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In the beginning, I was like,
"It'll be okay,"
4
00:00:39,889 --> 00:00:41,993
trying to reassure
myself and my family.
5
00:00:42,026 --> 00:00:43,827
But then,
as the days grew longer,
6
00:00:43,860 --> 00:00:44,794
it was very clear:
7
00:00:44,828 --> 00:00:45,963
No, it wasn't okay
8
00:00:45,997 --> 00:00:47,731
and it was gonna get worse.
9
00:00:53,971 --> 00:00:56,173
I found that
over the past weeks that
10
00:00:56,207 --> 00:00:57,741
I've needed
this moment in the morning
11
00:00:57,774 --> 00:00:58,976
just to be quiet
12
00:00:59,010 --> 00:01:01,112
and to think
about what's happening.
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00:01:01,145 --> 00:01:02,980
You know, you take
a little moment like,
14
00:01:03,014 --> 00:01:05,216
it's okay to cry right now,
'cause, you know,
15
00:01:05,249 --> 00:01:07,751
my kids aren't gonna see me
and be upset, but also,
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00:01:07,784 --> 00:01:08,852
my colleagues
aren't gonna see me,
17
00:01:08,885 --> 00:01:13,224
because I feel like
I have to be strong at work too,
18
00:01:13,257 --> 00:01:16,093
for them and for me.
19
00:01:16,127 --> 00:01:17,995
So it's nice to be home
and to be
20
00:01:18,029 --> 00:01:19,964
a little bit vulnerable
sometimes,
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00:01:19,997 --> 00:01:22,899
and that's okay,
'cause, uh...
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00:01:22,932 --> 00:01:26,703
you know, I think everybody
has lived through a lot,
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00:01:26,736 --> 00:01:28,172
no matter where you are.
24
00:01:28,205 --> 00:01:31,908
So it's a precious moment
in the morning to be quiet
25
00:01:31,941 --> 00:01:36,180
and to have a few minutes
just by myself.
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00:01:47,258 --> 00:01:48,625
You always know
in the back of your mind
27
00:01:48,658 --> 00:01:52,329
something terrible
could happen.
28
00:01:52,363 --> 00:01:54,298
A terrible event
that you might be involved in
29
00:01:54,331 --> 00:01:55,899
as a healthcare professional,
30
00:01:55,932 --> 00:01:57,934
I think that looms in
our minds, we know that.
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00:01:57,968 --> 00:01:59,636
And yet, everything
that's happened has been
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00:01:59,669 --> 00:02:01,704
sort of surreal.
33
00:02:04,208 --> 00:02:06,110
Even though we knew
that COVID was
34
00:02:06,143 --> 00:02:07,610
in other parts
of the world,
35
00:02:07,644 --> 00:02:09,013
I don't know
that we really understood
36
00:02:09,046 --> 00:02:11,714
how overwhelming
this was going to be.
37
00:02:16,387 --> 00:02:19,223
As emergency nurses,
we are on the front line,
38
00:02:19,256 --> 00:02:21,658
and when a patient
arrives in the hospital,
39
00:02:21,691 --> 00:02:23,094
we're gonna do
everything we can
40
00:02:23,127 --> 00:02:25,963
in this moment of time
to save their lives.
41
00:02:40,944 --> 00:02:43,746
What brings you
to the hospital today?
42
00:02:43,780 --> 00:02:45,748
How's your pain now,
on a scale of 0 to 10?
43
00:02:45,782 --> 00:02:47,418
New patient, room 12,
44
00:02:47,451 --> 00:02:50,254
new triage patient, room 12.
45
00:02:50,287 --> 00:02:52,889
Do you feel like you're having
difficulty breathing?
46
00:02:52,922 --> 00:02:54,358
Rate's like 25.
47
00:02:54,391 --> 00:02:58,095
126 over 89, pulse 160.
48
00:03:05,202 --> 00:03:07,371
Truly, your ability
to care for another
49
00:03:07,404 --> 00:03:09,306
in their greatest
moment of need
50
00:03:09,340 --> 00:03:11,041
is in an emergency department.
51
00:03:20,384 --> 00:03:21,751
I have three children,
and they'll say,
52
00:03:21,784 --> 00:03:23,287
"Mom, what did you do
at work today?"
53
00:03:23,320 --> 00:03:25,389
And I'll say, "Well...
54
00:03:25,422 --> 00:03:26,890
took care of some patients."
55
00:03:28,993 --> 00:03:31,195
I can't explain to them
that I had a 46-year-old male
56
00:03:31,228 --> 00:03:32,997
that came in with
a gunshot wound to the head.
57
00:03:33,030 --> 00:03:33,964
You know,
I can't explain to them
58
00:03:33,998 --> 00:03:36,467
that I held a patient's face
against my hand,
59
00:03:36,500 --> 00:03:38,701
and she leaned into me
as she was dying.
60
00:03:40,904 --> 00:03:42,339
It's about as real-life
as you get.
61
00:03:44,908 --> 00:03:48,279
We are the mirror of society.
62
00:03:48,312 --> 00:03:49,946
If there's an Ebola scare,
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00:03:49,980 --> 00:03:52,782
if there's a bus
that turns over,
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00:03:52,815 --> 00:03:55,452
if there's the flu season,
where do they go?
65
00:03:55,486 --> 00:03:59,056
They come here.
We are the safety net.
66
00:03:59,089 --> 00:04:03,027
The trauma surgeon is saying,
"Get the patient to OR, now."
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00:04:03,060 --> 00:04:06,964
The care is not based on
whether you're insured or not.
68
00:04:06,997 --> 00:04:09,200
We're the ones that connect
with the patients first,
69
00:04:09,233 --> 00:04:11,235
and then we're the ones
that advocate for them.
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00:04:11,268 --> 00:04:13,370
A lot of stuff
that comes in here,
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00:04:13,404 --> 00:04:15,738
you wish you don't see again.
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00:04:15,772 --> 00:04:19,243
The traumatic events,
the gunshot wounds.
73
00:04:19,276 --> 00:04:20,843
I walk in here,
74
00:04:20,877 --> 00:04:22,912
and we'll have had
another overdose death.
75
00:04:22,946 --> 00:04:26,383
This opioid epidemic
is a crisis.
76
00:04:26,417 --> 00:04:28,818
There is no other place
for them to turn,
77
00:04:28,851 --> 00:04:30,387
and so they come to us.
78
00:04:30,421 --> 00:04:32,822
I think most of us are
very drawn to the adrenaline.
79
00:04:32,855 --> 00:04:34,291
We're drawn to the fast pace.
80
00:04:34,325 --> 00:04:38,028
We're drawn to the unexpected.
81
00:04:38,062 --> 00:04:41,498
Either it fits your soul
or it doesn't.
82
00:04:45,902 --> 00:04:48,771
Emergency medicine's
a very young specialty.
83
00:04:48,805 --> 00:04:50,140
It didn't always exist.
84
00:04:50,174 --> 00:04:52,209
Before,
it was the accident ward.
85
00:04:52,243 --> 00:04:55,045
The accident ward was
really run by the nurses.
86
00:04:55,079 --> 00:04:57,181
They pulled it all together.
87
00:04:57,214 --> 00:04:59,516
You would come up
and you would ring the doorbell
88
00:04:59,550 --> 00:05:02,419
and the nurse would
open up the door,
89
00:05:02,453 --> 00:05:04,288
and you would hope
they found a team
90
00:05:04,321 --> 00:05:05,855
to take care of the issue.
91
00:05:05,888 --> 00:05:07,291
Everybody says ER,
92
00:05:07,324 --> 00:05:09,393
and technically, actually,
it's an emergency department.
93
00:05:09,426 --> 00:05:11,462
We're not just
a little room anymore.
94
00:05:11,495 --> 00:05:14,298
I'm very drawn to
a large emergency department.
95
00:05:14,331 --> 00:05:16,100
I was attracted
to the trauma,
96
00:05:16,133 --> 00:05:17,968
and when we moved to this area,
97
00:05:18,002 --> 00:05:20,404
I'd been stalking St. Joseph's
for three years,
98
00:05:20,437 --> 00:05:24,208
'cause I really wanted
to come to this hospital.
99
00:05:24,241 --> 00:05:25,942
We are the third busiest
emergency department...
100
00:05:25,976 --> 00:05:28,312
freestanding emergency
department in the U.S.
101
00:05:28,345 --> 00:05:31,814
So on average, we see between
450 and 500 patients per day.
102
00:05:31,848 --> 00:05:34,084
That's crazy busy.
103
00:05:43,193 --> 00:05:44,328
Begum?
104
00:05:45,996 --> 00:05:46,597
Hello there.
105
00:05:46,630 --> 00:05:48,098
I'm here for translate.
106
00:05:48,132 --> 00:05:50,833
Translate? My name is Kim,
I'm one of the nurses.
107
00:05:50,867 --> 00:05:52,336
What brings you in today?
108
00:05:52,369 --> 00:05:54,271
It's like almost
three months, right?
109
00:05:54,305 --> 00:05:56,140
That finger,
she can't even move,
110
00:05:56,173 --> 00:05:57,541
and it hurts a lot.
111
00:05:57,574 --> 00:05:59,576
A lot of what we do
in emergency medicine
112
00:05:59,610 --> 00:06:01,211
comes from the military.
113
00:06:01,245 --> 00:06:02,513
Triage is exactly
one of those things
114
00:06:02,546 --> 00:06:06,016
that we've brought
to the civilian world.
115
00:06:06,050 --> 00:06:08,218
The triage nurse intercepts
every single person
116
00:06:08,252 --> 00:06:10,054
who's coming through
the front door,
117
00:06:10,087 --> 00:06:12,589
and that nurse,
in our department,
118
00:06:12,623 --> 00:06:14,891
she might see
100 patients in six hours.
119
00:06:14,924 --> 00:06:17,894
All right, I'm just gonna
check your blood pressure, okay?
120
00:06:17,927 --> 00:06:19,963
Where in your back
is the pain?
121
00:06:19,997 --> 00:06:21,332
- Sciatica...
- Sciatica.
122
00:06:21,365 --> 00:06:22,633
...and...
123
00:06:22,666 --> 00:06:24,435
My job is to look
at the patient and say,
124
00:06:24,468 --> 00:06:26,537
"Is this patient gonna die
if I don't intervene
125
00:06:26,570 --> 00:06:28,305
in the next 10 minutes?"
126
00:06:28,339 --> 00:06:30,641
Who is the most sick, who's
gonna use the most resources,
127
00:06:30,674 --> 00:06:33,310
and what level of care
does this patient need?
128
00:06:33,344 --> 00:06:34,211
On a scale of 0 to 10,
129
00:06:34,244 --> 00:06:35,878
how would you rate your pain
right now?
130
00:06:35,912 --> 00:06:38,315
- Eight.
- An eight.
131
00:06:38,349 --> 00:06:39,949
Okay, so you can have a seat
back over there,
132
00:06:39,983 --> 00:06:42,119
they're gonna call you
from one of the back doors.
133
00:06:42,152 --> 00:06:43,487
You take that with you,
okay?
134
00:06:43,520 --> 00:06:45,122
Is there a long wait?
135
00:06:45,155 --> 00:06:48,092
Um, I can't say
how long it's gonna be.
136
00:06:48,125 --> 00:06:50,927
It's not too bad right now,
though, okay?
137
00:06:55,232 --> 00:06:56,933
I'm gonna do it right here.
138
00:06:56,967 --> 00:06:58,202
You're gonna feel
a big pinch, okay?
139
00:06:58,235 --> 00:07:00,304
All right.
140
00:07:00,337 --> 00:07:02,172
It happened so fast,
just like,
141
00:07:02,206 --> 00:07:03,574
soon as I hopped
outta my truck,
142
00:07:03,607 --> 00:07:06,343
the dog just came at me
and bit me.
143
00:07:06,377 --> 00:07:08,278
I've been having a pain
144
00:07:08,312 --> 00:07:10,381
for, like, five...
three days,
145
00:07:10,414 --> 00:07:12,416
since Tuesday to now.
146
00:07:12,449 --> 00:07:14,952
Since it's getting worse
instead of getting better,
147
00:07:14,985 --> 00:07:17,054
I came here to see
what's going on.
148
00:07:17,087 --> 00:07:18,956
All right, you ready?
149
00:07:18,989 --> 00:07:20,090
Okay, you can go ahead
and lie back.
150
00:07:20,124 --> 00:07:22,693
We're just gonna put you
on a cardiac monitor, okay?
151
00:07:22,726 --> 00:07:24,361
It's not just
the high-powered trauma,
152
00:07:24,395 --> 00:07:25,529
it's not just about cardiac,
153
00:07:25,562 --> 00:07:27,264
it's everything from your
earache and your sore throat
154
00:07:27,297 --> 00:07:29,266
to having a stroke.
155
00:07:29,299 --> 00:07:32,536
Tech to the trauma room,
tech to the trauma room!
156
00:07:32,569 --> 00:07:35,672
Sorry, lot of things are
gonna happen right now, okay?
157
00:07:35,706 --> 00:07:39,942
- 132 on 98.
- Open your eyes for me.
158
00:07:39,977 --> 00:07:42,713
Can we just call
for an EKG stat?
159
00:07:42,746 --> 00:07:44,348
Gimme a good
cardiac emergency,
160
00:07:44,381 --> 00:07:45,682
a good respiratory emergency!
161
00:07:45,716 --> 00:07:48,118
I am... I love that.
162
00:07:48,152 --> 00:07:50,053
You know where you are
right now?
163
00:07:50,087 --> 00:07:51,455
In the hospital, okay.
164
00:07:51,488 --> 00:07:52,589
Okay, what's wrong
with this patient?
165
00:07:52,623 --> 00:07:54,258
What do we need to do?
What do they need immediately?
166
00:07:54,291 --> 00:07:56,360
What do they need
in the next hour?
167
00:07:56,393 --> 00:07:57,995
Can you lift this arm up?
168
00:07:59,696 --> 00:08:00,764
Okay, put it down.
169
00:08:00,798 --> 00:08:02,699
All right, we'll call it
a stroke code to make sure...
170
00:08:02,733 --> 00:08:05,102
Lift up this leg.
171
00:08:05,135 --> 00:08:05,935
Your attention, please.
172
00:08:05,969 --> 00:08:09,440
Code stroke,
emergency department,
173
00:08:09,473 --> 00:08:11,375
code stroke,
emergency department.
174
00:08:11,408 --> 00:08:12,743
You're just constantly with
one patient after the other,
175
00:08:12,776 --> 00:08:15,245
and very seldom,
it's something very simple.
176
00:08:15,279 --> 00:08:17,981
Every patient has
their own complicated story.
177
00:08:18,015 --> 00:08:19,583
Rate's like 25.
178
00:08:19,616 --> 00:08:21,084
I didn't start
in the emergency department.
179
00:08:21,118 --> 00:08:23,153
I never actually thought
I would end up here.
180
00:08:23,187 --> 00:08:25,055
I was a little nervous at first.
181
00:08:25,088 --> 00:08:26,356
The turnover of patients,
182
00:08:26,390 --> 00:08:28,692
the acuity of patients,
I wasn't used to that,
183
00:08:28,725 --> 00:08:32,763
and it just quickly became
everything that I loved.
184
00:08:32,796 --> 00:08:35,265
What happened?
185
00:08:35,466 --> 00:08:37,434
Your mom died?
I'm sorry to hear that.
186
00:08:37,468 --> 00:08:38,735
You were drinkin' today?
187
00:08:41,038 --> 00:08:42,372
You were trying
to detox yourself?
188
00:08:42,406 --> 00:08:43,507
Yeah.
189
00:08:43,540 --> 00:08:45,242
When was the last time
you drank?
190
00:08:49,346 --> 00:08:52,149
Alcohol. It's always that.
191
00:08:52,182 --> 00:08:54,351
I tried to detox on my own,
192
00:08:54,384 --> 00:08:57,454
and I thought
I was having a seizure.
193
00:08:57,488 --> 00:09:00,491
Just... it's stupid.
194
00:09:00,524 --> 00:09:01,592
I thought I could do it.
195
00:09:01,625 --> 00:09:04,194
I got him... I got this one.
196
00:09:04,228 --> 00:09:05,462
My name's Angel,
I'm one of the techs, honey.
197
00:09:05,496 --> 00:09:06,530
We're gonna do an EKG,
198
00:09:06,563 --> 00:09:08,165
we're gonna take a look
at your heart really fast,
199
00:09:08,198 --> 00:09:09,433
- okay?
- Are you gonna take blood too?
200
00:09:09,466 --> 00:09:11,502
Oh yeah!
All that good jazz.
201
00:09:11,535 --> 00:09:13,670
I don't like hospitals too much.
202
00:09:13,704 --> 00:09:15,572
Yeah. Well, after today,
I'm done.
203
00:09:15,606 --> 00:09:17,407
I'm too old for this.
204
00:09:17,441 --> 00:09:19,142
Do you have any allergies
to food or medicines?
205
00:09:19,176 --> 00:09:21,278
No?
206
00:09:21,311 --> 00:09:22,646
How tall are you?
207
00:09:22,679 --> 00:09:25,349
Five... with heels, 5'2".
208
00:09:25,382 --> 00:09:27,651
With heels?
What about without heels?
