A couple of weeks ago, I had to attend a debriefing about a patient we had to code for more than 2.5 hours in the Emergency Room. The debriefing was necessary in this case largely because of the unexpected emotional toll it brought to everyone involved in the resuscitation. Typically, us medical providers are able to separate emotions and compartmentalize, but for some reason this patient managed to put tears rolling down on our cheeks in the very short period of time that we spent with her. During the debriefing, I realized how much emotional trauma and baggages I now carry from working in the Emergency Room for five years. Well, I've only been a nurse for three and a half, but during those years, I thought I was doing very well in my journey of becoming an ideal highly functional nurse devoid of any emotional attachments with patients. For crying out loud, I have not cried because of a patient for years! For somebody like me, who wear my heart on my sleeve, that is a huge feat!
I can still vividly remember the first time I cried; I was in my first semester of nursing school, doing one of my rotations in a nursing home. I witnessed an eminent death unfolding and the patient's hand just simply reminded me of my grandfather. I guess those wrinkled, paper-thin skin, with countless of freckles, have a soft spot in my heart. The second one was my actual first death. It was almost at the end of 2019, but right before COVID. I had a patient with Stage 4 Cancer with DIC, clotting and exangounoulsy bleeding at once, already intubated and sedated, maxed out on three vasopressors, on platelet & blood transfusions, on a bear hugger, and already coded 4 times during night shift. When he coded again on my shift, the ICU MD called it by the second round of CPR. I was running around like a headless chicken for a solid 4 hours, constantly titrated the vasopressors and propofol, hanged bazillions of blood product, and also infinitely cleaned up my patient from the gushes of blood coming out from all the orifices of his body. It was a lot of work. I was so exhausted that when the ICU called it, I was so upset. I felt like all of my hard work was for nothing! “How dare you die and give up on your life when I was working so fucking hard for you?" I mumbled on my patient as I sobbed for 3 hours that my charge nurse had to let me go home early from my shift.
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| September 2022 |
In my defense, at the height of COVID, I only cried once when we had to code our own fellow ER Radiology Staff. See, apparently, putting countless of bodies in body bags and stacking these bodies on the morgue every single shift never bothered me.
Or so I thought.
After hundreds of deaths I witnessed for 2 years during the heat of the pandemic, we were only given a couple of minutes to process our emotions until the next patient rolled in and we had to put on our happy selves. The cycle was never ending. We never really had the opportunity to grieve the person we just lost -- we ✨ simply ✨ just continued onto the next patient. The show must go on, so they say. For our own sanity, we didn't dwell much into each death that we witnessed, but rather, we tried to move on in the most inhumanly ways possible. We were expected to function like robots who can turn off feelings in a simple flicker of the switch. In this line of job, being in your feelings is seen as a weakness --and weakness, my friend, can be a liability. When your whole ER have at least 8-10 intubated ICU hold at once, focusing on the baggages you need to unpack is the last thing on the to do list.
Well, now that COVID is finally gone, all the unpacking has now begun. The death of that patient weeks ago just highlighted all of my unprocessed trauma I seriously need to speak with a therapist. I thought the absence of my tears over the years signified that I have finally learned to cope. Little I know, I just got better at hiding them by sweeping all of these multiple giant heavy tangled curled balls of emotional baggages under the rug. I underestimated off my capacity to do so, because when they got so big that even just a peck of dust landed on it, they exploded so hard that all the contents came up bursting up to my dry throat that they choked me.
It's funny because I kept reminding myself at that time that the patient was not even mine to begin with, as an attempt to bargain with my soul so I would stop crying. "I was just helping out! I was just doing CPR! I was just setting up the A-line, the central line, pulling up and mixing up the tPA! Drawing and pushing Epi! I was just taking turns with Jen scribbling down all the meds we have given in between the chest compression and all other tasks we had to do at once."
Nevertheless, it was futile.
No amount of self rationalization can magically fix years of damages that accumulated from seeing and attempting to physically prevent hundreds of deaths. Each patient is a reminder of the fragility of my own mortality and my irrational fear of dying the next day while not having done anything significant in my life, nor having lived it to the fullest. I do not fear death, but I fear living an empty life. I fear not having touched and hugged the people that I like, not having spent actually walking on this beautiful Earth and being on top of the mountains where I could see the horizon that meets the sky over the golden rays of sunrise. I fear being stuck on the exact same place where I was, with no progression, no changes, no nothing. I fear having any regrets if I lived my life like an hollow shell.
Life is short.
I fear being put in a body bag, like the countless of bodies I had to zip in and toe-tagged, when I haven't had the chance to fully give love and receive love, or even experience everything that our world has to offer. Worse, I fear living long enough, but only having spent all of my time working, that the next thing I know, I quantum jumped from being an employee to being a nursing home resident.
An average life expectancy in the U.S. is 77 years old, with the retirement age of 67. Isn’t crazy that we are expected to spend 45 years of our lives working only to enjoy 10 years of our retirement? Only 10 years, where we can barely walk for less than quarter a mile because of our fucking arthritis, or partial hip and knee replacement? My bet is my back would never not let me make it from the airport lobby to the departure gate on time, even with my TSA pre-check. I would miss all of my flight because at 77 years old, I guarantee you, my walking speed would be less that 1mph.
Then I die.
And that's on the best case scenario, with only orthro problems to deal with. What if my other co-morbidities were all acting up at the same time? Is this life really just expecting me to spend my 10 years of retirement on a nursing home bed, waiting for the muscles of my body to all contract and atrophied, waiting for my CNA to flip me over while I'm laying on my own urine and feces? With my stage 3 pressure ulcers just get worse and worse in each day, until I finally pass away from sepsis? I see myself fully demented with an awful delirium, spitting on everybody who tried to even speak to me. Dude, I would be 100% completely deaf! Please make sure my hearing aids are always charged the night before or else everything would startle and scare me if I couldn't hear anything! What is the quality of life?
If there is something I learned as an ER nurse, that is to make sure that I have DNR/DNI papers by the age of 75. Lower that to 65 if I'm on anticoagulant with frequent falls of more than 3x in a month. Baby, just let me go. That's me trying to walk onto the tunnel of light. Don't even save me from this fucked up world. On the optimistic side, I learned to book as much vacation I could possibly fit in my fiscal year. I actually spend a portion of my salary dedicated to see the world, not because I wanna be an instagram influencer (like seriously, lol! or I mean, maybe? hahaha), but because first I was afraid, I was petrified... of an early unexpected death.
Nursing is like joining a mafia. Once you're in, you're in. It absolutely changed me in ways I could not imagine. There is this bitter-sweet moment when I realized I can never see turkey sandwiches the same as before ever again, without seeing all of my experiences as a nurse flash before my eyes. The irony though, I do still see myself staying in bedside nursing, despite everything. It is definitely the oddly weirdest thing. As a matter of fact, if I win the lottery today, I probably still gonna be a nurse, fetching my patients warm blanket with a cup of cranberry juice, with ice. I am actually happy working in the Emergency Room despite everything that I have seen and experienced. I still come back home fulfilled in each shift, even though I just dealt with an altered patient who was raw dogging, smackdown wrestling everyone of the staff. I still look for ways to improve my craft, learn more in each day, and earn as much certifications to make sure I'm providing the best care I can for my patients. I am happy as a nurse. Now, the only challenge is finding the fine line between doing what I love the most, without it destroying me.
Happy Nurse's Week.
