Working in the PACU, we think we have things under control. But in life, and medicine, you never know what will bubble to the surface.

Sometimes patients are overt in their desire for privileged treatment. Sometimes coworkers want to convey a desire for exceptional care for certain people. But in many circumstances the lines are a little blurry.

...[H]ow effective can we be if we don’t take care of ourselves?  And the worst of it is, I’m cutting a piece of myself every day hoping that sacrificing myself today will somehow make tomorrow better.  And every day my patient reminds me that there is no bigger lie.

Can I learn from my mistakes?

I observed how in the busiest of times when an ER nurse was trying to move patients “upstairs” (MedSurg or ICU), they would often feel a palpable amount of cultural tension.  Not only did other departments appear to work at different speeds, but had very different goals and ways of doing things.

I looked down at my admission slip and saw written "35-year-old male, high potassium, and low platelets.” Humm...okay. I already began to plan out in my mind all my interventions even before calling to get report. I'll never forget that report...even to this day, it seems like I can so clearly hear the sadness in the ER nurse's voice. The first words out of her mouth were "Oh man, this is a sad one.” 

We learned slowly that the only power we had to comfort people in pain as they entered a complex system of care was the softest power at all: tenderness. There were no promises we could make, and people often lied to us to protect themselves. So we smiled.

They gave her a heart shaped pillow that has the anatomy of the blood vessels and a heart on it. The surgeons signed the pillow with a sharpie and drew on the arteries that had been grafted. Her job is to hug this pillow when she moves, or when she coughs or sneezes. She wraps the pillow, we have the nurse, the PT, a respiratory therapist, another nurse and me, the newbie aide to use a slide board to move her to the chair. The PT reminds me to watch all the lines and go slow. I was on high alert and we slide her over.

I went from feeling like the guardian angel, to feeling like the grim-reaper himself. I knew we were doing everything right. I knew we followed the protocols correctly. I knew we worked with good crews and good hospitals. What I didn't know, were the statistics.

I went to an EMT class over the summer between my first and second year. It was a great program, taught by a crusty old Paramedic with more horror stories than I had ever imagined. One day in particular I remember best.  He came to the front of the class and showed us accidents that he had seen.  Cars and bodies mangled and disfigured in ways I could never have imagined possible. Watching us cringe, he put down the remote to the slide show.

I work in a rural hospital that is not a trauma center.  Sure, traumas come in, but it is our job to stabilize patients and send them to a facility with trauma teams and surgeons.  We call the cavalry, which is usually a helicopter, while we stabilize.

Office jobs don’t get the “oo” and “ah” response that EMTs, medics, flight medics, flight nurses, and SWAT medics, etc., receive.  It makes people think, and people have questions. They want to know about the horrible things, but not about the normal things. Have you ever noticed how sharing people are with terrible things?

My favorite ER love story starts in triage. A long line of people waiting to be seen. Enter two middle aged folks. Obviously homeless. Wearing clothes too large for them. And their skin is covered in pink and purple.

Nobody wants to appear weak, or be looked down on for not being a salty ol' pro who just muscles their way through the day. You have to be a machine, and not a human being with emotions and a gag reflex

If the person at the time of disrobing has all their facilities, then the hospital gown may seem better suited for a fraternity initiation stunt then the first step into the most advanced medical care in the world.  For most patients, conscious or otherwise, the hospital gown is rarely a confidence booster.

I want to give you a roadmap for what you are about to experience, to offer you hope and encouragement that this terrible thing does not have to be the thing that destroys you. 

Do you get really frustrated at a coworker who should be way ahead in their career but struggle with the simplest of things? Is there someone you looked up to, but soon discovered that despite their years of experience just aren’t the kind of person you aspire to be? What you are experiencing is what I call “the Gap”, and what you need, is to Leap.

I was sitting in the driver’s seat of my own ambulance when this story started to flood social media. 

Not that long ago, we would have heard about this story later that night – maybe the next day – and would’ve imagined how horrible it had been......We don’t get to imagine things anymore. 

Then the pager goes off. Highland. OR 6. I kegel, pound the rest of the latte, and start the car. OR 6 is where the big stuff happens – the stuff you see on the news. Many very bad traumas go in and few come out. 

This poem, inspired by a patient, grew and evolved through constraint.

Regret is an empty journal.