209
00:09:30,521 --> 00:09:32,389
When I was younger,
I was sick
210
00:09:32,422 --> 00:09:34,424
and in and out
of the hospital a lot.
211
00:09:34,458 --> 00:09:37,160
The nurses were just
such a huge part of my life.
212
00:09:37,194 --> 00:09:38,595
I never liked IVs.
213
00:09:38,629 --> 00:09:41,131
There was one nurse that always
was able to get my IVs,
214
00:09:41,164 --> 00:09:44,468
and I wouldn't let
anyone touch me but him.
215
00:09:44,501 --> 00:09:46,103
Thanks for choosing me.
216
00:09:46,136 --> 00:09:49,406
Oh, you're welcome!
217
00:09:49,439 --> 00:09:51,441
My lucky day.
218
00:09:51,475 --> 00:09:54,278
Night.
219
00:09:54,311 --> 00:09:58,582
- It is your lucky night.
- Yep.
220
00:09:58,615 --> 00:10:00,817
You just missed me.
221
00:10:00,851 --> 00:10:02,152
- I have to come back.
- You just wanted
222
00:10:02,185 --> 00:10:03,453
to come see me, yeah.
223
00:10:03,487 --> 00:10:06,456
- I knew it.
- I needed a fix.
224
00:10:06,490 --> 00:10:08,625
What a pain in the neck am I.
225
00:10:08,659 --> 00:10:10,160
You're not a pain in the neck.
226
00:10:10,193 --> 00:10:12,296
Okay.
227
00:10:12,329 --> 00:10:14,398
Your veins are really tiny,
though.
228
00:10:14,431 --> 00:10:15,399
They always have trouble.
229
00:10:15,432 --> 00:10:17,401
My mom...
230
00:10:17,434 --> 00:10:18,769
we both had such tiny veins.
231
00:10:18,802 --> 00:10:20,137
Mm-hm.
232
00:10:24,741 --> 00:10:26,143
Oh, you got it in?
233
00:10:26,176 --> 00:10:27,544
I did! Look at that.
234
00:10:27,578 --> 00:10:29,680
- Yeah, buddy.
- Yeah, buddy!
235
00:10:32,182 --> 00:10:34,618
- Was it the first shot?
- First shot.
236
00:10:34,651 --> 00:10:37,721
- Thank you, hon.
- You're welcome.
237
00:10:37,754 --> 00:10:41,291
The feeling that I had
when the nurses took care of me?
238
00:10:41,325 --> 00:10:42,759
That is what I wanted to...
239
00:10:42,793 --> 00:10:46,263
that's what I want to do
with somebody's life.
240
00:10:46,296 --> 00:10:49,132
Dr. Shelty, dial 3225...
241
00:10:49,166 --> 00:10:51,501
Patients allow nurses
into their lives
242
00:10:51,535 --> 00:10:53,570
in a way they wouldn't let
anybody else.
243
00:10:53,604 --> 00:10:55,872
We are given this
window of opportunity
244
00:10:55,906 --> 00:10:57,240
to care for them.
245
00:11:03,847 --> 00:11:05,916
Do you have any medical
problems that you know of?
246
00:11:05,949 --> 00:11:07,784
Nope! Just depression.
247
00:11:07,818 --> 00:11:09,152
So what happened today
that brought you
248
00:11:09,186 --> 00:11:11,488
to the emergency department?
249
00:11:11,521 --> 00:11:14,725
I never thought about trying
to commit suicide before,
250
00:11:14,758 --> 00:11:16,793
and it wasn't really
trying to commit suicide,
251
00:11:16,827 --> 00:11:18,795
it was kinda just
proving a point.
252
00:11:18,829 --> 00:11:21,398
My dad kinda freaked out
and that's why we're here.
253
00:11:21,431 --> 00:11:22,733
Okay.
254
00:11:22,766 --> 00:11:24,468
Are you still having
these feelings now?
255
00:11:24,501 --> 00:11:26,903
Not at all.
256
00:11:26,937 --> 00:11:29,272
What about feelings
of harming other people?
257
00:11:29,306 --> 00:11:30,774
- No.
- No?
258
00:11:30,807 --> 00:11:33,777
Are you seeing or hearing
anything that's not here?
259
00:11:33,810 --> 00:11:35,746
Nope.
260
00:11:35,779 --> 00:11:38,415
In general, emergency
departments are not good venues
261
00:11:38,448 --> 00:11:39,783
to care for somebody
who is struggling with
262
00:11:39,816 --> 00:11:43,286
a behavioral health issue.
263
00:11:43,320 --> 00:11:44,588
A lot going on,
264
00:11:44,621 --> 00:11:46,223
competing demands
of other patients
265
00:11:46,256 --> 00:11:47,924
that are really, really sick
as well.
266
00:11:47,959 --> 00:11:49,961
We often do not have
enough physical beds
267
00:11:49,994 --> 00:11:52,763
to accommodate
their care needs,
268
00:11:52,796 --> 00:11:55,967
and our nurses don't have
probably enough training
269
00:11:56,000 --> 00:11:58,201
in the care of
this patient population.
270
00:11:58,235 --> 00:11:59,670
There's many pieces
to this puzzle.
271
00:11:59,703 --> 00:12:01,571
I think we need more resources
in the communities
272
00:12:01,605 --> 00:12:03,874
so we can keep them
out of hospital.
273
00:12:03,907 --> 00:12:06,243
I mean, my arm is good.
274
00:12:06,276 --> 00:12:09,413
All I wanna do
is go home and sleep.
275
00:12:15,019 --> 00:12:16,553
The emergency department
is a safety net.
276
00:12:16,586 --> 00:12:18,255
We catch them
when they fall.
277
00:12:18,288 --> 00:12:20,958
But we can't be their
primary service provider.
278
00:12:23,760 --> 00:12:25,963
There's got to be more
for them.
279
00:12:28,298 --> 00:12:29,566
The people in this community,
280
00:12:29,599 --> 00:12:30,801
they don't have healthcare.
281
00:12:30,834 --> 00:12:32,502
They don't have
primary care physicians.
282
00:12:32,536 --> 00:12:34,371
They don't have a psychiatrist
who's gonna take care of them
283
00:12:34,404 --> 00:12:35,706
in the community.
284
00:12:35,739 --> 00:12:37,541
We are their
primary healthcare,
285
00:12:37,574 --> 00:12:39,509
and that is something
that we're really seeing
286
00:12:39,543 --> 00:12:40,811
in all of our
emergency departments
287
00:12:40,844 --> 00:12:42,579
across the U.S.
288
00:12:42,612 --> 00:12:43,280
It's so much bigger
than us here.
289
00:12:43,313 --> 00:12:45,649
We're just the starting point.
290
00:13:18,915 --> 00:13:20,884
One of the hardest challenges
in Kentucky
291
00:13:20,917 --> 00:13:22,519
that I've come to face
292
00:13:22,552 --> 00:13:24,755
is the big lack
of primary care,
293
00:13:24,788 --> 00:13:26,958
and whether it's the patients
don't have insurance
294
00:13:26,991 --> 00:13:29,292
or there's not enough
primary care providers,
295
00:13:29,326 --> 00:13:32,029
we will prescribe a medication
for a chronic disease,
296
00:13:32,063 --> 00:13:33,730
and then we'll say,
"Follow up,"
297
00:13:33,764 --> 00:13:36,566
and then they're back
in the ER in two weeks.
298
00:13:36,600 --> 00:13:38,401
So it's kinda like
we put Band-Aids on
299
00:13:38,435 --> 00:13:41,838
a lot of the big issues
that we can't fix.
300
00:13:41,872 --> 00:13:43,507
We want to get people
to feel better.
301
00:13:43,540 --> 00:13:45,375
We want them to recover.
302
00:13:45,408 --> 00:13:47,078
It is distressing
to a lot of us
303
00:13:47,111 --> 00:13:51,015
when patients come in
day after day.
304
00:13:51,048 --> 00:13:52,984
One of the very
challenging parts is
305
00:13:53,017 --> 00:13:54,718
seeing those same patients
over and over again,
306
00:13:54,751 --> 00:13:57,088
and keeping the smile,
keeping the compassion,
307
00:13:57,121 --> 00:13:58,889
and not judging.
308
00:13:58,922 --> 00:14:01,458
I think a big problem is,
people don't understand
309
00:14:01,491 --> 00:14:03,760
the choices they make,
how they impact their life.
310
00:14:03,794 --> 00:14:05,562
A lot of times, they don't
realize how sick they are.
311
00:14:05,595 --> 00:14:07,497
They just know
they just wanna go smoke,
312
00:14:07,531 --> 00:14:09,033
and you're trying
to let them know, like,
313
00:14:09,066 --> 00:14:10,433
"If you go smoke,
314
00:14:10,467 --> 00:14:12,803
you might just pass out
and die out there."
315
00:14:12,836 --> 00:14:15,338
We give them
temporary solutions.
316
00:14:15,372 --> 00:14:17,474
But there has to be
other resources out there
317
00:14:17,507 --> 00:14:20,844
for ongoing care
in the community.
318
00:14:20,877 --> 00:14:21,979
We have over 100 patients
in the department,
319
00:14:22,013 --> 00:14:25,448
at some times, and, you know,
we have our fast track,
320
00:14:25,482 --> 00:14:27,417
which is the small things
that are going on,
321
00:14:27,450 --> 00:14:28,852
and then you have
super-sick patients
322
00:14:28,885 --> 00:14:30,453
that are waiting
in the waiting room,
323
00:14:30,487 --> 00:14:32,422
and you're having to go out
and say, "I'm sorry,
324
00:14:32,455 --> 00:14:34,959
it's gonna be a little bit."
325
00:14:34,992 --> 00:14:37,561
It's my job as
an emergency care nurse
326
00:14:37,594 --> 00:14:40,397
to take care of you
no matter what,
327
00:14:40,430 --> 00:14:43,800
and it's one patient
every single time.
328
00:14:46,570 --> 00:14:49,372
I think people think
that being a nurse is
329
00:14:49,406 --> 00:14:52,442
exciting, because
you get to save lives,
330
00:14:52,475 --> 00:14:53,944
you kind of think
what the movies are.
331
00:14:53,978 --> 00:14:56,746
"You're gonna marry a doctor"
is a thing that everybody...
332
00:14:56,780 --> 00:14:58,381
everybody says.
333
00:14:58,415 --> 00:15:01,484
That's probably the opposite
of what it actually is,
334
00:15:01,518 --> 00:15:03,787
but for me, it's
the meaningful relationships
335
00:15:03,820 --> 00:15:05,889
that I've made.
336
00:15:05,922 --> 00:15:07,959
- Any family?
- Uh, son is on his way.
337
00:15:07,992 --> 00:15:09,961
All right, thank you.
338
00:15:09,994 --> 00:15:11,963
Hey, hon, my name's Michelle,
I'm gonna be one of the nurses
339
00:15:11,996 --> 00:15:13,663
- working with you, okay?
- Okay.
340
00:15:13,697 --> 00:15:15,699
There's gonna be lots
of people in here.
341
00:15:15,732 --> 00:15:17,500
We have to cut your shirt
to make sure you don't have
342
00:15:17,534 --> 00:15:19,569
anything broken,
I'm sorry.
343
00:15:19,603 --> 00:15:21,771
I hope these weren't
your favorite clothes.
344
00:15:24,175 --> 00:15:26,509
- Not hardly.
- 'Kay, good.
345
00:15:26,543 --> 00:15:28,812
I'm just gonna feel the pulse
on your right foot, okay?
346
00:15:28,845 --> 00:15:32,049
I'll try not to hurt you
or move it.
347
00:15:32,083 --> 00:15:35,819
Can you wiggle your toes?
348
00:15:35,852 --> 00:15:38,455
Okay. Go ahead and pull.
349
00:15:38,488 --> 00:15:41,158
Sorry, sweetie... okay.
350
00:15:41,192 --> 00:15:42,759
Okay, we got it out, okay?
351
00:15:42,792 --> 00:15:44,494
Does that feel
a little bit better?
352
00:15:44,527 --> 00:15:46,696
Whew! Okay.
353
00:15:46,730 --> 00:15:48,032
What's hurting right now?
354
00:15:48,065 --> 00:15:49,599
- The right hip?
- Yeah.
355
00:15:49,633 --> 00:15:51,701
Okay. I'm gonna give you
some pain medication.
356
00:15:51,735 --> 00:15:54,604
It should hopefully help
with your leg.
357
00:15:54,638 --> 00:15:58,009
- Yeah, and hurry up.
- 'Kay! I'm giving it right now.
358
00:16:00,844 --> 00:16:02,679
This should hopefully
take the edge off
359
00:16:02,712 --> 00:16:04,781
for them to take that x-ray,
okay?
360
00:16:04,814 --> 00:16:06,583
- Okay.
- All right? I'll be back.
361
00:16:06,616 --> 00:16:08,986
When you have those moments,
those good moments,
362
00:16:09,020 --> 00:16:10,887
it's something you'll
never get anywhere else.
363
00:16:10,921 --> 00:16:12,889
All right, hon, I got you
the new warm ones, okay?
364
00:16:12,923 --> 00:16:16,193
Okay.
365
00:16:16,227 --> 00:16:18,828
- Does that feel better?
- Yeah, that feels good.
366
00:16:18,862 --> 00:16:20,630
At least that's
a little warm.
367
00:16:20,664 --> 00:16:21,631
I'm gonna pull
these other ones down
368
00:16:21,665 --> 00:16:23,500
so that the warms ones
are next to your body.
369
00:16:23,533 --> 00:16:25,835
It's like being in a cocoon.
370
00:16:25,869 --> 00:16:27,470
- How's that?
- That's good.
371
00:16:27,504 --> 00:16:30,241
Is that better? Okay.
372
00:16:30,274 --> 00:16:33,643
I had a patient that was here
for a heart transplant,
373
00:16:33,677 --> 00:16:35,712
and I asked, you know,
"Do you need pain meds,
374
00:16:35,745 --> 00:16:36,981
do you," you know,
"do you need a blanket?
375
00:16:37,014 --> 00:16:38,815
Like, what do you need
right now?"
376
00:16:38,848 --> 00:16:42,987
And he said, "Is there any way
that I can get a card?"
377
00:16:43,020 --> 00:16:44,621
And I was like,
"Why do you need a card?"
378
00:16:44,654 --> 00:16:47,590
And he said, "Well,
it's our sixth anniversary,
379
00:16:47,624 --> 00:16:49,592
wedding anniversary,
and we're homeless,"
380
00:16:49,626 --> 00:16:52,997
and his wife had been sleeping
on the stretcher next to him,
381
00:16:53,030 --> 00:16:55,565
and he said,
"I always give her a card.
382
00:16:55,598 --> 00:16:57,201
That's one thing
that I always do."
383
00:16:57,234 --> 00:16:59,070
So I got the time
to run up to the gift shop
384
00:16:59,103 --> 00:17:01,771
and I bought a card
and I brought it down to him,
385
00:17:01,805 --> 00:17:03,074
and he started crying.
386
00:17:03,107 --> 00:17:04,507
You know, I wrote
in the card for him,
387
00:17:04,541 --> 00:17:06,643
'cause his hand was
too weak to write.
388
00:17:06,676 --> 00:17:09,746
And giving that to him
and doing that for him was,
389
00:17:09,779 --> 00:17:11,915
you know, something
that you would never think
390
00:17:11,948 --> 00:17:13,516
would be part of nursing.
391
00:17:13,550 --> 00:17:15,552
You can't... I mean,
nobody tells you that
392
00:17:15,585 --> 00:17:17,721
at nursing school.
393
00:17:17,754 --> 00:17:19,023
Did they give you pain meds?
394
00:17:19,056 --> 00:17:20,057
- No.
- Have they... no, they haven't
395
00:17:20,091 --> 00:17:21,292
- done any of that?
- No.
396
00:17:21,325 --> 00:17:22,226
Okay. They just gave you
the tetanus shot?
397
00:17:22,259 --> 00:17:23,660
- Yes.
- Okay.
398
00:17:23,693 --> 00:17:26,596
All right.
Lemme go check.
399
00:17:26,629 --> 00:17:27,965
I was at the shop.
400
00:17:27,999 --> 00:17:30,134
I was filling
one of the tires up.
401
00:17:30,167 --> 00:17:31,835
It blew up
and the rim flew off
402
00:17:31,868 --> 00:17:34,804
and it hurt... hit my hand.
403
00:17:37,874 --> 00:17:39,243
Is your pain
a little bit better?
404
00:17:39,276 --> 00:17:41,678
Okay, good.
I'll be back.
405
00:17:41,711 --> 00:17:42,612
They're ready for you.
406
00:17:42,645 --> 00:17:45,216
X-ray, yeah.
407
00:17:49,954 --> 00:17:51,821
And I've heard of this
happening with tires,
408
00:17:51,855 --> 00:17:53,623
I just never seen it happen.
409
00:17:53,656 --> 00:17:56,327
Got the first... what do they say,
front-row seats?
410
00:17:56,360 --> 00:17:58,229
Usually, I don't go
to the hospital.
411
00:17:58,262 --> 00:17:59,662
Even if it's bad...
412
00:17:59,696 --> 00:18:02,632
I didn't even wanna come
for this.
413
00:18:02,665 --> 00:18:05,236
Yeah, insurance is...
it's too high, you know?
