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Posted: Jun 03, 2008 11:33 PM
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On my way to work I usually got the "performance jitters" - you see, I was not the Nurse my patients saw each day, that was a role that I played; I played it well.
Each shift "Nancy Nurse",my character, was efficient, intelligent, quick thinking, compassionate, organized, quick witted and funny. She also had excellent assessment skills, and even better intuition. She always "knew" which patients required closer monitoring - sometimes it was just a "feeling", but over the years - she learned her feelings were rarely wrong. This was "Nancy Nurse" - ER nurse extraordinaire!
Inside "Nancy" was her other persona, Babs. Babs was a good nurse, but prone to anxiety, self doubts, afraid of things she might see like bones protruding, arteries pulsating blood around the room, taking off the boot of the farmer whose chainsaw "slipped" and cut through the boot, or looking under the bandaged foot of the patient whose every step dropped maggots on the floor - or worse, the elderly man who shot away half his head but whose heart still beat so we had to "work him" even though we all knew what the outcome would be. "Nancy" got an adrenalin rush from these things, Babs did not.
Babs has seen lot's of things. She and "Nancy" once spent 8 hours taking care of an 11 month old who was found not breathing while sleeping face down on a water bed. Every one told "Nancy" that dead babies look like "beautiful sleeping china dolls", Babs noted this baby was mottled, gray and looked dead - nothing like a China doll - and Babs was very sad and confused and thought a lot about this over the 8 hours she and "Nancy" spent keeping this child "alive".
"Nancy" was excited with this new challenge. She expertly administered chest compressions, medications, LOTS of epinephrine and when the babies heart was beating on it's own, it was Babs that noticed she was pale, but at least didn't look dead anymore. "Nancy" monitored everything from the ET tube to the foley. Both waited during the snowstorm for the transport team to come to pick up the baby to take her to a pediatric ICU 45 min away. By the time the transport team got there, "Nancy" and Babs had spent the last half hour cleaning up the blood coming from the ET tube, her eyes, nose, ears, every place we stuck her with a needle, her rectum, and her foley. Both suspected DIC. "Nancy" gave the transport nurse a concise and efficient report - even nodding in agreement when the transport nurse said "This is a waste of time". Babs just felt exhausted, and very sad, and embarrassed because "Nancy" agreed with the transport nurse, but Babs didn't. It wasn't a waste of time. If nothing else, it gave the family a longer time to come to grips with the inevitable.
One day "Nancy" was eagerly awaiting a code that was on the way in with a 34 y/o female. She had been seen in our ER twice that week for chest pain. Babs was DREADING the patient coming in. "Nancy" took over - because she had to, she managed things that Babs found difficult to handle.
In comes this asystolic women, CPR in progress, intubated. "Nancy" put her on the monitor, verified ET placement, listened to lung sounds. Continued ACLS protocol - all to no avail. Babs was content to observe - she noticed things like voices of the family in the hall, jokes told by all those involved in the code, both she and "Nancy" heard when the code was called. Both knew this would be a coroners case, so all IV's, and tubes were left on the body. Babs washed up around her mouth, and put a pillow behind her head and covered her up with a blanket. Babs noted she looked like the color of clay - and she looked very dead.
"Nancy" efficiently recorded the code happenings, notified the coroner and looked over all the testing done on this woman on her two other visits to the ER that week. She had had CXR's, VQ Scan, many labs, EKG's, CT scan etc... all negative. On the second visit the ER doc wanted to admit her - she declined and signed AMA paperwork - "Nancy" made a mental note that that could have been the difference right there - perhaps a lethal arrhythmia that only showed up from time to time - if she had stayed - maybe she would still be alive.
Babs noticed a man pushing a stroller go into this woman's room - the chaplain was with him. Babs went in, after all, this was still her patient (and Nancy's as well). This was the moment that Babs and "Nancy" both saw the same thing - these two nurses came together for the FIRST time.
When they walked into the room, they noticed the body of the woman, she was center stage on the gurney, still gray and lifeless. Then both noticed a man sitting with the chaplain, both talking quitely, then both heard laughter and giggling, and keys jingling. It was then that they saw this baby, a beautiful one year old cheerfully throwing her arms up and down, jingling the keys and smiling - two feet from her gray, dead mother.
This, for whatever reason, was the turning point for "Nancy" and Babs. They became one. The haunting image of this beautiful baby with her dead mother will follow Babs forever.
After 8 years in the ER, this image, more than any other, took the joy out of the ER for "Nancy" and helped Babs see that she was probably never meant for the ER in the first place. Babs left within a month after that for another position.
Now Babs relies on herself. Her horror coping mechanism "Nancy" is gone. I hope to never need "Nancy" again.
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