The Reality Behind Seven O’clock
Written by T.A., RN
For those of you that exist in the supernatural world of medicine, you’ve likely heard over and over again that nursing is a tough job. So, no need to sell you that via one more medical blog, right? Nursing is also incredibly rewarding, like that patient you see extubated for the first time who convinced you they would never breathe again on their own. The patient that thinks you’re the best thing since sliced bread when you bring them a simple cup of ice after being NPO for three days. When your fellow nurses and hospital residents call you on CCRT for back up and anxiously await your arrival to the scene, like a marvel character in a movie, batman saving Gotham City yet again!
I love my job. My job doesn’t define me but it is a core piece of who I am. It continuously challenges my ability to critically think and appraise a variety of situations. It has fostered my growth as a human being, emotionally and spiritually. Nursing has taken my position on faith and what I ultimately believe in on an incredible journey, granted with its ups and downs. How could it not? We see people in their most vulnerable hours, through times of pain and suffering, sorrow and despair, happiness and victory; it can be an emotional roller coaster. So sure, nursing like every job has its sunshine and cloudy skies but here’s what you may not know about my job. Although it doesn’t define me, it never leaves me. The high waves and still waters that paint the scenery of nursing life are in fact the swimming conditions my emotions, mental and physical health are faced with daily. Although I have many vivid memories of patients and the families I have cared for in my short career as an ICU nurse thus far, the images that choose to stay come with a cost.
It’s day three of your four consecutive shifts and the critically ill patient you are looking after, sedated and intubated, has become your priority for the thirty-six hours you’ve dedicated to her so far. Although you cannot converse with her, you learn about her. You get to know the things she loves most in life, her hobbies and interests, just as you now know every scratch and scar on her body. You talk to her children, her grandchildren and learn about the exciting experiences she has had and some of the hard times too.
It’s nearing hour five on your shift and her condition doesn’t allow for you to sit down, go to the bathroom or eat a meal because she requires your full attention. You gaze at your patients face, her skin, her breathing. This rapid visual assessment forces you to look at the continuously buzzing cardiac monitor because your experience dictates what is about to happen. Your heart sinks. Your patient’s blood pressure drops and her heart beat decreases so you call in the Calvary and begin to compress her frail body. You’ve kicked into the fight response, you’re an ICU nurse, and this is what you do. You are forced to ignore the sobs of her grief stricken family members that you’ve spent more time with than your own this week, and focus on the task at hand. Thirty minutes goes by but it seems like two and your team makes the decision to terminate the code. Away walks your army of medical soldiers and for the first time, you are alone. You stare at your lifeless patient and you reach for her pale, cold hand to hold it one last time. Everyone comes into this world received by the warmth of the human connection; shouldn’t everyone leave this way to? Thoughts race through your head: Why couldn’t I stop this? Did I miss something? No, this was for the best, she had a long and challenging battle, she feels no pain now. Will her family understand? Will they cope? What now? You hurry to tidy up the battle zone that has become your room. You remove the invasive tubes and lines that seemed to dehumanize the woman you were looking after and as you tidy her up with fresh linens and a patient gown, you talk to her. You provide chairs, and Kleenex, anything that you feel might comfort her family and you invite them into her room to say their final goodbyes. You walk on eggshells to ensure that you provide a sense of comfort for her family, without having your emotions influence them. You are a rock, a crutch, an ear, a shoulder, a concierge, a punching bag?
Your charge nurse informs you that there is a patient in the emergency department in need of your care and they must come right away. You and your colleague work diligently to set up an empty room and prepare for whatever conditions your new patient might arrive in, balancing the emotions of grief counsellor and superhero in anticipation. The residents meet to debrief the code that took place in your room, prior to the arrival of their new admission. Wait a second… they debrief, but what about me? That’s right; my role is at the bedside. I swallow the pseudo pit that exists inside my throat and prepare for my next patient. He arrives and the chaos is real but the clock is reaching my twelfth hour. My focus has been to keep him safe and alive. His upset wife asks me questions that I cannot answer: Why would they make him wait? Why did this have to happen? Why hadn’t they just listened to us before? I nod my head and apologize for their ill experience, trying to demonstrate empathy all while doing my best to thoroughly care for her husband. The on-coming nurse arrives to take over the care of my patient. I deliver handover, going through every piece of information I’ve learned about him so far, meticulously. Alas my shift is done.
On the contrary to the belief of many, I don’t “clock out”, I simply cannot. I listen to music that pacifies my dazed mind until I pull into my driveway, unaware of how I even made it home. I enter my house with a greeting from my dog, over the moon to see me and in the mood to play, which I am not. I strip off my scrubs and get into the shower, where the visible events of the day wash off my body. I cry. I cry for the family I spent hours talking to about their loved one and the hopes and dreams they had of taking her home. I cry for the patient I had filled the last three days getting to know, aware of the battles she had experienced leading up to her passing. I cry because I cannot imagine how my patient’s wife must feel, and I am sorry that I could not spend more time with her. I cry because now I no longer have to be the pillar of iron. I put on my pajamas and slide into my bed, alarm set for whatever tomorrow’s work day will bring.
You see, the job I do every day is one that I love. I love caring for those that are in their weakest hours. I have great joy in nursing my patients’ families and getting to know them through the stories and memories they choose to share with me. I love the business and the chaos that at times exists heavily, all while demanding the ability to act quickly and think critically. All of these things are in my opinion sustainable, but not without support.
Who is there to look after me when the dust settles? Does this responsibility fall on my family members and loved ones? How is that fair to them? The reality is, we don’t always use the resources we have access to. The hospital’s support telephone hotline seems great, except at nine o’clock at night, after a day like the one described my mind likely wouldn’t comprehend how to input the digits into the phone, let alone have an emotionally heightened and draining conversation with a complete stranger. We are nurses, bread to tough out the worst of situations, hold our pee and suck it up. After all, this is what I signed up for isn’t it? Yes, I am a nurse but I am also a daughter, sister, a partner and a friend. I too am human and require the love and care that I try my very best to show my patients every single day.
As clinicians we need to do a better job of showing one another the emotional support that we all feel is lacking at times. We should be lifting each other up and ensuring that we are included in the debriefing sessions that take place amongst the medical residents, in fact, we should be leading them. We need to stick together like the resilient bond of the wolf pack, ensuring that no one is ever left behind. We are nurses, strong, passionate, and caring individuals but we are human and that doesn’t change at seven O’clock.