414
00:18:05,269 --> 00:18:06,669
It is too high.
415
00:18:06,703 --> 00:18:09,140
That's why you can't get
sick or hurt, you know?
416
00:18:09,173 --> 00:18:12,343
You're better off
to try to patch it yourself.
417
00:18:12,376 --> 00:18:15,879
If this gets all fixed up,
bandaged, everything,
418
00:18:15,912 --> 00:18:20,017
maybe it costs me
three grand, four grand.
419
00:18:20,051 --> 00:18:22,019
It's still cheaper to pay
the medical bill
420
00:18:22,053 --> 00:18:24,587
than it is to pay
for insurance.
421
00:18:24,621 --> 00:18:27,091
It's just how we are
in the U.S.,
422
00:18:27,124 --> 00:18:29,226
you know, we don't have
enough insurance for everybody,
423
00:18:29,260 --> 00:18:31,028
and if you do,
that doesn't mean
424
00:18:31,062 --> 00:18:33,930
that you don't have a $100
co-pay when you come to the ER,
425
00:18:33,964 --> 00:18:37,301
and that's something that
a lot of people can't afford.
426
00:18:37,334 --> 00:18:39,769
Right here... 79, guys.
427
00:18:45,708 --> 00:18:48,778
Sometimes, you'll see
15 to 20 patients in one night,
428
00:18:48,812 --> 00:18:51,148
and there's
a very, very fine line
429
00:18:51,182 --> 00:18:53,783
between getting to do
everything quickly,
430
00:18:53,817 --> 00:18:55,119
because you need to do
everything quickly,
431
00:18:55,152 --> 00:18:56,987
there's time frames
that we need to meet,
432
00:18:57,021 --> 00:18:58,222
but at the same time,
433
00:18:58,255 --> 00:18:59,689
you don't wanna make
the patient feel like
434
00:18:59,722 --> 00:19:01,891
I don't have time for you,
I'm too busy.
435
00:19:01,925 --> 00:19:03,227
And sometimes,
it's really hard to do,
436
00:19:03,260 --> 00:19:05,362
especially when you have
a patient that's upset.
437
00:19:05,396 --> 00:19:06,896
They're hurting,
they're grumpy,
438
00:19:06,930 --> 00:19:07,797
not wanting to be
in the hospital...
439
00:19:07,831 --> 00:19:10,934
like, who wants to be
at the hospital?
440
00:19:10,968 --> 00:19:12,869
Mm-hm, next one down.
441
00:19:12,902 --> 00:19:14,205
Can you wiggle your toes
for me one more time?
442
00:19:14,238 --> 00:19:15,172
Is that good right there,
443
00:19:15,206 --> 00:19:16,373
or do you want the pillow
a little higher?
444
00:19:16,407 --> 00:19:18,842
Okay.
445
00:19:18,875 --> 00:19:21,245
Okay. How's that?
446
00:19:21,278 --> 00:19:22,179
That's okay? Okay.
447
00:19:22,213 --> 00:19:24,215
What hurts the most right now,
your head?
448
00:19:24,248 --> 00:19:26,050
No, my... my leg.
449
00:19:26,083 --> 00:19:27,418
Your leg... the left leg?
450
00:19:27,451 --> 00:19:31,322
- Yeah.
- Okay.
451
00:19:34,024 --> 00:19:35,126
Do you have somebody
that's taking care
452
00:19:35,159 --> 00:19:36,360
of your children right now?
453
00:19:36,393 --> 00:19:38,928
Do you know her phone number,
can I call her?
454
00:19:43,300 --> 00:19:45,302
They'll have to make a plan
alongside medicine
455
00:19:45,336 --> 00:19:46,870
on whether or not
they wanna do surgery
456
00:19:46,903 --> 00:19:48,405
and when to do surgery.
457
00:19:48,439 --> 00:19:50,307
And hopefully,
we'll get you up and moving
458
00:19:50,341 --> 00:19:51,941
pretty quickly
after surgery
459
00:19:51,976 --> 00:19:53,776
and go from there.
460
00:20:00,251 --> 00:20:03,920
All right, sir.
461
00:20:03,954 --> 00:20:05,688
Little poke.
462
00:20:18,902 --> 00:20:20,971
So if you spend a little time
in Kentucky,
463
00:20:21,005 --> 00:20:23,174
there's... I call them
Kentucky roads.
464
00:20:23,207 --> 00:20:25,176
These roads are just
narrow roads,
465
00:20:25,209 --> 00:20:27,178
one car goes one way
each way,
466
00:20:27,211 --> 00:20:28,778
and they swerve around.
467
00:20:28,811 --> 00:20:31,382
Sometimes you have four or five
ambulances that come
468
00:20:31,415 --> 00:20:33,984
that were all motorcycle
accidents, car accidents.
469
00:20:34,018 --> 00:20:35,286
They're all here
at the same time.
470
00:20:35,319 --> 00:20:38,222
Everybody ready?
One, two, three.
471
00:20:40,391 --> 00:20:43,127
You have any family members
who are coming?
472
00:20:43,160 --> 00:20:45,362
- I'm not sure.
- Okay, have we...
473
00:20:45,396 --> 00:20:46,997
did they contact
anybody for you?
474
00:20:47,031 --> 00:20:48,399
- Yeah.
- They did? Okay.
475
00:20:48,432 --> 00:20:50,267
On my way back home,
476
00:20:50,301 --> 00:20:52,336
a deer darted in front of me
477
00:20:52,369 --> 00:20:54,871
and I went through
a metal pole
478
00:20:54,904 --> 00:20:56,839
in the middle of about
a ten-foot embankment
479
00:20:56,873 --> 00:20:59,376
and hit into water.
480
00:20:59,410 --> 00:21:00,477
What's your pain at,
0 to 10,
481
00:21:00,511 --> 00:21:01,878
ten being the worst?
482
00:21:01,911 --> 00:21:03,380
- It's ten.
- Ten, okay.
483
00:21:03,414 --> 00:21:06,250
They told me that I
fractured my spine
484
00:21:06,283 --> 00:21:08,285
or something like that.
485
00:21:08,319 --> 00:21:09,987
The back surgery
was so complex,
486
00:21:10,020 --> 00:21:13,224
they couldn't handle it,
so I had to come here.
487
00:21:13,257 --> 00:21:14,191
Just try to hold still,
488
00:21:14,225 --> 00:21:16,826
since you've had
this back fracture, okay?
489
00:21:16,859 --> 00:21:18,529
It just hurts so...
490
00:21:18,562 --> 00:21:21,065
Push down for me.
Pull up.
491
00:21:21,098 --> 00:21:23,400
Good.
492
00:21:23,434 --> 00:21:25,236
Okay.
493
00:21:25,269 --> 00:21:28,072
I'm a first generation
American here.
494
00:21:28,105 --> 00:21:31,342
I was a refugee in Thailand
after the Vietnam War.
495
00:21:31,375 --> 00:21:35,145
Honey, I got some pain medicine
for you, okay?
496
00:21:35,179 --> 00:21:37,248
I'm the only one
in my whole family
497
00:21:37,281 --> 00:21:39,283
who has finished high school
498
00:21:39,316 --> 00:21:41,884
gone on to get
a college degree,
499
00:21:41,918 --> 00:21:43,220
so, you know,
500
00:21:43,254 --> 00:21:44,989
all my little nieces
and nephews
501
00:21:45,022 --> 00:21:46,557
have someone to look up to.
502
00:21:48,559 --> 00:21:50,461
I'm the divisional charge nurse
on the weekends.
503
00:21:50,494 --> 00:21:53,264
That's when
all the action happens.
504
00:21:53,297 --> 00:21:55,266
People in the general public
don't know
505
00:21:55,299 --> 00:21:57,268
what we're going through
as emergency nurses.
506
00:21:57,301 --> 00:22:00,803
You see these very intense
situations,
507
00:22:00,837 --> 00:22:03,474
and it eats away at you.
508
00:22:03,507 --> 00:22:04,841
Emergency nurses are known
509
00:22:04,874 --> 00:22:06,410
to not really talk
about their feelings
510
00:22:06,443 --> 00:22:08,811
when something sad happens.
511
00:22:08,845 --> 00:22:10,314
I'm gonna get emotional!
512
00:22:10,347 --> 00:22:13,384
I remember one time,
I had a six-week baby code,
513
00:22:13,417 --> 00:22:16,153
and...
514
00:22:16,186 --> 00:22:18,921
I had to hold it together,
'cause I was the team leader.
515
00:22:18,956 --> 00:22:20,958
And I did,
and the nurses came,
516
00:22:20,991 --> 00:22:23,060
the other nurses
that took care of the code.
517
00:22:23,093 --> 00:22:25,229
We're crying,
and I still held it together,
518
00:22:25,262 --> 00:22:28,065
but when I got to my car,
I lost it.
519
00:22:28,098 --> 00:22:30,134
I just... just lost it.
520
00:22:30,167 --> 00:22:33,170
And then you just kinda take
a deep breath and... move on.
521
00:22:33,203 --> 00:22:35,905
We had this patient that had
a devastating head bleed
522
00:22:35,938 --> 00:22:37,441
that he was gonna die from.
523
00:22:37,474 --> 00:22:39,510
The family was there,
it was beautiful,
524
00:22:39,543 --> 00:22:41,911
you know,
we had a pastor there, we just...
525
00:22:41,944 --> 00:22:43,846
it was as perfect
of a situation
526
00:22:43,880 --> 00:22:45,449
as you could possibly have
for a death,
527
00:22:45,482 --> 00:22:46,984
if that makes sense.
528
00:22:47,017 --> 00:22:49,852
I came back out
and just started bawling,
529
00:22:49,886 --> 00:22:51,888
and I was so embarrassed.
530
00:22:51,921 --> 00:22:55,426
And I remember my preceptor
saying, "You'll be okay.
531
00:22:55,459 --> 00:22:58,195
The fact that this
makes you cry,
532
00:22:58,228 --> 00:22:59,963
you'll be okay."
533
00:22:59,997 --> 00:23:04,867
I had a child who was shot
by her uncle,
534
00:23:04,901 --> 00:23:06,537
who was 12 years old.
535
00:23:06,570 --> 00:23:08,339
He just received
a brand-new shotgun
536
00:23:08,372 --> 00:23:09,906
as a Christmas gift.
537
00:23:09,939 --> 00:23:13,377
That day, I helped care for
three children
538
00:23:13,410 --> 00:23:15,179
who had passed away.
539
00:23:15,212 --> 00:23:17,081
I helped clean up the body,
540
00:23:17,114 --> 00:23:20,517
prepare the body for the parents
to come see the children.
541
00:23:20,551 --> 00:23:23,053
I provided care
to one child who
542
00:23:23,087 --> 00:23:25,155
was left in the care
of a boyfriend,
543
00:23:25,189 --> 00:23:27,024
'cause the mother
had to go work.
544
00:23:27,057 --> 00:23:29,593
The child was shaken to death
and beaten to death.
545
00:23:29,626 --> 00:23:32,563
For the next two weeks,
I went home,
546
00:23:32,596 --> 00:23:35,099
I woke up having nightmares.
547
00:23:35,132 --> 00:23:36,467
You know, as a nurse,
548
00:23:36,500 --> 00:23:38,369
that has the impact
and the struggle
549
00:23:38,402 --> 00:23:40,371
that everybody deals with.
550
00:23:54,084 --> 00:23:55,119
When you're at work,
you're at work,
551
00:23:55,152 --> 00:23:57,955
and when you leave,
you try to leave it at work.
552
00:23:57,988 --> 00:23:59,523
'Cause the things
that we're seeing
553
00:23:59,556 --> 00:24:01,992
and the things that
we're dealing with sometimes,
554
00:24:02,025 --> 00:24:05,529
if you bring it home with you,
it's exhausting.
555
00:24:09,266 --> 00:24:11,101
You're not gonna be able
to go home
556
00:24:11,135 --> 00:24:13,370
and explain to your mom
or your dad
557
00:24:13,404 --> 00:24:14,571
or your family member
558
00:24:14,605 --> 00:24:17,241
exactly what you did today,
they're not gonna get it.
559
00:24:17,274 --> 00:24:20,611
It's very hard to explain
to anybody else what we do.
560
00:24:20,644 --> 00:24:25,215
Um, it just doesn't seem
imaginable sometimes, does it?
561
00:24:25,249 --> 00:24:28,352
I expect my staff to call me
if they're having a tough day
562
00:24:28,385 --> 00:24:30,487
and they've had something
just horrendous
563
00:24:30,521 --> 00:24:31,555
that they've had
to go through,
564
00:24:31,588 --> 00:24:33,290
because I want them
to verbalize it
565
00:24:33,323 --> 00:24:35,025
and work through it
if they need to.
566
00:24:35,058 --> 00:24:37,194
We all care for each other.
567
00:24:37,227 --> 00:24:39,663
Nurses who work in these
high-intensity areas,
568
00:24:39,696 --> 00:24:41,698
if we don't find ways
of maintaining
569
00:24:41,732 --> 00:24:45,269
our own balance,
of being resilient,
570
00:24:45,302 --> 00:24:48,071
uh, nurses will burn out
in these areas very quickly.
571
00:24:48,105 --> 00:24:50,274
It's hard,
it's tough nursing.
572
00:25:09,626 --> 00:25:11,695
We are in the beautiful
state of Vermont.
573
00:25:13,397 --> 00:25:15,165
The geographic nature
of our state
574
00:25:15,199 --> 00:25:17,134
proves challenging.
575
00:25:17,167 --> 00:25:19,303
We're the only level one
trauma center in Vermont,
576
00:25:19,336 --> 00:25:22,606
so we do see a fair amount
of trauma.
577
00:25:22,639 --> 00:25:24,541
I remember being
a young nurse
578
00:25:24,575 --> 00:25:28,078
and loving anything
that just was, you know,
579
00:25:28,111 --> 00:25:29,513
highly acute.
580
00:25:31,381 --> 00:25:33,317
The traumas,
and the GI bleeds,
581
00:25:33,350 --> 00:25:36,520
and the cardiac arrests
and those kinds of patients
582
00:25:36,553 --> 00:25:38,188
were the ones
that I gravitated to,
583
00:25:38,222 --> 00:25:40,724
that I just, ohh, couldn't
wait to get my hands into,
584
00:25:40,757 --> 00:25:42,292
literally, sometimes.
585
00:25:42,326 --> 00:25:44,628
Now, I'm gravitating
a little bit more towards
586
00:25:44,661 --> 00:25:48,699
the little old lady
who has the dwindles
587
00:25:48,732 --> 00:25:51,101
and who needs some loving.
588
00:25:53,337 --> 00:25:55,372
No day is the same.
589
00:25:55,405 --> 00:25:58,642
It's a wild lens
to look at the world through.
590
00:26:00,777 --> 00:26:04,681
You know, you can have
a baby born one minute
591
00:26:04,715 --> 00:26:07,150
and a code come in
the next minute.
592
00:26:07,184 --> 00:26:10,153
The whole spectrum,
from life to death,
593
00:26:10,187 --> 00:26:13,090
and everything in between.
594
00:26:13,123 --> 00:26:16,226
There are some days that really
blow my socks off, though.
595
00:26:16,260 --> 00:26:18,495
The high that you get when
you start somebody's heart?
596
00:26:18,529 --> 00:26:19,763
That's what carries you through.
597
00:26:19,796 --> 00:26:21,265
Lie straight back.
598
00:26:21,298 --> 00:26:23,433
You can leave your shoes on
if you'd like, or...
599
00:26:23,467 --> 00:26:25,435
- No, very comfortable.
- There you go.
600
00:26:25,469 --> 00:26:27,404
The ER sits in a really
interesting place
601
00:26:27,437 --> 00:26:30,407
between inpatient
and outpatient medicine.
602
00:26:30,440 --> 00:26:32,576
How long have you been
short of breath for?
603
00:26:32,609 --> 00:26:34,211
Couple of days.
604
00:26:34,244 --> 00:26:35,812
We're involved in
sorting out the mystery
605
00:26:35,846 --> 00:26:37,514
of what is wrong.
606
00:26:37,548 --> 00:26:39,516
Have you had any recent
medication changes?
607
00:26:39,550 --> 00:26:44,154
Uh... yeah,
bronchodilator for the...
608
00:26:44,187 --> 00:26:46,857
- Started a new one?
- Yeah, about two weeks ago,
609
00:26:46,890 --> 00:26:49,326
$160 co-pay is a little steep,
610
00:26:49,359 --> 00:26:53,330
so it made me choose
an alternate medication,
611
00:26:53,363 --> 00:26:56,667
and I've had some bouts
with bronchitis before,
612
00:26:56,700 --> 00:27:00,637
but this one was
at another level.
613
00:27:00,671 --> 00:27:01,805
Well, after last night,
614
00:27:01,838 --> 00:27:03,874
I was happy to wake up
this morning.
615
00:27:03,907 --> 00:27:08,712
- It was pretty brutal.
- Mm-hm.
616
00:27:08,745 --> 00:27:10,881
I don't think there's
much scarier in this world
617
00:27:10,914 --> 00:27:13,250
than not being able to breathe.
618
00:27:13,283 --> 00:27:14,618
We're gonna make sure that
you can get up and walk around
619
00:27:14,651 --> 00:27:16,420
today before you leave here.
