It’s 4 AM. I just got off work a half an hour ago. I should be in bed, my baby will be up in a few short hours and ready to start her day of adventures. Yet, I don’t feel ready for sleep yet.
I feel dazed, I drove home in a daze.
A part of me didn’t want to drive home, a part of me didn’t want to get out of the car once parked safely in my garage. A big part of me wanted to stop at one of the many gas stations on my way home to buy a pack of cigarettes, and relight the old flame of comfort and temporary peace.
When I accepted a position in the ER, I understood that there would be things that I would see that would bother me, change me, rock me at my core. I knew that many years from that moment, I may face a day where I could no longer carry the heavy burden of loss and grief on my shoulders; tired from waging a war between life and death day after day, night after night.
In the end that’s what causes nurses to burn out in the ER right? Death, tragedy, loss, senseless trauma and violence—one nurse can only take so much.
Not even off orientation yet, I feel the pangs of burnout deep within my gut. More bothersome than the feeling is knowing that what caused them is something I was entirely unprepared for, that I’m not sure has a name.
I start my shift receiving a girl from the off-going nurse. The patient is 15, friendly, just starting her Sophomore year of high school probably. New mass found today, likely cancer with mets. The scan four years prior shows a mass as well, but then it looked like an enlarged lymph node which fit her symptoms at that visit.
I spend time at the bedside, making sure the patient and Mom are okay. They seem so calm. Perhaps the gravity of the situation has not sunk in yet. Mom is quiet and strong, but I can tell she looks like she wants to cry every time she looks at her daughter; she’s afraid.
After this, I visit another room. The wife of a patient berates me for how long they have been in the ER. Why does the doctor keep trying to medicate her husband for pain?? Because he’s in pain, I explain. She refuses. Why haven’t we figured out what’s wrong, it seems like all we do is tests here and he’s fine and he should just be going home.
I think to myself, “Why did you bring him in then??” A thought I find myself asking over and over and over again each night. She continues to tell me how awful the hospital is because he has been there 4 hours and hasn’t eaten anything.
Another patient complains about her 30 minute wait. I say the social worker will be right with her. I call to check on the social worker who explains she is about to tell the wife of a patient brought in by ambulance as a full arrest that he didn’t make it, and will be with us soon. Meanwhile, the patient yells that this place is awful and no one cares about his pain.
We get a twofer in room 10, Mom brings in her two kids for a litany of complaints. She’s gone from hospital to hospital and no one can tell her what’s wrong with them. The son was here 3 days prior and received a cadillac of workups, but nothing was wrong with him. We work them both up to the same result. Mom finds out the provider is a NP and not a doctor, and we lose all credibility. Mom leaves with the kids prior to discharge and refuses to speak to a doctor.
Another patient avulsed a small part of his finger cutting carrots at work. He gets Motrin and Norco for pain. Curses us because we don’t use lidocaine to numb his hand prior to getting saline sprayed on it for wound cleansing.
The thirty minute wait is too long, why isn’t my mom admitted for her stroke yet—it’s been 45 minutest? No one has given me a sandwich! Why can’t the doctor write me a script till my appointment in 4 months for Norco and Xanax and cover me until then? Why can’t you do a MRI for my foot pain that’s been going on for 6 years? This wait is ridiculous. This is a big hospital, why doesn’t my husband have a bed? Why is there no TV in this room? Why can’t my son have his own room? I’m reporting this. I’m not paying for this. You guys are terrible here. You should be ashamed of yourselves. I’m going to sue you all.
I feel sucked dry. Meanwhile, a little newborn is facing a possibly lethal illness, and yet another man is coding, the techs are busy with post-mortem care, I’m 2 patients behind in charting, and another patient looks at me like I’m lazy, sitting on the computer doing nothing.
I know now it isn’t the deaths and codes that kill the ER nurse.
My charge nurse said today that he’d rather take a well organized code blue, irregardless of the outcome, over patients who we just couldn’t please, any day. He said, “Does that make me sound twisted?” No, I get it. We are waging a losing battle over death, a losing battle over pleasing the patient, a losing battle over being 100% pain free, 100% satisfaction guaranteed, the customer is always right.
And I’m the awful nurse. Me, with no lunch break, no time to pee, $150,000 in debt for my education, who’s taking 6 patients when the ratio is 4 in order to get you back to see the doctor, me who breaks her back to take care of you—I suck at my job. In what other area can you show up to a place and treat people like that?
My head is fuzzy now from the wine, lack of sleep, lack of food and water. I can’t win, and one day they’ll beat me too. Another wide eyed new nurse will take my spot in the ER hoping to help people, hoping to save a life.
The old me would have wished her well, the new me knows it’s only a matter of time.
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