Maybe tomorrow will be different

(written last Thursday)

Today was another busy one in the ED. I won't go into details but one of my patients had to be flown to Hartford and another had to go to the OR for emergency surgery. We have a 33 bed main ED and what I like to call "pseudo beds". The pseudo beds have names like 6a, 8a, hall 3, hall 10, etc. They are every nook and crannie of the ED that a stretcher will fit into. They were all in use today. That means that at no time did I have less than 5 patients. Every other nurse was in the same predicament, so expecting help was unreasonable. Now, 5 patients might not seem overwhelming but you have to remember that they arrive with symptoms, not a diagnosis. They need IV lines, blood draws, EKGs, X Rays, etc. On days like this the doctors are backed up with work so we need to use our clinical judgment to initiate protocols and order tests and meds we deem appropriate. That autonomy is one of the things that makes the practice of ED nursing so rewarding, but it also makes it tiring. At the end of a day like this one I'm both exhausted and satisfied, in that I know I made a difference. A day like today is also not highly unusual, which is also both tiring and satisfying. All the same, I hope tomorrow is easier. (ps Friday was not better)

They're eating snakes!

Triage has to be one of the funniest places in the world. I know, how can a place where people come to when they or a family member is sick or injured be funny, but it is. Maybe it's just that twisted ER sense of humor.
First of all, look at the word "triage". It's French for "to sort". In a profession dominated by Latin root words, it's French! It's mispronounced often enough that we call the triage nurse the "tree hag" nurse. Working in triage is also called being sent to the box, short for penalty box, because after a shift of listening to 50 people explain to you why they're the sickest person alive, you realize that you must have offended the charge nurse in some way.
In our triage, people fill out a green slip of paper with their name, the time, and what is the reason for their visit. These are precious. One of my favorites is "sick". (Thanks for narrowing that down for us). Others include, "my tutu hurts", "I want a pregnancy test", "my doctor said to come", "blank stuck in my blank", and "my doctor won't give me pain meds", just to name a few.
I was not born with the ability to spell. (Spellcheck has been good to me) I had a nursing instructor who put it this way. "John, you're going to be a great nurse but if you don't learn how to spell no one will know it. " We had a doctor, Anna, who had great laughs at my expense. She used to say she enjoyed reading my charts because she could read my hand writing and if she sounded out what I wrote she could figure out what I meant, and it entertained her. She's moved to Florida but I think she stayed around a little longer just to enjoy the laughs. I remember telling one coworker that I spelled phonetically and she said "no you don't", to which I replied, "yes I do, it's just that I also mispronounce my words". She thought for a moment and replied, "your right."
What God did not give me in spelling ability He made up with in the ability to laugh at myself.
Anyway, one day I had triaged a woman with abdominal pain. We were busy so I sent her to the waiting room. Shortly after I observed her eating. Wanting to update the triage note but not being sure how to spell Doritos, I wrote "patient eating snacks in waiting room", however, true to form, I misspelled and it came out,
"Patient eating SNAKES in waiting room".
As luck would have it, Dr Anna ended up with the chart. She came in chuckling, and said, "I think we know why you're having abdominal pain".

I think Grandpa would be proud

When I was growing up we visited my grandparents most weekends. We spent summer evenings playing in their yard with our cousins. In Grandma and Grandpa's living room was a tall piano. I never saw anyone play it but on top of it was a line of wooden hammers. I later learned these were Grandpa’s gavels and that Grandpa, James J Brady, received one for each session of the Rhode Island State Senate that he presided over as President Pro Tem. He had done what many Irish Americans had done, served in politics. The early Irish Americans saw politics as a way to improve the lives of their families and their communities. On several occasions he acted as the Governor in the absence of the Governor and Lieutenant Governor. His daughters became teachers and all his son's enlisted and served in the armed forces in World War II. My own father, John J Brady, left college and enlisted in the US Marines. He was wounded during an amphibious landing on a beach in the south Pacific when he was hit by a flamethrower. Only the valor of his buddies pulling him to safety saved him. His burns kept him in the hospital in San Diego for a year, he received Last Rites more than once. He survived with multiple skin grafts. Some time after meeting my wife she confided that the first time she met him she was shocked by the scars on his face, I had never noticed. He went on to get his degree, marry, and raise 6 children. He died of a heart attack at age 60, too young, and yet God had given him 40 extra years and he never spent another day in the hospital. He never entered politics but always felt a duty to vote in every election. He taught me that every person has dignity, whatever his race, religion, or position. He taught me to never seek out a fight but to never run from one either. I miss him every day.
What we have done in forming a union is something I believe my grandparents, my father, and my uncles would be proud of. I know my mother and my aunts are. We have stood together, tall and proud, we have stood against adversity, fighting for what lives in the deepest place in our hearts. We have stood up although we feared it might cost us our jobs as we struggled against one of the best union busting firms in the country, Jackson Lewis. We had no choice, we had to, we were compelled to, because of something deep inside us.