620
00:27:16,453 --> 00:27:17,554
Excellent.
621
00:27:17,588 --> 00:27:19,823
- Sounds good, thank you.
- You're welcome.
622
00:27:19,856 --> 00:27:21,658
You cherish the times
when people are
623
00:27:21,692 --> 00:27:23,827
thankful and appreciative,
624
00:27:23,860 --> 00:27:25,729
because over the 10 years
I've been a nurse,
625
00:27:25,762 --> 00:27:28,165
the environment has become
more aggressive.
626
00:27:28,198 --> 00:27:32,536
We have become a society
of immediate gratification.
627
00:27:32,569 --> 00:27:35,906
I think that has a lot to do
with our technology.
628
00:27:35,939 --> 00:27:38,508
The elderly generation
is just very grateful
629
00:27:38,542 --> 00:27:40,844
that they are being
taken care of.
630
00:27:40,877 --> 00:27:44,314
- Take your time and have a seat.
- I can't move too fast.
631
00:27:44,348 --> 00:27:46,917
That's a nice dressing,
who put that together?
632
00:27:46,950 --> 00:27:49,486
- Me and the wife.
- Excellent.
633
00:27:49,519 --> 00:27:50,854
Me and the wife.
634
00:27:50,887 --> 00:27:52,823
She did most of it,
635
00:27:52,856 --> 00:27:54,691
but I told her
wrap it good and tight.
636
00:27:54,725 --> 00:27:57,160
How'd you do this?
637
00:27:57,194 --> 00:28:00,530
- Snow blower.
- Aye yi yi yi yi!
638
00:28:00,564 --> 00:28:02,466
Blower itself was in neutral,
639
00:28:02,499 --> 00:28:05,202
put my hand in the chute
and I thought it was off.
640
00:28:05,235 --> 00:28:06,470
Oh!
641
00:28:06,503 --> 00:28:08,572
There's a lot of why,
642
00:28:08,605 --> 00:28:10,507
where you roll your eyes
and go, "Really?
643
00:28:10,540 --> 00:28:11,675
At what time
did you ever think
644
00:28:11,708 --> 00:28:13,510
that this was a good idea?
645
00:28:13,543 --> 00:28:15,178
- Shouldn't have had my hand...
- ..in there in the first place,
646
00:28:15,212 --> 00:28:16,713
- yes, sir.
- That's number one.
647
00:28:16,747 --> 00:28:18,682
Probably gonna go for x-ray,
'cause they're gonna wanna see
648
00:28:18,715 --> 00:28:20,350
what's going on
underneath there.
649
00:28:20,384 --> 00:28:21,818
You could pull that one
right out.
650
00:28:21,852 --> 00:28:24,588
No, let's not pull... we'll leave
it in place for right now.
651
00:28:24,621 --> 00:28:26,757
Having been in the game
for a long time,
652
00:28:26,790 --> 00:28:29,626
I have found
that sitting and chatting
653
00:28:29,660 --> 00:28:31,228
just with a patient,
654
00:28:31,261 --> 00:28:32,529
stunning what you'll find out.
655
00:28:32,562 --> 00:28:33,864
So what do you do
for Christmas,
656
00:28:33,897 --> 00:28:35,666
with grandchildren
great-grandchildren,
657
00:28:35,699 --> 00:28:36,933
- and great-greats?
- Well, we send 'em
658
00:28:36,968 --> 00:28:39,603
birthday cards
and all that stuff.
659
00:28:39,636 --> 00:28:41,538
So do you have
any grandkids around
660
00:28:41,571 --> 00:28:43,740
that could do
the snow blowing for you?
661
00:28:43,774 --> 00:28:45,742
- No.
- All kinda like went "poof"?
662
00:28:45,776 --> 00:28:47,277
- All over the place.
- Go forth and multiply,
663
00:28:47,310 --> 00:28:48,679
did they do that?
664
00:28:48,712 --> 00:28:51,715
There's a huge difference
as to what nursing was
665
00:28:51,748 --> 00:28:53,784
31 years ago
compared to now.
666
00:28:53,817 --> 00:28:57,788
Patients stayed
in the hospital for months,
667
00:28:57,821 --> 00:28:59,923
where you actually
became intimately acquainted
668
00:28:59,957 --> 00:29:01,591
with their families,
669
00:29:01,625 --> 00:29:03,894
and now,
it's day surgery.
670
00:29:03,927 --> 00:29:05,429
Hey, sir!
They want me to bring you down
671
00:29:05,462 --> 00:29:07,631
to x-ray your fingers.
You're 92?
672
00:29:07,664 --> 00:29:09,299
- Yes, sir.
- You look fantastic.
673
00:29:09,332 --> 00:29:12,402
- Well, thank you.
- I'm super impressed.
674
00:29:12,436 --> 00:29:14,005
All right,
here we roll, my friend.
675
00:29:14,038 --> 00:29:16,506
Where emergency nursing
started, you know,
676
00:29:16,540 --> 00:29:17,975
I think it progressed.
677
00:29:18,009 --> 00:29:19,710
From Florence Nightingale,
678
00:29:19,743 --> 00:29:22,879
probably got a huge boost
with all the wars.
679
00:29:22,913 --> 00:29:24,314
Look at MASH.
680
00:29:24,347 --> 00:29:25,983
I bet you that
Hot Lips Houlihan
681
00:29:26,017 --> 00:29:28,351
wasn't called an emergency nurse
in those days,
682
00:29:28,385 --> 00:29:29,954
but that's damn well
what she was doing.
683
00:29:29,987 --> 00:29:31,254
Excuse me, darn well.
684
00:29:31,288 --> 00:29:34,291
I'm Deb.
I'd shake your hand, but...
685
00:29:34,324 --> 00:29:36,259
We'll try that one!
686
00:29:36,293 --> 00:29:38,562
So I'm gonna numb
just the fingers, yeah.
687
00:29:38,595 --> 00:29:40,664
And she's gonna make
those fingers not hurt.
688
00:29:40,697 --> 00:29:42,365
- She is going to?
- Yes, sir.
689
00:29:42,399 --> 00:29:44,434
Well, that'll be something.
690
00:29:44,468 --> 00:29:46,037
I know... it burns.
691
00:29:46,070 --> 00:29:48,438
Somewhere in the last 20 years,
692
00:29:48,472 --> 00:29:50,607
the concept of pain
has changed.
693
00:29:50,640 --> 00:29:52,342
This nail will come off,
probably.
694
00:29:52,375 --> 00:29:53,610
Well, usually what we do,
695
00:29:53,643 --> 00:29:54,678
we'd sew 'em in there,
696
00:29:54,711 --> 00:29:57,982
and then usually,
that'll push the old nail out.
697
00:29:58,015 --> 00:29:59,883
- You doing okay?
- Feeling better.
698
00:29:59,916 --> 00:30:01,318
Excellent.
699
00:30:01,351 --> 00:30:03,286
They just feel numb now,
that's that.
700
00:30:03,320 --> 00:30:04,421
Perfect.
701
00:30:04,454 --> 00:30:05,789
- They feel numb.
- Perfect.
702
00:30:05,822 --> 00:30:08,291
- Numb is good.
- Like when they're froze, right?
703
00:30:08,325 --> 00:30:11,461
I remember when
the pain scale came out.
704
00:30:11,495 --> 00:30:15,066
Every nurse in this hospital
had to go to a special session
705
00:30:15,099 --> 00:30:18,335
where we were educated
on the pain scale,
706
00:30:18,368 --> 00:30:21,505
and any pain over 4
needs to be treated.
707
00:30:21,538 --> 00:30:23,074
When you ask a patient
in the emergency department,
708
00:30:23,107 --> 00:30:24,474
"What's your pain?",
709
00:30:24,508 --> 00:30:25,876
it's always 8 or 9.
710
00:30:25,909 --> 00:30:27,344
I think a lot of times,
people will think
711
00:30:27,377 --> 00:30:28,645
that if they have
a higher pain scale,
712
00:30:28,678 --> 00:30:30,447
they'll get treated faster.
713
00:30:30,480 --> 00:30:33,817
- Burns.
- Burns? But tolerable?
714
00:30:33,850 --> 00:30:35,052
Not too bad.
715
00:30:35,086 --> 00:30:36,988
Don't look.
We won't either.
716
00:30:37,021 --> 00:30:39,589
I'm kidding.
717
00:30:39,623 --> 00:30:41,025
You have to respect the patient.
718
00:30:41,058 --> 00:30:43,527
It's not my perception,
it is their perception.
719
00:30:43,560 --> 00:30:46,730
You have an old Vermont farmer
who's having a heart attack,
720
00:30:46,763 --> 00:30:48,331
but you have to ask
that pain scale.
721
00:30:48,365 --> 00:30:49,699
"So, sir, on a scale
from 0 to 10,
722
00:30:49,733 --> 00:30:51,068
0 no pain,
10 the worst pain,
723
00:30:51,102 --> 00:30:52,936
where are you right now?",
as you're wheeling them,
724
00:30:52,970 --> 00:30:54,504
you know,
through the door.
725
00:30:54,538 --> 00:30:57,641
"Oh, honey, it's just
some heartburn, it's a 4,"
726
00:30:57,674 --> 00:31:00,577
I'm like, geez.
727
00:31:00,610 --> 00:31:01,578
We're gonna put
some dressings on
728
00:31:01,611 --> 00:31:04,781
that are gonna stay on
for the next two days.
729
00:31:04,815 --> 00:31:08,919
So you're off of dish duty,
snow blowing duty.
730
00:31:08,953 --> 00:31:11,956
I'll put in a special order,
no more snow.
731
00:31:11,989 --> 00:31:13,991
There.
732
00:31:14,025 --> 00:31:16,927
I'll make a bow
for the holidays for you.
733
00:31:16,961 --> 00:31:18,628
Here, what we're gonna do
is we're gonna put
734
00:31:18,662 --> 00:31:20,097
the hurt hand in first.
735
00:31:20,131 --> 00:31:21,665
Every time you take care
of a patient,
736
00:31:21,698 --> 00:31:23,800
you're trying to give something
from yourself,
737
00:31:23,834 --> 00:31:26,137
you're trying to give respect
and give kindness
738
00:31:26,170 --> 00:31:28,438
and your knowledge,
you know.
739
00:31:28,471 --> 00:31:31,708
And if it just is always
taking, taking, taking, taking,
740
00:31:31,741 --> 00:31:32,943
same as with anything in life,
741
00:31:32,977 --> 00:31:36,013
then you run out of steam.
742
00:31:36,047 --> 00:31:39,116
So a patient that stops you
on the street and says,
743
00:31:39,150 --> 00:31:41,052
"Oh, thank you so much,"
744
00:31:41,085 --> 00:31:44,421
that's why I've been doing it
for 31 years.
745
00:32:17,989 --> 00:32:19,957
ER nurses have to know
a little bit about...
746
00:32:19,991 --> 00:32:21,691
about everything,
747
00:32:21,725 --> 00:32:26,063
from OB, trauma,
psychiatric health problems.
748
00:32:26,097 --> 00:32:28,932
About everything,
a little bit about everything.
749
00:32:30,800 --> 00:32:33,937
Children are, you know...
it's my focus,
750
00:32:33,971 --> 00:32:36,439
and I feel like
I'm helping them most
751
00:32:36,473 --> 00:32:38,808
to be their voice.
752
00:32:38,842 --> 00:32:41,045
I love the geriatric
population.
753
00:32:41,078 --> 00:32:43,847
They're sometimes
the forgotten population,
754
00:32:43,880 --> 00:32:47,051
so somebody has
to advocate for them.
755
00:32:47,084 --> 00:32:49,220
I just know
the people we talk to,
756
00:32:49,253 --> 00:32:51,521
people from different
nationalities,
757
00:32:51,554 --> 00:32:53,723
people from different cultures.
758
00:32:55,926 --> 00:32:58,828
Lot of refugees in Dallas,
and they come to see us.
759
00:32:58,862 --> 00:33:01,198
It is a challenge
with communication,
760
00:33:01,232 --> 00:33:04,567
but I have these patients
who see the world differently,
761
00:33:04,601 --> 00:33:06,670
and I kind of get
a glimpse into that.
762
00:33:09,106 --> 00:33:11,841
Don't just think because
you don't speak the language,
763
00:33:11,875 --> 00:33:13,910
nobody is gonna help you.
764
00:33:13,944 --> 00:33:15,246
I came from Peru,
765
00:33:15,279 --> 00:33:16,880
I did not speak the language.
766
00:33:16,913 --> 00:33:22,719
So, helping is like
a gratitude to me.
767
00:33:28,259 --> 00:33:30,161
I'm from Peru originally,
768
00:33:30,194 --> 00:33:32,729
and I decided
to come to the States.
769
00:33:32,762 --> 00:33:35,032
People think sometimes
that it's easy to do
770
00:33:35,066 --> 00:33:36,533
that transition.
771
00:33:36,566 --> 00:33:39,703
But when you get here,
it's totally different.
772
00:33:39,736 --> 00:33:43,040
You get here and you see,
"I don't speak English.
773
00:33:43,074 --> 00:33:44,075
What am I gonna do?
774
00:33:44,108 --> 00:33:45,176
I don't have a car.
775
00:33:45,209 --> 00:33:46,876
I don't have money."
776
00:33:52,016 --> 00:33:53,150
- Okay.
- Okay?
777
00:33:54,818 --> 00:33:57,754
My mom used to work
as a nurse assistant,
778
00:33:57,787 --> 00:33:58,956
so I would look at her
as a model.
779
00:33:58,990 --> 00:34:03,827
I said, "She went to school,
work, and take care of us?"
780
00:34:03,860 --> 00:34:05,729
I can do it.
781
00:34:05,762 --> 00:34:07,064
I enrolled to a school,
782
00:34:07,098 --> 00:34:08,765
I finished my English,
783
00:34:08,798 --> 00:34:11,801
and when I was ready,
I got my license.
784
00:34:11,835 --> 00:34:13,870
I've been working
for Texas Health Dallas
785
00:34:13,903 --> 00:34:17,141
for about 12 years.
786
00:34:17,174 --> 00:34:19,076
One time,
we had a patient who
787
00:34:19,110 --> 00:34:21,278
was having a miscarriage.
788
00:34:21,312 --> 00:34:24,647
And we saw the little fetus.
789
00:34:24,681 --> 00:34:27,051
Arms and legs and head.
790
00:34:27,084 --> 00:34:29,619
I can't imagine how she felt.
791
00:34:29,652 --> 00:34:32,089
She only spoke also Spanish,
792
00:34:32,123 --> 00:34:35,658
so we have to be sure
she stopped bleeding,
793
00:34:35,692 --> 00:34:37,962
you give the appropriate care,
appropriate follow-up,
794
00:34:37,995 --> 00:34:40,064
and, you know, giving support,
emotional support,
795
00:34:40,097 --> 00:34:41,664
is very important.
796
00:34:41,698 --> 00:34:43,334
Twenty years old,
her first baby, pregnant,
797
00:34:43,367 --> 00:34:45,769
and now, she had a miscarriage,
798
00:34:45,802 --> 00:34:47,904
so I said, "Oh my gosh,
if nobody was there,
799
00:34:47,937 --> 00:34:50,007
who will help...
who's gonna help them?"
800
00:34:50,041 --> 00:34:51,674
I'm glad I was there.
801
00:34:53,610 --> 00:34:56,280
One, two, three.
802
00:34:56,313 --> 00:34:57,781
Can you tell me your name?
803
00:34:57,814 --> 00:34:58,715
- Jose.
- Jose, do you know
804
00:34:58,748 --> 00:35:00,117
what happened?
805
00:35:00,151 --> 00:35:01,986
Yeah, I had a car accident.
806
00:35:02,019 --> 00:35:03,753
Do you remember why
you got in an accident?
807
00:35:03,787 --> 00:35:05,789
- I don't know...
- Can you raise this arm up?
808
00:35:05,822 --> 00:35:07,924
Keep it up, don't let it fall,
keep it up, up.
809
00:35:07,958 --> 00:35:09,592
Touch my hand.
810
00:35:09,626 --> 00:35:11,694
We have this stroke scale
that we do.
811
00:35:11,728 --> 00:35:13,897
Smile.
Raise your eyebrows.
812
00:35:13,930 --> 00:35:16,233
Raise your arms,
raise your legs.
813
00:35:16,267 --> 00:35:18,202
Tell me these words.
814
00:35:18,235 --> 00:35:20,237
Move your toes...
wiggle your toes.
815
00:35:20,271 --> 00:35:23,040
Your toes.
816
00:35:23,074 --> 00:35:24,774
This one, this leg.
817
00:35:31,148 --> 00:35:32,749
One, two, three.
818
00:35:47,998 --> 00:35:49,133
- Ready?
- One, two, three.
819
00:35:56,407 --> 00:35:58,942
He said he was driving okay
and he made a U-turn
820
00:35:58,976 --> 00:36:00,643
and he didn't see a car,
821
00:36:00,677 --> 00:36:03,813
but he's having
some double vision.
822
00:36:03,847 --> 00:36:05,782
I wonder if the car came
from the left side.
823
00:36:05,815 --> 00:36:07,384
Maybe. Also, he's diabetic
824
00:36:07,418 --> 00:36:09,652
and he has not been taking
his medicines.
