I was recently assaulted (again) at my Level 1 knife and gun club. We have more behavioural emergencies than traumas some nights.
I practice in an urban ED, which city is known for it's tolerance of drugs/alcohol and social liberalism.
I am also a former Paramedic who spent most of my street time in the ghetto. (No offense, but ghetto Medics know what I speak of)
I am also a former Navy Hosptial Corpsman who spent the majority of my two tours with the operating forces on a small combat ship wo a physician and with the Fleet Marine Force. One of my tours was a combat tour during the First Gulf War.
I came back from that experience with PTSD and have not had a military flashback for a number of years.
In the last bit of my training I was primary for a 3 yo female who had been accidentally run over by her daddy. I had an out of body experience, saw her face in my dreams.
Sought help, but not a good fit. Then just sucked it up and soldiered on, relapsed with cigarettes...yech. (thank goodness for nicorette)
State ENA president has criticized at a meeting my specific ED for the lack of Critical Incident Debriefings. For instance, he also is an EMS leader and after a 12 yo girl was sqaushed on the freeway, immediately got a Critical Incident Debriefing for PD, CHP, FD, and EMS, when he asked my hospital to send the ED Nurses he was told "...they are too busy and can't come"
So I was set up to fail to a degree, part of which is my own lack of self care, part of it instiutional culture.
In a period of 3 weeks, I had three "stable and tucked" patients (our population has a long problem list, Axis one and two, with multiple co morbidities).
All three of these folks suddenly went south in a matter of seconds, with A, B and C problems. I was alone as they tried to die, and did the appropriate interventions, ie getting help, resusitating them etc. This is not unusual in our setting. Despite ratios, we "must be ready to code a patient on a second's notice, as our patients are so sick, so my kids must be ready to jump in right away" says our Nurse Manager.
Then I witnessed a new Nurse get sucker punched in the jaw by a drunken female.
All of this within weeks.
A female patient was intoxicated at a local sporting event, fought with her girlfriend and assaulted two Police Officers in trying to subdue her.
Both Officers were taken out, one with a kick to the knee and ACL tear, one with multiple heel vs testicles and human bite.
She went to jail, was refused and ended up in the ED on a BB, c collar, spit mask and four point soft ties. The look on the Paramedics faces was one of abject fear. (I know that feeling all too well)
Seriously the worst behavioural emergency in 29 years. She was banging her occiput to the back board with that sickening watermelon like sound and it required the Attending, one resident and four RN's to prevent her from hurting herself. We HAC'd her and were waiting for it to take effect.
She spit on the Attending's face shield. Then somehow managed to spit under my face shield and glasses directly into my eye and attempted to sink her fangs into my wrist. I had gloves on and the spit mask prevented a human bite. (Four of us were physically holding her down, no choice)
But I then had a flashback to my colleague getting sucker punched and then had like an out of body vision of my dominant hand becoming infected with a rapidly spreading cellulitis. There goes my career..I envisioned.
I arrested her and had to leave work as I was unable to safely care for my other patients.
Had three days off, did all the right self care things and as soon as I hit the campus had a huge panic attack and again went home.
Was off for 5 weeks, saw EAP, and essentially the root cause analysis of my PTSD was RT the little 3 yo girl. No critical incident debriefing in our culture remember, no closure.
Started on prozac and a little metop. Also started working out again, huge help.
Now I am back to full duty, and am doing quite well thank you.
I did some online research and found that up to 10 percent of Critical Care Nurses (ED, ICU, CCU) at some point suffer from PTSD, a higher rate for noc shift.
I am thinking of writing my story up in a journal. I would really like to share my story with others so that they can learn just how important self care is.
Despite the barriers my house has..
If anyone knows of any good articles on PTSD re Critical Care Nurses and/or wishes to share story, I would be greatful.
This is not about me, but rather about us.
Our own unique "Band of brothers and sisters"
Respectfully,
Mike
