Saturday, August 29, 2009


"I try to visit people in hospitals when I can, smiling and joking while I'm there. But when I leave, I just start crying." Loretta Lynn

There isn't a nurse I know who hasn't had to sit down at the end of the day and release some tears. Heck, sometimes we even release them during the shift, in a break room or bathroom. Just after the first time I ever did CPR on a hospitalized patient, after she was safely transferred to the ICU, I completely lost it and bawled my head off a few minutes. It was such a release of all the pent up emotions. I was kind of embarrassed at the time, but I literally could not hold it back.

The main underlying attitude that helped me to stay on task at work, was to think about the discomfort of the people I was helping, and not my own. I think most nurses learn this. I had to find a way to displace or delay these normal reactions in order to be a help, to be in service. Plus, I was raised by a rather stern father, who happened to be a veterinarian. (My first nursing job was assisting him.) The main coping mechanism he modeled for me was a "Suck it up and be tough" attitude.

There's a process as a nurse matures where (hopefully) we learn healthy ways of dealing with those stresses. Yes, there's lots of unhealthy ways: excessive eating, drinking, tv watching, etc. Of course, it's healthier in the long run to have a good cry at the end of the day, or go for a run, or spend time with a pet.

I believe alot of nurses learn to reduce our sensitivities and are many times,  pushing our feelings down. However, other sensitivities often become heightened.

I worked for upwards of 15 years in ICU. I actually enjoyed the highly technical aspects of ICU and the balancing act of keeping an eye on multiple issues at the same time. I also liked the intimacy of getting to know two patients and their families, in depth. I learned SO MUCH from my patients -- because they often needed a sounding board, as they faced some of these scary situations. Patients often say things to their nurses that they wouldn't necessarily express to their families. They would impart so much wisdom. It often reminded me of that scene in City Slickers when Bruno Kirby and Billy Crystal talked about their best and worst days.

I also appreciated a great working relationship with a few physicians. The wisest Intensivists ... were the ones you could call with just a bad feeling and a report of a few subtle shifts in vital signs... and they'd know the right questions to ask, the right tests to order, or at least come and assess the patient. These "intuitive hunches", shared with the correct MD, very often headed off a complication at the pass.

And there is the smell thing. I won't go into details, but a really good nurse, can smell so many conditions without even examining a person. A yeast overgrowth, an alcoholic, cancer, burns, GI bleeding, people on dialysis, a liver that's shutting down ... they all have their own scent. It's not a skill that most people talk about, but often nurses develop a very acute sense of smell.

For me, eventually the stress of working in ICU got to be too much. The HMO that ran the South Florida hospital I worked in, started changing the patient-nurse ratios. Now each ICU RN was in charge of 3 patients. We just couldn't be as thorough with three patients and we were with two -- that was distressing. (Today, many states have a safe nurse-patient ratio laws in effect.) There seemed to be more and more alcoholics and drugs addicts that were abusing the system-- being admitted to ICU while drug-seeking. Ecstasy and 'club drug' overdoses accelerated in my city, and young people came into ICU comatose, with temperatures of 106 degrees. (I've never referred to a drug as "recreational".) I was assaulted at work -- punched in the face by a man who had taken too much MDMA (like liquid ecstasy). There were patients who, at the end of life, ended up seeming to be abandoned and neglected, dying alone. And of course, the super-infections (MRSA and VRSA) became rampant. Also, my marriage was breaking down at that time. Looking back, I'm still not sure how I didn't end up in a rubber room myself!

S., the nurse that first introduced me to reiki, then saved my sanity by encouraging me to work in Recovery Room. He and I used to work in ICU together and he had transferred to PACU (Post Anesthesia Care Unit, another title for Recovery Room). He told me to at least come there for one shift and see how it went.

PACU/RR is where nurses monitor patients that are waking up from surgeries and procedures that require anesthesia. Right away, I could see the light. People who were getting operated on, generally didn't have those horrible infections. I didn't have to work around ten different tubes and wires just in order to wash them. In fact, I usually didn't have to deal with baths and bedpans, at all. And instead of calling five different doctors (one for the heart, one for the lungs, one for the diabetes, one for the antibiotic coverage), I primarily had the anesthesiologist and surgeon to answer to. And they seemed to love what they were doing! There was this lightness and sense of accomplishment in Recovery Room that I didn't experiences in ICU anymore. Usually the surgeons came out of surgery happy and lighthearted, because they loved doing surgery. These were some of the same MDs that were fairly cranky when they had to round in ICU.

So these days, I have found my niche. (Thank GOD) It's wonderful when someone wakes up and they get to hear "It looked clear to me. We'll run the frozen sections, but it doesn't look like cancer" from their surgeon. Or -- even if they do have cancer, sometimes surgery is their first huge step to healing, and there's a sense of empowerment, of their recovery plan being in place and underway.

How do I get so far off topic while writing this blog? I guess that these days, it's not that I think I am 'too sensitive' to work in ICU anymore, but it's a choice point for me. I'm choosing to work where I feel like I am making a difference, and where I feel like patients are on the road to healing.

I'm still sensitive in many ways, but the days where I need to cry at the end of my shift are practically non-existent.

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