready to leave (again), the phone rings. STEMI. If you don't know, a STEMI is a heart attack, with obvious EKG changes. It's not a "cardiac event", it's the Fred G Sanford "this is the big one. I'm coming to you lisabeth." one. As a side note, if you're old enough to remember Sanford and son, you're old enough to have a STEMI. Anyway, STEMIs are also labor intensive and second shift was tied up with the stroke and everything else so Kate says to me, "come on John, we'll get this ." A few years ago I orientated Kate as a new nurse to the ED. Now she was taking the lead and I was assisting. We had a great medic and the STEMI was lined, labed, medicated, and on the helicopter to the Yale cath lab in no time. Teamwork, multiple people working cases together, one shift helping another, a student leading the teacher, the ED-Lifestar-Yale team, what we can't do alone, we can do together. Teamwork, many people, each doing their part, working towards one goal it's a powerful thing, a beautiful thing.