825
00:36:09,686 --> 00:36:11,754
He ran out for
three to five days.
826
00:36:11,788 --> 00:36:13,224
I always tell my co-workers,
827
00:36:13,257 --> 00:36:14,992
"I'm a qualified
bi-lingual interpreter
828
00:36:15,025 --> 00:36:18,028
for the hospital,
and I'm here
829
00:36:18,062 --> 00:36:21,065
if you need me
to talk to anybody.
830
00:36:21,098 --> 00:36:24,435
You want me to translate
for consent, for surgery?
831
00:36:24,468 --> 00:36:26,403
Any little thing,
if you feel like you need me
832
00:36:26,437 --> 00:36:30,207
to talk to face-to-face,
personally, I'm here.
833
00:36:30,241 --> 00:36:31,741
The patient has a right
834
00:36:31,774 --> 00:36:33,377
to have their language
to explain.
835
00:36:41,051 --> 00:36:43,154
Ready now for the infusion.
836
00:36:47,258 --> 00:36:48,392
- Okay?
- Okay.
837
00:36:53,998 --> 00:36:56,733
I'm trying always my best
to take care of them,
838
00:36:56,766 --> 00:36:57,834
but sometimes it's hard,
839
00:36:57,867 --> 00:37:00,337
'cause you gotta... you gotta
move to a new patient
840
00:37:00,371 --> 00:37:03,040
that's coming,
who's sicker, who's critical.
841
00:37:03,073 --> 00:37:05,409
This is such
a fast-paced environment.
842
00:37:05,442 --> 00:37:06,977
There's seven in the lobby.
843
00:37:07,011 --> 00:37:09,413
We have pending discharges,
pending admits,
844
00:37:09,446 --> 00:37:12,116
so we basically manage flow.
845
00:37:12,149 --> 00:37:14,185
We're the epicenter of the ER,
846
00:37:14,218 --> 00:37:16,453
so the goal is to minimize
our wait times,
847
00:37:16,487 --> 00:37:18,189
our ED wait times.
848
00:37:18,222 --> 00:37:21,125
And people can sometimes
feel herded,
849
00:37:21,158 --> 00:37:22,459
like, you know, cattle,
you know,
850
00:37:22,493 --> 00:37:23,561
you're moving them along,
851
00:37:23,594 --> 00:37:25,996
so you still have to remember
to treat the person
852
00:37:26,030 --> 00:37:27,931
like a human being, that...
853
00:37:27,965 --> 00:37:29,266
that you have to care.
854
00:37:29,300 --> 00:37:31,402
It's not that we're
855
00:37:31,435 --> 00:37:33,370
desensitized
to what's going on.
856
00:37:33,404 --> 00:37:34,471
'Cause I've cried
with parents,
857
00:37:34,505 --> 00:37:36,340
I've cried with patients,
858
00:37:36,373 --> 00:37:38,442
but you just know
that that's what you thrive on,
859
00:37:38,475 --> 00:37:40,777
that's what you're...
you're there to do.
860
00:37:42,446 --> 00:37:45,082
We have varied roles
in the ED,
861
00:37:45,115 --> 00:37:48,419
so I'll do charge,
and I'm also part of...
862
00:37:48,452 --> 00:37:50,521
I do trauma,
and I love it.
863
00:37:50,554 --> 00:37:52,156
As soon as somebody says,
864
00:37:52,189 --> 00:37:54,358
"There's a trauma coming in,"
it's like, your juices...
865
00:37:54,391 --> 00:37:56,393
you get excited.
866
00:37:56,427 --> 00:38:00,097
Because that's an opportunity
to kind of save a life.
867
00:38:00,130 --> 00:38:02,466
If he's got a fracture
through the facet,
868
00:38:02,499 --> 00:38:03,968
let's use the slide board
869
00:38:04,001 --> 00:38:06,237
and let him come over
gently, please.
870
00:38:06,270 --> 00:38:09,173
All right, cross your arms, bud,
we've got you.
871
00:38:09,206 --> 00:38:11,208
One, two...
872
00:38:13,077 --> 00:38:14,979
Let's get a pillow here.
873
00:38:15,012 --> 00:38:17,847
Or a couple of blankets,
maybe?
874
00:38:20,251 --> 00:38:22,852
We're gonna get
a second IV over here, sir.
875
00:38:22,885 --> 00:38:25,189
I really chose
to work in the ER
876
00:38:25,222 --> 00:38:28,192
because of the variety
of things I would see.
877
00:38:28,225 --> 00:38:29,826
My last summer of college,
878
00:38:29,859 --> 00:38:31,996
I was teaching English
through conversation,
879
00:38:32,029 --> 00:38:34,231
and one of my students
was a Karenni refugee
880
00:38:34,265 --> 00:38:37,368
who was teaching me about
this cloth called a pakuma,
881
00:38:37,401 --> 00:38:38,835
just a square cloth.
882
00:38:38,868 --> 00:38:40,237
You can use it
for many different reasons...
883
00:38:40,271 --> 00:38:42,106
to wash, to wear as clothes.
884
00:38:42,139 --> 00:38:44,408
And then he started
casually telling me how
885
00:38:44,441 --> 00:38:46,143
you use it as a tourniquet
when your friend
886
00:38:46,176 --> 00:38:47,511
steps on a land mine.
887
00:38:47,544 --> 00:38:49,280
Or you can throw your child
on your back
888
00:38:49,313 --> 00:38:51,215
and wrap her up
with that pakuma
889
00:38:51,248 --> 00:38:53,950
and run away with her when
your village is under attack.
890
00:38:53,984 --> 00:38:59,856
And he was so casual about it,
I... I was haunted, shocked by it.
891
00:38:59,889 --> 00:39:03,294
I want to know what to do
when terrible things happen.
892
00:39:03,327 --> 00:39:06,463
Okay, sir, so right now,
we got some fractures on you,
893
00:39:06,497 --> 00:39:08,098
so you can't be moving
your neck, okay?
894
00:39:08,132 --> 00:39:10,067
That's why they gave you
that collar.
895
00:39:10,100 --> 00:39:11,568
Just hold real still for us.
896
00:39:11,602 --> 00:39:14,505
You hurting anywhere?
897
00:39:14,538 --> 00:39:16,040
It's a very vulnerable space
898
00:39:16,073 --> 00:39:19,143
for people to be
in the emergency room.
899
00:39:19,176 --> 00:39:22,246
People come in physically hurt,
emotionally hurt,
900
00:39:22,279 --> 00:39:25,516
even people who wear a smile,
they're hurt some way.
901
00:39:27,584 --> 00:39:30,087
I just feel like
sharing these emotions
902
00:39:30,120 --> 00:39:33,856
and these stories
to your loved ones sometimes,
903
00:39:33,890 --> 00:39:35,359
it helps you to be stronger.
904
00:39:35,392 --> 00:39:38,062
You know? To keep going.
905
00:39:38,095 --> 00:39:40,564
Sometimes, we forget
to say "I love you,"
906
00:39:40,597 --> 00:39:44,234
or "Thank you for this,
thank you for that."
907
00:39:44,268 --> 00:39:45,502
'Cause you never know
if you're going to see
908
00:39:45,536 --> 00:39:47,237
your loved ones again.
909
00:39:50,407 --> 00:39:53,544
Every day,
you gotta be thankful.
910
00:39:53,577 --> 00:39:57,914
Look at the sky and say,
"What a beautiful morning."
911
00:39:57,947 --> 00:40:02,219
We're lucky... to breathe.
912
00:40:02,252 --> 00:40:04,455
To have food.
913
00:40:04,488 --> 00:40:07,124
To come home
and see your kids.
914
00:40:07,157 --> 00:40:08,292
Yes.
915
00:40:15,399 --> 00:40:18,135
Sometimes we have patients that
really, really stick with us
916
00:40:18,168 --> 00:40:20,903
and stories that probably
will never, ever leave us,
917
00:40:20,937 --> 00:40:24,074
and in one of the hospitals
that I worked in,
918
00:40:24,108 --> 00:40:26,343
we had a call from
the pre-hospital crew
919
00:40:26,377 --> 00:40:29,946
that a two-year-old
in cardiac arrest was coming in.
920
00:40:29,980 --> 00:40:33,217
And I remember as I kind of
leaned down to him
921
00:40:33,250 --> 00:40:35,152
that I caught a whiff
of baby powder,
922
00:40:35,185 --> 00:40:36,420
'cause he was still in a diaper,
923
00:40:36,453 --> 00:40:38,655
and he was this beautiful
little blonde boy.
924
00:40:38,689 --> 00:40:40,958
Right after he arrived,
his mother arrived,
925
00:40:40,991 --> 00:40:44,261
and we really believe as nurses
in family presence
926
00:40:44,294 --> 00:40:46,430
during invasive procedures
and resuscitation.
927
00:40:46,463 --> 00:40:49,600
So we welcomed his mother
into the room with us,
928
00:40:49,633 --> 00:40:51,934
and the rule with family
presence is you don't just
929
00:40:51,969 --> 00:40:54,104
let somebody sit in the corner
and watch what we're doing.
930
00:40:54,138 --> 00:40:56,974
No, the mother or the father
or the important person
931
00:40:57,007 --> 00:40:59,476
in the patient's lives
must have a person.
932
00:40:59,510 --> 00:41:01,645
So I was the mom's person.
933
00:41:01,678 --> 00:41:04,281
And we were doing CPR
and everything that we could
934
00:41:04,314 --> 00:41:06,250
to resuscitate this little boy.
935
00:41:06,283 --> 00:41:09,386
And at the time when the child
came in, I knew he was gone,
936
00:41:09,420 --> 00:41:11,955
but we worked on this little boy
for a very long time.
937
00:41:11,989 --> 00:41:15,159
Unfortunately, we were not able
to revive him.
938
00:41:15,192 --> 00:41:18,629
I got the mom and I got her into
the stretcher with the baby,
939
00:41:18,662 --> 00:41:20,264
and I wrapped him
in warm blankets
940
00:41:20,297 --> 00:41:22,032
and I tucked him into her arms,
and I said,
941
00:41:22,065 --> 00:41:24,668
"You hold him, you hold him
and you be with him now."
942
00:41:27,471 --> 00:41:30,507
You know, as a team,
you walk away and go,
943
00:41:30,541 --> 00:41:32,342
"Ah, what just happened there?"
944
00:41:32,376 --> 00:41:36,079
You know, could we have done
anything else?
945
00:41:36,113 --> 00:41:37,481
No, there was nothing
we could've done.
946
00:41:37,514 --> 00:41:39,316
We did the very best we could.
947
00:41:39,349 --> 00:41:41,351
And you feel like, "Oh boy,
948
00:41:41,385 --> 00:41:45,055
this was not what we were
supposed to see today."
949
00:41:49,326 --> 00:41:53,330
After we have a patient die
in the emergency department,
950
00:41:53,363 --> 00:41:55,399
we will do something
called "the pause"
951
00:41:55,432 --> 00:41:57,534
and we gather as a team
around the bedside,
952
00:41:57,568 --> 00:41:59,036
we cover the patient
to make sure
953
00:41:59,069 --> 00:42:01,505
that they are dignified
and cared for,
954
00:42:01,538 --> 00:42:04,174
we take a moment of silence
to acknowledge their life
955
00:42:04,208 --> 00:42:05,509
and to respect them.
956
00:42:05,542 --> 00:42:07,644
It's not religious,
it's not a prayer.
957
00:42:07,678 --> 00:42:09,446
It is an acknowledgement
of somebody's life
958
00:42:09,480 --> 00:42:11,081
and respecting them as a person
959
00:42:11,114 --> 00:42:12,683
and acknowledging them
as a person.
960
00:42:12,716 --> 00:42:15,752
It's a brief minute,
but it helps us to stop
961
00:42:15,786 --> 00:42:17,521
and reset and take a breath,
962
00:42:17,554 --> 00:42:21,425
and then we say, "Thank you for
everything you've done today.
963
00:42:21,458 --> 00:42:23,360
You were this patient's
best chance.
964
00:42:23,393 --> 00:42:24,728
Let's move on with our day.
965
00:42:24,761 --> 00:42:26,296
The next patient needs you."
966
00:42:42,579 --> 00:42:45,082
I grew up just south
of Des Moines, Iowa.
967
00:42:45,115 --> 00:42:47,050
Raised on a small, small farm.
968
00:42:47,084 --> 00:42:49,786
I was the dairy princess,
three titles.
969
00:42:49,820 --> 00:42:52,456
Woot, woot.
970
00:42:52,489 --> 00:42:56,126
I remember like
it was yesterday.
971
00:42:56,159 --> 00:42:58,729
We pulled over and somebody
helped me get my dad down
972
00:42:58,762 --> 00:43:01,265
from the car
and we started CPR on him
973
00:43:01,298 --> 00:43:03,166
on the side of the road.
974
00:43:03,200 --> 00:43:05,736
Nothing mattered,
everything was just right here
975
00:43:05,769 --> 00:43:08,071
trying to get my dad back,
976
00:43:08,105 --> 00:43:11,375
and we get him to the ER,
977
00:43:11,408 --> 00:43:13,310
and after two hours,
978
00:43:13,343 --> 00:43:15,479
they got a heartbeat back,
979
00:43:15,512 --> 00:43:18,081
but he was gone.
980
00:43:18,115 --> 00:43:20,651
And so when my dad passed away,
981
00:43:20,684 --> 00:43:22,419
right before they turned off
the machines,
982
00:43:22,452 --> 00:43:26,523
I told him that I would take
care of my mom
983
00:43:26,557 --> 00:43:29,826
and that he could go
because it was gonna be okay.
984
00:43:31,728 --> 00:43:35,132
I was in the ER the whole time
as they were working on him,
985
00:43:35,165 --> 00:43:38,302
and I just saw how hard
they were doing everything,
986
00:43:38,335 --> 00:43:41,104
and I was already a nurse
at the time,
987
00:43:41,138 --> 00:43:43,674
but I remember thinking,
"This is so far
988
00:43:43,707 --> 00:43:44,875
from what I could do.
989
00:43:44,908 --> 00:43:47,110
I wanna do that."
990
00:43:54,718 --> 00:43:58,355
You're just not feeling good
at all, are ya?
991
00:43:58,388 --> 00:44:00,223
It's basically like
the same signs from last time.
992
00:44:00,257 --> 00:44:01,758
The cough and the throwing up.
993
00:44:01,792 --> 00:44:04,595
And last time he was diagnosed
with just bronchitis?
994
00:44:04,628 --> 00:44:07,731
Overall, he's just been
diagnosed with bronchitis.
995
00:44:07,764 --> 00:44:08,865
Okay.
996
00:44:08,899 --> 00:44:11,368
All right, he's really wheezy.
997
00:44:11,401 --> 00:44:15,238
See how he's breathing so much
and it's really pulling in?
998
00:44:15,272 --> 00:44:17,507
That means he's working
really, really hard.
999
00:44:17,541 --> 00:44:20,210
How long has he been
doing this for?
1000
00:44:20,243 --> 00:44:22,412
I wanna say
it's been just today.
1001
00:44:22,446 --> 00:44:23,614
Just today, perfect.
1002
00:44:23,647 --> 00:44:25,415
What time,
like this morning or...
1003
00:44:25,449 --> 00:44:28,251
- Mm-hm.
- Yeah, okay, it's okay.
1004
00:44:28,285 --> 00:44:30,187
We're gonna give him
a breathing treatment, okay?
1005
00:44:30,220 --> 00:44:31,555
I know, honey, I know.
1006
00:44:31,588 --> 00:44:32,923
We'll get him okay.
1007
00:44:32,957 --> 00:44:34,625
All right, buddy.
1008
00:44:34,658 --> 00:44:37,794
We have that special mask with
that extra special medicine
1009
00:44:37,828 --> 00:44:39,796
that goes in your lungs, okay?
1010
00:44:39,830 --> 00:44:42,633
- Can we do that, yeah?
- Alrighty.
1011
00:44:42,666 --> 00:44:44,768
I'm just gonna go like this,
okay?
1012
00:44:44,801 --> 00:44:45,736
Just hold it right there.
1013
00:44:45,769 --> 00:44:48,305
You take nice, big,
deep breaths, pumpkin.
1014
00:44:48,338 --> 00:44:50,507
- Nice deep breaths.
- Good job.
1015
00:44:52,809 --> 00:44:54,578
I know it's scary,
I know it's scary,
1016
00:44:54,611 --> 00:44:55,946
but already his oxygen's better
1017
00:44:55,980 --> 00:44:57,881
and he's breathing better, okay?
1018
00:44:57,914 --> 00:44:59,683
We'll get him
on the right stuff.
1019
00:44:59,716 --> 00:45:02,419
You are probably my best patient
all day.
1020
00:45:02,452 --> 00:45:03,787
Did you know that?
1021
00:45:03,820 --> 00:45:06,456
Yeah, yeah?
1022
00:45:06,490 --> 00:45:09,493
Can I fist bump?
1023
00:45:09,526 --> 00:45:10,627
Ouch!
1024
00:45:10,661 --> 00:45:13,897
How'd you get so strong, huh?