This is my story, but I am sure each of us has a similar story, about those who influenced us.

Now it is time to get to work again, to work together with management, but I could not look forward without taking a moment to look back and recognize where we came from and acknowledge those who made us who we are.

I think they would be proud.

Deep Breath

The first responder comes upon an MVA. She calls 911 and stays with the driver until the ambulance arrives.
Deep breath.
The ambulance crew stabilizes the patient and transports to the hospital.
Deep breath.
The ED gets X-rays, CT, labs, gives blood, and transports to the OR.
Deep breath.
The OR performs initial lifesaving surgery and hands off to critical care.
Deep breath.
The initial steps of survival and eventual recovery.

Months have passed since our first meetings with organizers and fellow nurses in coffee shops. Many hours in meetings, visiting houses, talking with nurses, planning and making decisions. It wasn’t easy, there were many episodes of personal attacks, being called traitors, bullies, being accused of neglecting patients, being told our coworkers had complained. We have withstood captive audience meetings, as a group and when managers cornered us one on one.
We stood strong because we stood together, and we prevailed. We should be proud of what we have accomplished, we have done what few people ever get the chance to do, we have built a union.
Deep breath.
Now we go to the next step, there is still work to do. The patient is stabilized and now recovery can begin.
We are reaching out to ALL RNs. Every nurse has an equal voice, regardless of their feelings prior to the vote, regardless of the level of their involvement up to this point. We are forming a bargaining committee to lead us and we must all stay involved. There is a role for everyone.
Like the links in the Chain of Survival, our union will only be as strong as our weakest link, our least involved member.
Join us on this journey. If you have been waiting, consider this your invitation. We both want and need you. We begin this Friday at our first meeting/victory party. Hope to see you there.
Deep breath.

Everyday Heroes

Carol stops by the school on the way home from work to pick up the kids from after school recreation, she's been on her feet all day, and she really needs to sit with a glass of wine. She catches the end of Oprah on her 12-inch under the counter TV while she prepares supper.
She finally sits to eat, gets the first bite of mashed potatoes, and the tones go off!
Tonight she's "running" with her town ambulance crew. She is one of the countless men and women across our country who volunteers their time and energy to keep all of us safe. Their reward is only the knowledge that what they do is noble and right, that they truly make a difference.
Across this country and around the world Emergency Medical Services members are the front line of our safety. The EMRs, EMTs, Paramedics, Fire and Police, paid and volunteers, truly are everyday heroes.
She gets up from the table, grabbing a piece of chicken and heads out the door. It's Mrs. Jones from across town, her CHF acting up. (Probably that ham she's been eating). By the time Carol gets to the hospital, gives turnover, writes her report, returns the ambulance and gets home, it's 9:15. There's a plate of food in the refrigerator that her family prepared, ready to warm in the microwave. She's too tired to eat. She showers and crawls into bed, asleep before her head hits the pillow, it's 9:50.
10:30, the tones go off.
"Are you fricking kidding me?!"
It's an MVA, a car into a tree. 2 high school students, same school as her son. One of them will not survive.
These are the calls she hates.
She performs like the professional she is, she calls for a paramedic and lifestar, she packages them up. The paramedic arrives first, he makes the tough call, who flies to the level 1 trauma center, who goes by ground with him, to a level 3. Carol goes with the medic, after they hand off to the trauma team she retreats to the EMS office and does her report.
She is tired, she is hungry, she is emotionally spent, and she cries.
Her EMS brothers and sisters are there for her, they are a tight community, bonded together in a way that must be witnessed to understand, felt to be understood.

1am, Carol crawls back into bed and wraps herself around her husband.  She will fill him in tomorrow, she wants him to sleep. He rolls over, he knows it was a rough night from listing to the radio, he holds her tight. In 4 hours the alarm-clock will go off and another day will begin.

May 15-21 is set aside to honor these men and women, our everyday heroes. God bless them all, keep them safe, and keep them always in our hearts.

I consider myself blessed as an ER nurse to get to witness this heroism on a daily basis. It is an honor to know them and to call them friends.