Insight to my life as an emergency room nurse

ACEP News September 2006
By David F. Baehren, M.D.

For a generation or two, we have lamented the loss of role models in society. As parents and individuals, we naturally seek out others we would like to emulate. Sadly, a serious search through the popular culture leaves us empty-handed and empty-hearted. Thanks to a long list of legal and moral shenanigans, many entertainers, politicians, and athletes long since abdicated this momentous position of responsibility.

We usually look afar for heroes and role models, and in doing so overlook a group of professionals who live and work in our midst: nurses.

And not just any kind of nurse: the emergency nurse. There are plenty of people involved in emergency care, and no emergency department could function without all of these people working as a team. But it is the emergency nurse who shoulders the weight of patient care. Without these modern-day heroes, individually and collectively we would be in quite a pinch. This unique breed of men and women are the lock stitch in the fabric of our health care safety net. Their job is a physical, emotional, and intellectual challenge.

Who helped the paramedics lift the last 300-pound patient who came in?
Who took the verbal lashing from the curmudgeon giving admitting orders over the phone?
Who came to tell you that the guy you ordered the nitro drip for is taking Viagra?

The emergency nurse has the thankless job of sitting in triage while both the long and the short buses unload at once. With limited information, they usually send the patient in the right direction while having to fend off some narcissistic clown with a zit on his butt. They absorb the penetrating stares from weary lobby dwellers and channel all that negative energy to some secret place they only tell you about when you go to triage school.

Other kinds of nurses serve key roles in health care and attend to their patients admirably. However, few function under the gun like emergency nurses do.

It is the emergency nurse who cares for the critical heart failure patient until the intensive care unit is "ready" to accept the patient. The productivity of the emergency nurse expands gracefully to accommodate the endless flow of patients while the rest of the hospital "can't take report." Many of our patients arrive "unwashed." It is the emergency nurse who delivers them "washed and folded." To prepare for admission a patient with a hip fracture who lay in stool for a day requires an immense amount of care--and caring.

Few nurses outside of the emergency department deal with patients who are as cantankerous, uncooperative, and violent. These nurses must deal with patients who are in their worst physical and emotional state. We all know it is a stressful time for patients and family, and we all know who the wheelbarrow is that the shovel dumps into.

For the most part, the nurses expect some of this and carry on in good humor. There are times, however, when the patience of a saint is required.

In fact, I believe that when emergency nurses go to heaven, they get in the fast lane, flash their hospital ID, and get the thumbs-up at the gate. They earn this privilege after being sworn at, demeaned, spit on, threatened, and sometimes kicked, choked, grabbed, or slugged. After this, they go on to the next patient as if they had just stopped to smell a gardenia for a moment.

Great strength of character is required for sustained work in our field. The emergency department is a loud, chaotic, and stressful environment. To hold up under these conditions is no small feat. To care for the deathly ill, comfort suffering children, and give solace to those who grieve their dead takes discipline, stamina, and tenderness. To sit with and console the family of a teenager who just died in an accident takes the strength of 10 men. Every day emergency nurses do what we are all called to do but find so arduous in practice. That is: to love our neighbors as ourselves.

They care for those whom society renders invisible. Emergency nurses do what the man who changed the world 2,000 years ago did. They look squarely in the eye and hold the hand of those most couldn't bear to touch. They wash stinky feet, clean excrement, and smell breath that would give most people nightmares.

And they do it with grace.

So, here's to the emergency nurse. Shake the hand of a hero before your next shift.

DR. BAEHREN lives in Ottawa Hills, Ohio, and practices emergency medicine. He is the author of "Roads to Hilton Head Island."

Such a slacker

O My Gosh.............I just realized I seriously haven't posted in TWO MONTHS. What the hell have I been doing? Who knows but I will try to recap and fill you in on all the things I can remember. Actually Ive been working a lot but y'all already knew that!

This may disturb some, but just laugh a little with me please. Lets see, there is such a thing as a fecal (rectal) bag - yes it attaches to your butt hole and drains well you know.....and honestly I.m sure the person who invented that made bank sadly enough. Why wasn't it me? The night I learned of such a thing I was kinda in shock I had heard there was such a thing, but seriously didn't believe it! I had made a copy of the directions just so I could post them for your enjoyment but right now its in my car, so here is a link to a picture of one http://www.nextag.com/rectal-bag/search-html . The best part were the instructions on the one we had in the ED which had 'Be sure to cut hair prior to attaching' listed as one of steps. I seriously could only laugh...........

Last week I got to shock a patient, he was in cardiac arrest it was only my second time doing that and I happened to be the closest one to the machine that shocks. So it was my duty but I was freaking out for fear that I wasn't going to remember how to do it - but I did. Unfortunately we didn't get him back but, I got the experience.

In that same night I put a HUGE (well for me) 18 gauge needle in an old guys arm, but that's cause he needed a transfusion. I have only put in like 3 of these in my life.....and sadly enough they make them bigger than this! Here is a link so u can see the size......and laugh with me this is off a veterinarian supplies site and it lists the 18g as for a HORSE!! That should give u an idea how damn big it is......... http://www.drsfostersmith.com/product/prod_display.cfm?pcatid=11043&cm_mmc=Shopping%20Portal-_-NexTag-_-Dogs-_-Monoject%20Needle,%2018%20gauge,%201&ref=3665&subref=AA&GCID=C12188x007 LOL!! The 20g next to the 18 is what I typically put in people. Just look at the difference in SIZE of the barrel.

O and to end the night, I got to stop a mans heart again - he was in SVT where his heart beat was in the 180's. I pushed a medicine and he converted into a nice Sinus Rhythm just like that!! :) It was sweet! Pts just become very symptomatic and complain of bad chest pain or that the are going to pass out, and some do.

I have oriented two different new nurses over the last two months - on an as needed basis. One was just about to come off orientation and the other had been in the ED a while so they both were fairly competent, however its awesome to know I am trusted and respected by the 'higher ups' enough to allow me to do this!

I should also be orienting to triage soon.......but that really isn't anything terribly exciting, just something that will be a change of pace. (well last night I was put in triage WITHOUT any orientation!! How scary is that......but I did just fine! I still want to be oriented for the simple sake of doing it cause there are things I would have questions about. )

Yesterday I completed my ACLS - Advanced Cardiovascular Life Support Class, so now I am certified in that. I have to attain my PALS certification within the next few months - that's Pediatric Advanced Life Support. And finally, I will probably be going after a S.A.F.E. - Sexual Assault Forensic Examiner certification later this fall. It means if someone comes in after a rape and the police are brought in to prosecute and/or find the suspect, I will be the one who does the exam, takes the photos, documents the pts description of what happens and the one who is responsible for making sure the 'evidence' has a chain of command so that it can be used in the trial. I think it will be very rewarding to help people who have been assaulted. I know it wont be an easy certification as there is lots of training, orienting and METICULOUS documentation involved. But I am certainly interested.

I'm house, well condo, searching. Had originally looked in Westminster but decided what I was looking at and the size just wasn't where and what I wanted. Currently the hunt is on in Frederick and I have several I am interested in - all basically in one area. I'd like to be able to buy and move within the next few months (2-4). Basically I have most everything paid off except my car and student loans, so those few months I'm going to be really checking out whats available I should be able to finish paying off the credit card debt I still have - but its a LOT less than it was!
Tricia and Desi are engaged! I have a wedding to be in this November and I love our dresses. Looking forward to the events for that.

That's all for now, but that's cause I'm tired of thinking and need to get this post out.