1025
00:45:13,930 --> 00:45:17,868
When you have a patient where
you as a nurse can identify
1026
00:45:17,901 --> 00:45:21,505
that they're struggling
with something right now
1027
00:45:21,538 --> 00:45:24,976
and you can talk to them
and be on their level,
1028
00:45:25,009 --> 00:45:27,911
eye to eye, the only difference
between me and you
1029
00:45:27,944 --> 00:45:30,447
is that I'm on this side of
the bed and you're on that side.
1030
00:45:30,480 --> 00:45:32,883
That's that human component
that really...
1031
00:45:32,916 --> 00:45:34,918
it makes all the difference.
1032
00:45:34,951 --> 00:45:37,688
All right, one, two, three,
young lady.
1033
00:45:37,721 --> 00:45:39,289
Just gonna draw the blood off
so you don't have to
1034
00:45:39,322 --> 00:45:40,657
get poked again
and then I'll flush it
1035
00:45:40,691 --> 00:45:42,859
and we'll have an IV site, okay?
1036
00:45:42,893 --> 00:45:44,761
I come from a big family.
1037
00:45:44,795 --> 00:45:46,496
There was 10 children.
1038
00:45:46,530 --> 00:45:48,465
We lived on a farm.
1039
00:45:48,498 --> 00:45:51,368
Bringing the cows in
and milk them,
1040
00:45:51,401 --> 00:45:54,771
and feed the chickens,
and you name it.
1041
00:45:54,805 --> 00:45:56,306
She's just tough.
1042
00:45:56,339 --> 00:45:59,743
I mean,
she's a breast cancer survivor.
1043
00:45:59,776 --> 00:46:02,245
It's hard for her
to accept care,
1044
00:46:02,279 --> 00:46:04,581
'cause she's always been
the caregiver with eight kids.
1045
00:46:04,614 --> 00:46:06,950
She was always making sure
all of us were taken care of.
1046
00:46:06,984 --> 00:46:08,119
That's what she does.
1047
00:46:08,152 --> 00:46:11,621
Years ago, it used to be...
when we lived on the farm...
1048
00:46:11,655 --> 00:46:14,725
if somebody needed help,
you just automatically
1049
00:46:14,758 --> 00:46:18,395
went and helped them
and charged 'em nothing.
1050
00:46:18,428 --> 00:46:21,966
But then if you needed
help back, they were there.
1051
00:46:21,999 --> 00:46:24,035
We have to be in this together.
1052
00:46:24,068 --> 00:46:27,038
We all have those same desires,
aspirations,
1053
00:46:27,071 --> 00:46:28,805
frustrations and everything,
1054
00:46:28,839 --> 00:46:33,044
and when you can acknowledge
that and be present with someone
1055
00:46:33,077 --> 00:46:35,712
and they realize
they're not alone,
1056
00:46:35,746 --> 00:46:38,381
it can be life-changing.
1057
00:46:38,415 --> 00:46:40,550
Is it really sore on your leg?
1058
00:46:40,584 --> 00:46:41,685
- Yeah.
- Yeah?
1059
00:46:41,718 --> 00:46:43,687
Okay, you take the door.
1060
00:46:43,720 --> 00:46:46,256
Got it, I'm here, I got ya.
1061
00:46:50,360 --> 00:46:54,931
Does this leg hurt more
or does this leg hurt more?
1062
00:46:54,966 --> 00:46:58,568
This leg hurts more
and it hurts from here to here?
1063
00:46:58,602 --> 00:47:00,303
- Yeah.
- Okay.
1064
00:47:00,337 --> 00:47:01,938
So we're gonna draw
a bunch of labs
1065
00:47:01,973 --> 00:47:03,540
and kinda go from there.
1066
00:47:03,573 --> 00:47:04,875
I'm gonna take
another look here.
1067
00:47:04,908 --> 00:47:05,842
It's okay.
1068
00:47:05,876 --> 00:47:06,910
Should we sing a song?
1069
00:47:06,943 --> 00:47:08,612
Would that make it better?
1070
00:47:08,645 --> 00:47:11,515
Should we make it
a country song?
1071
00:47:11,548 --> 00:47:14,618
Almost Heaven
1072
00:47:14,651 --> 00:47:17,989
West Virginia
1073
00:47:18,022 --> 00:47:20,590
Blue Ridge Mountains
1074
00:47:20,624 --> 00:47:24,661
Shenandoah River
1075
00:47:24,694 --> 00:47:27,364
Life is old there
1076
00:47:27,397 --> 00:47:31,568
Older than the trees
1077
00:47:34,905 --> 00:47:37,407
Blowin' like a breeze
1078
00:47:37,440 --> 00:47:40,944
Country roads
1079
00:47:40,978 --> 00:47:44,548
Take me home
1080
00:47:44,581 --> 00:47:50,821
To the place I belong
1081
00:47:50,854 --> 00:47:53,991
West Virginia
1082
00:47:54,025 --> 00:47:57,627
Mountain mama
1083
00:47:57,661 --> 00:48:01,132
Take me home
1084
00:48:01,165 --> 00:48:04,901
Country roads
1085
00:48:22,519 --> 00:48:24,855
I walk in the hospital
and it smells right,
1086
00:48:24,888 --> 00:48:27,524
it feels right,
the energy's good.
1087
00:48:27,557 --> 00:48:28,625
I see the nurses
that are around me,
1088
00:48:28,658 --> 00:48:31,128
the physicians I work with,
the team that's here,
1089
00:48:31,162 --> 00:48:33,697
and they're like a family
and you feel like you're home.
1090
00:48:33,730 --> 00:48:36,100
In a very strange way
you feel like you're home.
1091
00:48:36,133 --> 00:48:38,668
And so when you're here,
it's almost like another life.
1092
00:48:41,805 --> 00:48:43,673
I am a clinical education
specialist.
1093
00:48:43,707 --> 00:48:46,978
I train nurses,
and I can tell very quickly
1094
00:48:47,011 --> 00:48:49,479
if someone is going to be
successful here.
1095
00:48:49,512 --> 00:48:51,448
Okay, it's gonna be
a busy night.
1096
00:48:51,481 --> 00:48:53,985
I remember being a new nurse
and I look back now
1097
00:48:54,018 --> 00:48:56,820
and I realize how little I knew.
1098
00:48:56,853 --> 00:48:58,022
Open it up... now the way these...
1099
00:48:58,055 --> 00:48:59,156
blood can always
be hung in here,
1100
00:48:59,190 --> 00:49:01,591
but you need to be
on the lowest level.
1101
00:49:01,625 --> 00:49:02,826
You know, you push yourself
to grow,
1102
00:49:02,859 --> 00:49:04,628
you push yourself to learn.
1103
00:49:04,661 --> 00:49:06,964
I have memories of some of those
first patients I cared for.
1104
00:49:06,998 --> 00:49:10,034
We had a man that came in
and he was gray, and sweating,
1105
00:49:10,067 --> 00:49:12,936
and panicked, and he had this
horrible feeing in his chest.
1106
00:49:12,970 --> 00:49:15,072
And I remember
throwing IVs in him.
1107
00:49:15,106 --> 00:49:17,607
It was a big step for me to be
able to put IVs in very quickly
1108
00:49:17,641 --> 00:49:19,542
in those critical moments,
and I remember I said,
1109
00:49:19,576 --> 00:49:21,112
"I've got the line in here,"
and the other nurse is like,
1110
00:49:21,145 --> 00:49:22,779
"I'm getting the fluids for you,
hang on!"
1111
00:49:22,812 --> 00:49:24,614
But I had gotten it in so fast
and I remember thinking,
1112
00:49:24,648 --> 00:49:25,949
"Oh, I can do this now."
1113
00:49:25,983 --> 00:49:27,450
And one of the nurses
who was probably...
1114
00:49:27,484 --> 00:49:29,120
you know, probably my age now,
1115
00:49:29,153 --> 00:49:32,455
she looked at me, she said,
"You'll be fine down here."
1116
00:49:32,489 --> 00:49:33,991
Now what are the things
you think I'm looking for
1117
00:49:34,025 --> 00:49:35,592
to make sure
that I can effectively
1118
00:49:35,625 --> 00:49:36,526
resuscitate a patient?
1119
00:49:36,559 --> 00:49:38,828
What am I looking for?
What do you think?
1120
00:49:38,862 --> 00:49:41,598
- Enema bag.
- An enema bag is one thing.
1121
00:49:41,631 --> 00:49:43,067
I laugh when I talk
to my new nurses
1122
00:49:43,100 --> 00:49:44,168
and I tell them
I've been a nurse
1123
00:49:44,201 --> 00:49:46,870
for longer
than they have been alive.
1124
00:49:46,903 --> 00:49:49,673
I've certainly seen
within the past five years
1125
00:49:49,706 --> 00:49:54,178
a change in what patients
are presenting with.
1126
00:49:54,211 --> 00:49:57,647
One of the things that all
of you are going to encounter
1127
00:49:57,681 --> 00:49:59,516
at some point
in your practice here
1128
00:49:59,549 --> 00:50:00,850
is an opioid overdose.
1129
00:50:00,884 --> 00:50:02,719
The reality
of the opioid epidemic,
1130
00:50:02,752 --> 00:50:04,255
it is all across the U.S.,
1131
00:50:04,288 --> 00:50:06,991
it is every race,
every age group.
1132
00:50:07,024 --> 00:50:08,792
It is your 55-year-old
grandmother,
1133
00:50:08,825 --> 00:50:11,795
it is your 12-year-old child
in elementary school.
1134
00:50:11,828 --> 00:50:14,664
It is pervasive,
opioids don't discriminate.
1135
00:50:14,698 --> 00:50:17,901
So one of the best tools
that we have is the ability
1136
00:50:17,934 --> 00:50:20,737
to reverse an overdose
using Narcan.
1137
00:50:20,770 --> 00:50:22,173
You need to be able
to give it quickly.
1138
00:50:22,206 --> 00:50:25,142
So we use something
called a MAD device, okay?
1139
00:50:25,176 --> 00:50:26,843
So if they are actually
having an overdose,
1140
00:50:26,876 --> 00:50:29,046
you're probably already having
to open their airway
1141
00:50:29,080 --> 00:50:31,548
because they're probably
not breathing on their own.
1142
00:50:31,581 --> 00:50:32,649
Breathe normal.
1143
00:50:32,682 --> 00:50:34,185
I almost died today.
1144
00:50:34,218 --> 00:50:36,553
When I opened my eyes
and I saw paramedics,
1145
00:50:36,586 --> 00:50:40,157
I didn't even really have
any sense of where I was
1146
00:50:40,191 --> 00:50:44,061
or how I had sort of
gotten to where I was.
1147
00:50:44,095 --> 00:50:47,031
But the by the grace of God,
somebody saw me
1148
00:50:47,064 --> 00:50:50,800
and called them in.
1149
00:50:50,834 --> 00:50:55,172
My dad was diagnosed
with multiple myeloma
1150
00:50:55,206 --> 00:50:57,308
and my mom had a stroke
and a seizure
1151
00:50:57,341 --> 00:50:59,276
when I came home one day.
1152
00:50:59,310 --> 00:51:02,746
The oxys, more so than the pain
aspect of things
1153
00:51:02,779 --> 00:51:06,117
or even getting high,
it was emotionally numbing.
1154
00:51:06,150 --> 00:51:09,153
It got out of control,
so I tried to stop
1155
00:51:09,186 --> 00:51:12,189
and that was when I started
experiencing withdrawal.
1156
00:51:12,223 --> 00:51:15,759
That's like getting hit
with a bomb.
1157
00:51:15,792 --> 00:51:18,561
I ended up going into
a program, detoxing,
1158
00:51:18,595 --> 00:51:21,298
and I've been clean since.
1159
00:51:21,332 --> 00:51:24,567
Unfortunately, sort of
back to square one.
1160
00:51:24,601 --> 00:51:26,936
It's a beast.
1161
00:51:26,971 --> 00:51:29,006
The success rates of keeping
somebody clean,
1162
00:51:29,040 --> 00:51:31,075
it depends on having follow-up,
1163
00:51:31,108 --> 00:51:33,676
and otherwise,
it's a revolving door, guys.
1164
00:51:33,710 --> 00:51:36,579
We had one patient that
overdosed five times in one day
1165
00:51:36,613 --> 00:51:37,847
until finally we committed him,
1166
00:51:37,881 --> 00:51:39,849
because he was gonna
kill himself.
1167
00:51:39,883 --> 00:51:41,918
I can't even imagine
1168
00:51:41,951 --> 00:51:45,122
what this would've done
to my family.
1169
00:51:45,156 --> 00:51:48,825
I'm supposed to sort of try
and be rock in this situation
1170
00:51:48,858 --> 00:51:51,628
when Mom and Dad
are having tough times.
1171
00:51:51,661 --> 00:51:54,697
So, I'm very grateful for that,
1172
00:51:54,731 --> 00:51:58,735
that I'm still here.
1173
00:51:58,768 --> 00:52:01,138
You know, people don't wake up
instantaneously from Narcan.
1174
00:52:01,172 --> 00:52:02,806
If it's IV, it'll be faster,
1175
00:52:02,839 --> 00:52:04,375
but the first thing
you can say to them is,
1176
00:52:04,408 --> 00:52:06,876
"You almost died today,
we just saved your life.
1177
00:52:06,910 --> 00:52:08,645
Are you ready for treatment?
1178
00:52:08,678 --> 00:52:10,014
Are you ready to get clean?"
1179
00:52:10,047 --> 00:52:12,216
And that's something
we can help them with.
1180
00:52:12,249 --> 00:52:14,251
We have this idea
called a warm hand-off
1181
00:52:14,285 --> 00:52:15,086
where we're not just sort of
1182
00:52:15,119 --> 00:52:16,619
sending somebody off
on their own.
1183
00:52:16,653 --> 00:52:18,389
A warm hand-off means
I'm handing you
1184
00:52:18,422 --> 00:52:20,723
to somebody else who's gonna
continue your care.
1185
00:52:20,757 --> 00:52:23,160
Thirty-something-year-old male
who was found in his car today.
1186
00:52:23,194 --> 00:52:25,996
If someone has an overdose,
we have the opportunity
1187
00:52:26,030 --> 00:52:28,399
to have a counselor,
who is a recovering addict,
1188
00:52:28,432 --> 00:52:30,900
come from Eva's Village,
talk to the patient,
1189
00:52:30,934 --> 00:52:33,837
intercept them
to get them into rehab.
1190
00:52:33,870 --> 00:52:35,106
I'm Anthony, I'm an addict.
1191
00:52:35,139 --> 00:52:36,373
- Hi, Anthony.
- Hi, Anthony.
1192
00:52:36,407 --> 00:52:38,741
Practicing gratitude.
1193
00:52:38,775 --> 00:52:41,312
Eva's Village is a pretty
extraordinary organization
1194
00:52:41,345 --> 00:52:42,846
within the Paterson community.
1195
00:52:42,879 --> 00:52:44,881
They have had
tremendous success rates
1196
00:52:44,914 --> 00:52:48,651
of getting people into rehab
and keeping them clean.
1197
00:52:48,685 --> 00:52:51,422
One guy came up to me and said,
"You saved my life.
1198
00:52:51,455 --> 00:52:55,092
You gave me some Narcan and
you got me here into recovery."
1199
00:52:55,126 --> 00:52:59,263
I said to him, "Well, how did
you get addicted to opioids?"
1200
00:52:59,296 --> 00:53:02,099
And he says, "You know what,
it's a funny story, doc.
1201
00:53:02,133 --> 00:53:04,969
I came in with a shoulder injury
and you gave me
1202
00:53:05,002 --> 00:53:07,704
a prescription for Percocet
and I never stopped."
1203
00:53:07,737 --> 00:53:10,773
Emergency physicians
only prescribe eight percent
1204
00:53:10,807 --> 00:53:13,444
of the opioids that are
prescribed in the country,
1205
00:53:13,477 --> 00:53:16,013
but many of the first doses
are given
1206
00:53:16,046 --> 00:53:17,714
in the emergency department.
1207
00:53:17,747 --> 00:53:20,683
Our ALTO program is designed
1208
00:53:20,717 --> 00:53:23,220
to treat people with acute pain
1209
00:53:23,254 --> 00:53:26,823
without using addictive drugs
like opioids.
1210
00:53:26,856 --> 00:53:28,192
We use all sorts
of other medications
1211
00:53:28,225 --> 00:53:29,960
people aren't thinking about,
because sometimes
1212
00:53:29,994 --> 00:53:31,428
an opioid
is not the best choice.
1213
00:53:31,462 --> 00:53:33,763
Maybe a muscle relaxant
is a better choice.
1214
00:53:33,796 --> 00:53:36,333
We will use these drugs,
but we're careful
1215
00:53:36,367 --> 00:53:39,836
and we educate our patients
as a result.
1216
00:53:39,869 --> 00:53:42,106
We are seeing
too many young people die,
1217
00:53:42,139 --> 00:53:45,376
and the ripple effect of having
a loss of a young person,
1218
00:53:45,409 --> 00:53:48,878
it's tragic, it's tragic,
and it's preventable.
1219
00:54:19,476 --> 00:54:20,978
You have to do what
you're trained to do.
1220
00:54:21,011 --> 00:54:23,280
The training just kicks in.
1221
00:54:23,314 --> 00:54:25,249
I always do think
about my own family,
1222
00:54:25,282 --> 00:54:27,218
but you just put it away,
1223
00:54:27,251 --> 00:54:30,820
put it in the back of your head
and get it done.
1224
00:54:30,853 --> 00:54:34,258
I've been doing flight nursing
for about 18 years.
1225
00:54:41,198 --> 00:54:42,533
I was introduced
to flight nursing
1226
00:54:42,566 --> 00:54:44,301
when I was first a young nurse,
1227
00:54:44,335 --> 00:54:46,769
and I just begged
and begged and begged
1228
00:54:46,803 --> 00:54:48,805
to go on a flight.
1229
00:54:51,275 --> 00:54:54,011
People don't have access
to healthcare,
1230
00:54:54,044 --> 00:54:55,980
'cause they're living
in areas that are
1231
00:54:56,013 --> 00:54:58,382
hundreds of miles
away from care.
1232
00:54:58,415 --> 00:55:02,019
Some places don't even have
a little clinic to go to.
1233
00:55:02,052 --> 00:55:06,223
I was born in Oregon and
my father worked at a saw mill.
1234
00:55:06,257 --> 00:55:08,925
One of the logs busted through
the saw box
1235
00:55:08,959 --> 00:55:12,496
and this huge log smashed
his whole left side.
1236
00:55:12,529 --> 00:55:15,898
His collarbone was fractured
and his arm was shattered.
1237
00:55:15,932 --> 00:55:21,305
He's out in the middle
of frontier Oregon, really.
1238
00:55:21,338 --> 00:55:23,974
So they throw him
into the back of a pickup...
1239
00:55:26,010 --> 00:55:30,347
...and they travel
for four hours to get to care.
1240
00:55:30,381 --> 00:55:32,583
Okay, that's 50 years ago.
1241
00:55:32,616 --> 00:55:34,418
That happens today,
1242
00:55:34,451 --> 00:55:39,189
and if there was not some
kind of air medical service,
1243
00:55:39,223 --> 00:55:40,890
they would be stuck out there,
1244
00:55:40,923 --> 00:55:43,294
no pain meds, no blood products,
1245
00:55:43,327 --> 00:55:44,995
no medications.
1246
00:55:45,029 --> 00:55:47,031
Those people deserve care.
1247
00:55:51,302 --> 00:55:52,902
AirLink 1, go ahead.
1248
00:55:52,935 --> 00:55:56,407
We're being asked to activate
to Station 102.
1249
00:55:56,440 --> 00:56:01,245
This will be a trauma patient,
over.
1250
00:56:01,278 --> 00:56:03,846
AirLink, your patient's going
to be a 28-year-old male,
1251
00:56:03,880 --> 00:56:05,316
suffered
a traumatic head injury
1252
00:56:05,349 --> 00:56:08,018
after taking a ground level
fall onto concrete.
1253
00:56:08,052 --> 00:56:09,553
Patient's currently
got a GCS of 13,
1254
00:56:09,586 --> 00:56:12,489
a pulse of 103,
respiration's 18.
1255
00:56:14,924 --> 00:56:18,095
AirCom, AirLink 1 has landed
on the scene.
1256
00:56:25,935 --> 00:56:30,307
You want to move that patient
as quickly as you can,
1257
00:56:30,341 --> 00:56:34,478
because time is muscle,
time is brain.
1258
00:56:34,511 --> 00:56:37,047
Departing 102
for St. Charles Bend,
1259
00:56:37,081 --> 00:56:38,582
10 minutes, en route.
1260
00:56:38,615 --> 00:56:40,117
And here we go.
1261
00:56:43,987 --> 00:56:47,991
It would be easy to just
go through the ABCs of care...
1262
00:56:48,025 --> 00:56:49,460
airway, breathing,
circulation...
1263
00:56:49,493 --> 00:56:51,662
but it's really about
communicating with that person
1264
00:56:51,695 --> 00:56:55,199
and looking at them
and connecting with them.
1265
00:56:58,369 --> 00:57:02,072
We connect with our eyes
and often touch their hand,
1266
00:57:02,106 --> 00:57:05,676
and that has tremendous healing
in itself.
1267
00:57:05,709 --> 00:57:07,511
Sometimes on the monitor
1268
00:57:07,544 --> 00:57:10,080
you can see
their heart rate decrease.
1269
00:57:10,114 --> 00:57:12,149
It's kind of a combination
of the physical
1270
00:57:12,182 --> 00:57:13,517
and the emotional care.
1271
00:57:13,550 --> 00:57:15,885
And I'm on
a stabilized approach.
1272
00:57:17,654 --> 00:57:19,189
As far as flight nursing goes,
1273
00:57:19,223 --> 00:57:21,425
I think there has to come
with that person
1274
00:57:21,458 --> 00:57:24,228
a sense of hardiness.
1275
00:57:24,261 --> 00:57:26,029
You see the worst of the worst,
1276
00:57:26,063 --> 00:57:28,332
and you see it in its raw state.
1277
00:57:30,234 --> 00:57:32,035
We also see super great things.
1278
00:57:32,069 --> 00:57:34,638
We see people healed
from traumatic injuries.
1279
00:57:34,671 --> 00:57:38,709
We get to see
peoples' lives changed.
1280
00:57:38,742 --> 00:57:41,378
At night, we have to wear
night vision goggles.
1281
00:57:41,412 --> 00:57:43,213
Every time I put those on,
1282
00:57:43,247 --> 00:57:46,183
I don't just see the stars
that you guys are seeing.
1283
00:57:46,216 --> 00:57:48,185
I see a tremendous amount.
1284
00:57:48,218 --> 00:57:49,586
It reminds me every time
1285
00:57:49,620 --> 00:57:51,989
that there's a lot more
out there than me.
1286
00:58:14,378 --> 00:58:16,213
You try to pick out
the silver lining, right?
1287
00:58:16,246 --> 00:58:18,982
You thank the coworker
that came and helped you,
1288
00:58:19,016 --> 00:58:20,451
helped save this patient.
1289
00:58:23,554 --> 00:58:26,323
If you don't see it,
you don't understand
1290
00:58:26,356 --> 00:58:29,626
the depth and the breadth
of what goes on
1291
00:58:29,660 --> 00:58:32,062
in a department this big.
1292
00:58:33,730 --> 00:58:36,600
Seeing the people you work with,
seeing the influence
1293
00:58:36,633 --> 00:58:38,702
they have on you every day
to do better,
1294
00:58:38,735 --> 00:58:41,338
that's the reason
you keep going.
1295
00:58:41,371 --> 00:58:44,608
Every morning we have a list
of traumas that come through,
1296
00:58:44,641 --> 00:58:47,778
and gunshot, gunshot.
1297
00:58:47,811 --> 00:58:50,414
I think we all have some
sort of post-traumatic stress
1298
00:58:50,447 --> 00:58:52,616
from the things
we see every day.
1299
00:58:54,451 --> 00:58:58,355
You see things as basic
as dental pain,
1300
00:58:58,388 --> 00:59:00,224
but then you see things
as complicated
1301
00:59:00,257 --> 00:59:02,726
as a young girl coming in here
for dental pain
1302
00:59:02,759 --> 00:59:07,097
but really the issue
is sexual trafficking.
1303
00:59:07,130 --> 00:59:08,632
You have to change
your mindset that,
1304
00:59:08,665 --> 00:59:11,368
"I'm a mom, I'm a person,"
1305
00:59:11,401 --> 00:59:13,437
to, "I'm an evidence
technician."
1306
00:59:16,373 --> 00:59:18,775
You just have to be ready
on an everyday basis.
1307
00:59:18,809 --> 00:59:20,677
You know, reflect in the mirror
and make sure
1308
00:59:20,711 --> 00:59:22,613
this is what you really
wanna do every day.
1309
00:59:22,646 --> 00:59:24,414
Just breathe normally, you don't
have to hold your breath.
1310
00:59:24,448 --> 00:59:26,316
If you could reach
even a few people,
1311
00:59:26,350 --> 00:59:30,721
everybody needs help regardless
of what zip code or nationality.
1312
00:59:30,754 --> 00:59:33,257
You can strip away
the fancy technology,
1313
00:59:33,290 --> 00:59:34,625
you can strip away the CPR,
1314
00:59:34,658 --> 00:59:36,627
you can strip away
the medication.
1315
00:59:36,660 --> 00:59:39,696
It really comes down
to a conversation, right,
1316
00:59:39,730 --> 00:59:42,599
and understanding
what that person needs.
1317
00:59:50,173 --> 00:59:52,309
St. John's emergency room,
please go ahead.
1318
00:59:52,342 --> 00:59:53,610
St. John's emergency room,
1319
00:59:53,644 --> 00:59:55,846
84 Bravo 113, medic 13,
1320
00:59:55,879 --> 00:59:58,749
en route to facility,
priority one trauma.
1321
00:59:58,782 --> 01:00:01,852
Honestly, the ER
is a landing pad.
1322
01:00:01,885 --> 01:00:04,288
The nurses have to be sort of
a Jack and Jill of all trades.
1323
01:00:04,321 --> 01:00:06,657
You have to know a little bit
about everything.
1324
01:00:10,694 --> 01:00:12,696
We triage patients according
to what we call
1325
01:00:12,729 --> 01:00:14,598
an emergency severity index.
1326
01:00:14,631 --> 01:00:17,601
Level one meaning they're
the most severe patients.
1327
01:00:17,634 --> 01:00:21,138
I think we all start
sort of like trauma troopers.
1328
01:00:21,171 --> 01:00:22,706
We all love trauma patients.
1329
01:00:22,739 --> 01:00:24,441
Bed two, please.
1330
01:00:24,474 --> 01:00:27,844
We can see lungs and hearts
and deliver babies
1331
01:00:27,878 --> 01:00:31,481
and we like that immediate stuff
that we can see and fix.
1332
01:00:31,515 --> 01:00:33,850
So, 34-year-old female,
dog bite.
1333
01:00:33,884 --> 01:00:36,119
Several puncture marks
throughout her body.
1334
01:00:36,153 --> 01:00:38,455
She's got several larger wounds
to the upper arms
1335
01:00:38,488 --> 01:00:40,424
as well as the lower legs.
1336
01:00:40,457 --> 01:00:43,260
- Can I get a doppler?
- Right behind bed two.
1337
01:00:43,293 --> 01:00:44,861
- Dopplers.
- I got it, I got it.
1338
01:00:44,895 --> 01:00:47,431
Where are we getting pulses?
1339
01:00:47,464 --> 01:00:51,568
- Bilateral feet, no pulse?
- No pulse.
1340
01:00:51,602 --> 01:00:52,736
I have a femoral pulse.
1341
01:00:52,769 --> 01:00:54,705
Big poke over here on the side,
okay?
1342
01:00:54,738 --> 01:00:56,506
Big poke here.
1343
01:00:56,540 --> 01:00:57,708
I would just go ahead
and activate.
1344
01:00:57,741 --> 01:00:58,575
You wanna activate?
1345
01:00:58,609 --> 01:01:00,644
Three to four centimeter
laceration.
1346
01:01:00,677 --> 01:01:02,346
You know, it's always
fast, fast, fast.
1347
01:01:02,379 --> 01:01:03,847
We're cut off from our emotion.
1348
01:01:03,880 --> 01:01:05,515
Okay, so I've got right AC,
1349
01:01:05,549 --> 01:01:09,519
left ankle, right calf.
1350
01:01:09,553 --> 01:01:11,521
Oh, that hurts!
1351
01:01:11,555 --> 01:01:13,624
I've got medicine for you, love.
1352
01:01:15,592 --> 01:01:17,394
Patients are scared.
1353
01:01:17,427 --> 01:01:19,663
They don't understand
why there's 17 people
1354
01:01:19,696 --> 01:01:21,798
standing around them,
cutting off their clothes,
1355
01:01:21,832 --> 01:01:23,800
and putting needles
in their arm,
1356
01:01:23,834 --> 01:01:27,504
and it takes presence of mind
in the situation you're in
1357
01:01:27,537 --> 01:01:28,805
to talk to a person.
1358
01:01:28,839 --> 01:01:30,507
"Do you understand?
1359
01:01:30,540 --> 01:01:31,808
I know you're scared.
1360
01:01:31,842 --> 01:01:33,577
Are you in pain?"
1361
01:01:33,610 --> 01:01:36,179
Stephanie, we got you,
all right?
1362
01:01:36,213 --> 01:01:37,614
I'm gonna get you covered up,
okay?
1363
01:01:37,648 --> 01:01:39,316
- Okay.
- My name's Bonnie.
1364
01:01:39,349 --> 01:01:41,184
I'm one of the nurses
in the ER, okay?
1365
01:01:41,218 --> 01:01:43,553
You're gonna go
for a lot of tests.
1366
01:01:43,587 --> 01:01:46,890
Even something little
will change their perspective
1367
01:01:46,923 --> 01:01:50,594
of their trauma.
1368
01:01:50,627 --> 01:01:53,630
Open.
1369
01:01:53,664 --> 01:01:55,499
How's that feel?
1370
01:01:55,532 --> 01:01:56,867
We have to shut down
a little bit,
1371
01:01:56,900 --> 01:01:58,402
because there's always
1372
01:01:58,435 --> 01:02:00,704
someone new coming in
and a new trauma coming in,
1373
01:02:00,737 --> 01:02:04,908
and I think we're so bombarded
with the day to day,
1374
01:02:04,941 --> 01:02:06,810
it's hard to think
of the long game.
1375
01:02:06,843 --> 01:02:08,445
We see an escalation in
1376
01:02:08,478 --> 01:02:10,213
behavioral health patients
or gunshot wounds.
1377
01:02:10,247 --> 01:02:13,283
What are we gonna do
to help this in the future?
1378
01:02:13,316 --> 01:02:15,485
When you listen to the news
and you hear what happens
1379
01:02:15,519 --> 01:02:18,288
in the city of Detroit
with gun violence,
1380
01:02:18,321 --> 01:02:20,657
you wanna do all that you can.
1381
01:02:20,691 --> 01:02:22,659
Nursing kind of chose me
at an early age
1382
01:02:22,693 --> 01:02:24,628
of say, five years old.
1383
01:02:24,661 --> 01:02:27,931
If I had a second choice of
a career it would be a teacher.
1384
01:02:27,965 --> 01:02:29,266
So I'm getting a chance
to do that now.
1385
01:02:29,299 --> 01:02:30,101
I'm teaching in the community
1386
01:02:30,134 --> 01:02:33,503
about injury
and violence prevention.
1387
01:02:33,537 --> 01:02:34,738
Hi, everybody.
1388
01:02:34,771 --> 01:02:37,374
So when you guys come in
to the ER,
1389
01:02:37,407 --> 01:02:39,609
if you are a victim of trauma,
1390
01:02:39,643 --> 01:02:42,646
you get rushed right into our
trauma bay, which is over here.
1391
01:02:42,679 --> 01:02:45,382
The injury prevention program
is attached
1392
01:02:45,415 --> 01:02:47,684
to most level one
hospital centers.
1393
01:02:47,718 --> 01:02:51,388
Gun violence is very, very big
in the city of Detroit
1394
01:02:51,421 --> 01:02:52,522
and the surrounding areas.
1395
01:02:52,556 --> 01:02:54,791
82% of violent crimes
1396
01:02:54,825 --> 01:02:57,327
are committed with guns.
1397
01:02:57,360 --> 01:02:58,829
The violence
has to be interrupted.
1398
01:02:58,862 --> 01:03:01,298
How do we do that,
how do we interrupt violence?
1399
01:03:01,331 --> 01:03:04,401
By people getting involved
like myself, going out to speak.
1400
01:03:04,434 --> 01:03:06,336
I'm 48 years old.
1401
01:03:06,369 --> 01:03:09,372
Been a wheelchair user
for 30 years,
1402
01:03:09,406 --> 01:03:10,474
due to gang violence.
1403
01:03:10,507 --> 01:03:13,276
I look at this as bittersweet,
what happened to me.
1404
01:03:13,310 --> 01:03:16,847
I was 18, kicked out of
all Detroit public schools.
1405
01:03:16,880 --> 01:03:20,584
It took for me to get shot
to be like, "You know what?
1406
01:03:20,617 --> 01:03:21,952
This is something serious.
1407
01:03:21,986 --> 01:03:24,588
I gotta get my stuff together."
1408
01:03:24,621 --> 01:03:27,959
At the end of a class, someone
will walk up to me and say,
1409
01:03:27,992 --> 01:03:29,726
"You know, I really want
to talk to you
1410
01:03:29,760 --> 01:03:31,628
because my brother
was killed last week,"
1411
01:03:31,661 --> 01:03:33,965
or, "My next-door neighbor
was shot."
1412
01:03:33,998 --> 01:03:36,000
They always have
a story to tell.
1413
01:03:36,033 --> 01:03:38,602
Something in their lives
touched by gun violence.
1414
01:03:38,635 --> 01:03:41,371
I think of the 22-year-old kid
that comes in,
1415
01:03:41,404 --> 01:03:43,040
where we really pretty much
gotta filet his chest
1416
01:03:43,074 --> 01:03:44,841
and rip him open
just to squeeze his heart
1417
01:03:44,875 --> 01:03:45,876
to make sure he keeps breathing.
1418
01:03:45,909 --> 01:03:47,477
That's gun violence to me.
1419
01:03:47,511 --> 01:03:48,945
And it gets to be difficult,
1420
01:03:48,980 --> 01:03:52,415
but we're kind of a support
for one another.
1421
01:03:52,449 --> 01:03:54,051
We see people here sometimes
1422
01:03:54,085 --> 01:03:55,719
more than we see
our own families.
1423
01:03:55,752 --> 01:03:58,455
It's an extended family.
1424
01:03:58,488 --> 01:04:01,658
I didn't really set out to be,
1425
01:04:01,691 --> 01:04:04,061
"Okay, I want to be a ER nurse."
1426
01:04:04,095 --> 01:04:06,830
Taking care of my parents
and my family
1427
01:04:06,863 --> 01:04:09,800
was kind of a natural
cultural thing to do,
1428
01:04:09,833 --> 01:04:12,869
and got inspired from there,
really.
1429
01:04:12,903 --> 01:04:14,972
My wife, she's an engineer.
1430
01:04:15,006 --> 01:04:17,874
Engineering is such
a male dominated field
1431
01:04:17,908 --> 01:04:20,544
and nursing is such
a female dominated field.
1432
01:04:20,577 --> 01:04:23,446
So we kind of chuckle at that
once in a while.
1433
01:04:26,516 --> 01:04:29,953
I've been doing night shift here
for close to six years now,
1434
01:04:29,987 --> 01:04:33,124
and it's very raw here, right?
1435
01:04:33,157 --> 01:04:35,892
It's very in your face.
1436
01:04:35,926 --> 01:04:39,529
The traumatic events,
the gunshot wounds.
1437
01:04:39,563 --> 01:04:42,632
You just accept it, really.
1438
01:04:42,666 --> 01:04:44,734
You, you have to accept it,
right?
1439
01:04:44,768 --> 01:04:46,070
You got a job to do.
1440
01:04:46,103 --> 01:04:48,039
That's a level one.
1441
01:04:48,072 --> 01:04:49,673
- Level one trauma.
- You're good, bro.
1442
01:04:49,706 --> 01:04:51,541
- Hey, hey, hey.
- Gotta take this off, okay?
1443
01:04:51,575 --> 01:04:53,410
We're going to take care
of you, okay?
1444
01:04:53,443 --> 01:04:54,477
Just lay down, just lay down.
1445
01:04:54,511 --> 01:04:57,414
- I got a kid, man.
- It's okay, you're good, bro.
1446
01:04:57,447 --> 01:04:59,416
- Any medication?
- No, no medication.
1447
01:04:59,449 --> 01:05:00,617
Do we have a blood pressure yet?
1448
01:05:00,650 --> 01:05:01,818
Yup, it's coming right now.
1449
01:05:01,852 --> 01:05:03,420
I got your wife,
she's all right.
1450
01:05:03,453 --> 01:05:04,721
Okay, she's safe,
and she's good.
1451
01:05:04,754 --> 01:05:06,890
He has a 14, right upper bicep.
1452
01:05:06,923 --> 01:05:08,092
When was your last tetanus shot?
1453
01:05:08,125 --> 01:05:09,759
I don't know.
1454
01:05:09,793 --> 01:05:11,661
I'm just in panic mode,
that's all.
1455
01:05:11,695 --> 01:05:12,997
You're doing real good, okay?
1456
01:05:13,030 --> 01:05:14,798
- How many kids you got, man?
- One.
1457
01:05:14,831 --> 01:05:16,533
- Girl, boy?
- A girl.
1458
01:05:16,566 --> 01:05:18,468
- Nice, man, what's her name?
- Allison.
1459
01:05:18,501 --> 01:05:20,770
Most of the individuals
that come here,
1460
01:05:20,804 --> 01:05:22,974
they really need someone
just to listen to them,
1461
01:05:23,007 --> 01:05:24,674
and make decisions from there.
1462
01:05:24,708 --> 01:05:26,476
Because a lot of times
what you see on paper
1463
01:05:26,509 --> 01:05:28,411
is not what you're walking
into that room.
1464
01:05:28,445 --> 01:05:29,981
Ahhh.
1465
01:05:30,014 --> 01:05:32,116
Pain meds and some antibiotics
going in, okay?
1466
01:05:32,149 --> 01:05:33,184
- Okay.
- You're doing a good job.
1467
01:05:33,217 --> 01:05:35,619
- Doing good, man.
- I just wanna know if I'm okay.
1468
01:05:35,652 --> 01:05:37,554
You're doing okay,
are you a little cold?
1469
01:05:37,587 --> 01:05:38,755
Would you like
some warm blankets?
1470
01:05:38,788 --> 01:05:39,957
- So scared.
- Okay.
1471
01:05:39,991 --> 01:05:41,858
We gotta get a chest x-ray
from you, okay?
1472
01:05:41,892 --> 01:05:43,526
- Okay.
- Try not to slide down.
1473
01:05:43,560 --> 01:05:44,828
My name's Renee, that's Katie.
1474
01:05:44,861 --> 01:05:47,064
We're going to be taking
your x-rays.
1475
01:05:47,098 --> 01:05:48,798
I gotta give you some
pain medicine though, okay?
1476
01:05:48,832 --> 01:05:50,567
- I'm just scared, I'm sorry.
- I understand.
1477
01:05:50,600 --> 01:05:51,835
I just wanna know if I'm okay.
1478
01:05:51,868 --> 01:05:53,070
You're doing very well
right now.
1479
01:05:53,104 --> 01:05:54,171
We just want to make sure that
1480
01:05:54,205 --> 01:05:56,506
there's no internal bleeding
going on, that's all.
1481
01:05:56,539 --> 01:05:57,440
Okay.
1482
01:05:57,474 --> 01:05:59,043
You're gonna see your kid again,
I promise.
1483
01:05:59,076 --> 01:06:00,644
- Okay?
- Most definitely, man.
1484
01:06:00,677 --> 01:06:02,980
- Most definitely.
- Okay.
1485
01:06:03,014 --> 01:06:04,781
X-ray.
1486
01:06:04,814 --> 01:06:06,816
I lost my parents
at a young age.
1487
01:06:06,850 --> 01:06:08,618
My mama to cancer.
1488
01:06:08,652 --> 01:06:11,521
My daddy was, was murdered.
1489
01:06:11,554 --> 01:06:14,891
He got robbed, somebody shot him
and killed him.
1490
01:06:14,925 --> 01:06:16,793
I just can't believe this
happened to me.
1491
01:06:16,826 --> 01:06:18,062
Hey, what happened?
1492
01:06:18,095 --> 01:06:20,864
All I know is a fight broke out,
and I was just trying to leave.
1493
01:06:20,897 --> 01:06:21,698
It was a bunch of people.
1494
01:06:21,731 --> 01:06:22,666
Wanna give me
a setup real quick?
1495
01:06:22,699 --> 01:06:25,102
I just... when I heard the shot,
I just fell,
1496
01:06:25,136 --> 01:06:28,239
and I was like... I noticed,
I'm like, "It's me, I'm shot,"
1497
01:06:28,272 --> 01:06:30,975
and I just got up.
1498
01:06:31,008 --> 01:06:33,110
I started checking myself,
'cause when I heard the gunshot
1499
01:06:33,144 --> 01:06:35,545
I just fell, you know,
got low to the ground.
1500
01:06:35,578 --> 01:06:37,248
Saw the blood on my hand.
1501
01:06:37,281 --> 01:06:40,117
I'm like, "I'm shot."
1502
01:06:40,151 --> 01:06:41,118
We want to make sure
you don't get
1503
01:06:41,152 --> 01:06:43,054
any nasty infections, all right?
1504
01:06:43,087 --> 01:06:45,488
I got you,
I'm right here for you.
1505
01:06:45,522 --> 01:06:47,058
We don't close these up, okay?
1506
01:06:47,091 --> 01:06:48,993
We just clean 'em out real good.
1507
01:06:49,026 --> 01:06:51,895
Long as I know I'm gonna see
my daughter again, I'm okay.
1508
01:06:51,928 --> 01:06:55,632
I gotta see her turn 18,
I got to.
1509
01:06:55,665 --> 01:06:57,867
So I'll get you cleaned up,
I'll get you some fresh sheets.
1510
01:06:57,901 --> 01:06:59,636
Make you look presentable
so your girl can come in here
1511
01:06:59,669 --> 01:07:00,972
to see you, okay?
1512
01:07:01,005 --> 01:07:02,872
- Okay.
- All right.
1513
01:07:05,542 --> 01:07:07,777
You ask me about how
to fix gun violence.
1514
01:07:07,811 --> 01:07:10,047
I don't, I don't even know
where to begin.
1515
01:07:10,081 --> 01:07:13,017
Everything you see in the news
today, you get in this ER.
1516
01:07:13,050 --> 01:07:15,186
But we're not just
a reflecting mirror.
1517
01:07:15,219 --> 01:07:17,520
There's deeper issues
in the community
1518
01:07:17,554 --> 01:07:18,922
that have to be dealt with,
1519
01:07:18,956 --> 01:07:23,027
and it starts with the ER
being a bridge.
1520
01:07:25,795 --> 01:07:28,032
Sometimes change
comes out of necessity.
1521
01:07:28,065 --> 01:07:29,866
And I think more and more,
1522
01:07:29,899 --> 01:07:31,668
our leadership
are really listening
1523
01:07:31,701 --> 01:07:34,038
to the emergency nurses to
find out what their needs are
1524
01:07:34,071 --> 01:07:36,606
so that they can better serve
their patients.
1525
01:07:36,639 --> 01:07:40,777
Nurses have to find a way
to have their voice heard.
1526
01:07:40,810 --> 01:07:43,280
Welcome, everyone,
to the Nurse Practitioner Show
1527
01:07:43,314 --> 01:07:44,814
on Doctor Radio.
1528
01:07:44,848 --> 01:07:48,718
I am really excited
to have you join me today.
1529
01:07:48,752 --> 01:07:52,323
We're gonna be talking about
emergency nursing.
1530
01:07:52,356 --> 01:07:53,958
We have a call already,
1531
01:07:53,991 --> 01:07:56,559
so I wanna jump to the phone
to Dana.
1532
01:07:56,593 --> 01:08:00,097
Hello, so many years ago,
I started as a paramedic
1533
01:08:00,131 --> 01:08:02,166
and I noticed
that the population
1534
01:08:02,199 --> 01:08:04,268
does not truly understand
1535
01:08:04,301 --> 01:08:07,004
the real purpose
of the emergency department.
1536
01:08:07,038 --> 01:08:08,938
The hospital is bombarded
with things
1537
01:08:08,973 --> 01:08:11,641
that really could've been taken
care of at the doctor's office.
1538
01:08:11,674 --> 01:08:14,178
I think one of the mandates
of any nurse,
1539
01:08:14,211 --> 01:08:15,879
quite honestly, is education.
1540
01:08:15,912 --> 01:08:18,182
When our patients
are lucky enough to go home,
1541
01:08:18,215 --> 01:08:20,251
it is really our responsibility
to ensure that
1542
01:08:20,284 --> 01:08:21,885
they know how to care
for themselves
1543
01:08:21,918 --> 01:08:23,320
or their family member at home.
1544
01:08:23,354 --> 01:08:25,722
But the other reality too
is that patients and families
1545
01:08:25,755 --> 01:08:27,791
do not have primary healthcare
in the community.
1546
01:08:27,824 --> 01:08:29,093
They don't have insurance.
1547
01:08:29,126 --> 01:08:30,860
Sometimes it is
the emergency department
1548
01:08:30,894 --> 01:08:33,696
that's the only place that
they can go to receive care.
1549
01:08:33,730 --> 01:08:36,833
Our communities are struggling,
our people are struggling.
1550
01:08:36,866 --> 01:08:38,868
I think it comes down
to soliciting
1551
01:08:38,902 --> 01:08:40,104
the leaders in our communities,
1552
01:08:40,137 --> 01:08:41,905
and really insisting
that there is adequate
1553
01:08:41,938 --> 01:08:44,975
health insurance for all.
1554
01:08:45,009 --> 01:08:47,144
Patients are so sick
by the time they get to us
1555
01:08:47,178 --> 01:08:49,313
that we are just
chasing our tail.
1556
01:08:49,346 --> 01:08:51,115
If we could have caught them
in the community
1557
01:08:51,148 --> 01:08:52,983
with resources and support,
1558
01:08:53,017 --> 01:08:54,651
then we would have
been able to avoid
1559
01:08:54,684 --> 01:08:55,752
this visit to
the emergency department,
1560
01:08:55,785 --> 01:08:58,022
and probably
a hospital admission.
1561
01:08:58,055 --> 01:09:01,025
We see everybody,
with or without insurance.
1562
01:09:01,058 --> 01:09:02,725
Whether it is that skinned knee,
1563
01:09:02,759 --> 01:09:04,894
because the mom and dad don't
know quite what to do with it,
1564
01:09:04,928 --> 01:09:06,363
or whether it's that person
in their last moments
1565
01:09:06,397 --> 01:09:08,399
of living with cancer.
1566
01:09:08,432 --> 01:09:10,067
We are kind of the catchall
for people
1567
01:09:10,101 --> 01:09:12,902
who have nowhere else to go.
1568
01:09:12,936 --> 01:09:14,972
I don't know that society
really understands
1569
01:09:15,005 --> 01:09:17,041
what we're seeing,
what we're experiencing.
1570
01:09:17,074 --> 01:09:18,675
But I think if people did,
1571
01:09:18,708 --> 01:09:20,844
much more attention
would be paid
1572
01:09:20,877 --> 01:09:24,614
to these huge dilemmas
that our society's facing.
1573
01:09:47,371 --> 01:09:50,207
What we have been through
has been extremely trying.
1574
01:09:50,241 --> 01:09:51,808
We have seen so much suffering.
1575
01:09:51,841 --> 01:09:54,145
We have seen so much death.
1576
01:09:54,178 --> 01:09:56,679
I know I've been
very distracted.
1577
01:09:56,713 --> 01:09:59,450
I think that's the easiest way
to describe it.
1578
01:09:59,483 --> 01:10:01,385
Distracted by what we've seen
throughout the day
1579
01:10:01,418 --> 01:10:05,089
and my worry about what
the next day is gonna bring.
1580
01:10:05,122 --> 01:10:07,291
How much worse can this get?
1581
01:10:12,096 --> 01:10:13,964
There has to be
better solutions.
1582
01:10:13,998 --> 01:10:15,865
We need a little bit
of an overarching umbrella
1583
01:10:15,899 --> 01:10:18,735
to guide us through
these terrible, terrible
1584
01:10:18,768 --> 01:10:21,438
and challenging events.
1585
01:10:21,472 --> 01:10:23,773
I just think that
we have to be open
1586
01:10:23,806 --> 01:10:27,011
to looking outside
of what the structure
1587
01:10:27,044 --> 01:10:28,112
and the framework has been
1588
01:10:28,145 --> 01:10:29,812
traditionally in this country,
1589
01:10:29,846 --> 01:10:33,217
because it's not working
and COVID just amplified
1590
01:10:33,250 --> 01:10:35,052
where it doesn't work.
1591
01:10:37,454 --> 01:10:39,356
If you have not told
Maria or Cat
1592
01:10:39,390 --> 01:10:41,058
what the size of your masks are,
1593
01:10:41,091 --> 01:10:42,459
I know there's a list
going around.
1594
01:10:42,493 --> 01:10:44,761
There's a variety of brands
of N95s
1595
01:10:44,794 --> 01:10:46,063
and you need to make sure
whatever brand
1596
01:10:46,096 --> 01:10:47,931
you're wearing today
fits you properly.
1597
01:10:47,965 --> 01:10:49,866
Just a few huddle topics.
1598
01:10:49,899 --> 01:10:52,369
What's been happening
is body bags are ripping
1599
01:10:52,403 --> 01:10:56,906
and if they have bile or any
secretions from the patient,
1600
01:10:56,940 --> 01:11:00,411
the security officers
will get contaminated.
1601
01:11:00,444 --> 01:11:02,413
So please make sure
all the belongings
1602
01:11:02,446 --> 01:11:04,348
are attached to the bag.
1603
01:11:04,381 --> 01:11:06,350
When we first started
encountering patients
1604
01:11:06,383 --> 01:11:09,119
who were having COVID-like
symptoms, you know,
1605
01:11:09,153 --> 01:11:11,088
we did our best to get them
into the department.
1606
01:11:11,121 --> 01:11:13,057
We were trying to make sure
they were consolidated,
1607
01:11:13,090 --> 01:11:16,026
that they were in one place
or in isolation rooms.
1608
01:11:18,362 --> 01:11:22,132
When it first hit me
was when we received a patient,
1609
01:11:22,166 --> 01:11:23,866
she was demanding oxygen.
1610
01:11:23,900 --> 01:11:26,237
"I can't breathe,
I can't breathe,"
1611
01:11:26,270 --> 01:11:29,306
and she just snatched
the oxygen from me.
1612
01:11:29,340 --> 01:11:32,042
A couple minutes later
we intubated her,
1613
01:11:32,076 --> 01:11:33,510
then we did the chest x-ray
1614
01:11:33,544 --> 01:11:36,447
and very suspicious
for the COVID virus.
1615
01:11:36,480 --> 01:11:38,215
And then it was like a tsunami.
1616
01:11:38,249 --> 01:11:40,883
It just totally took over.
1617
01:11:40,917 --> 01:11:43,254
People were just desperately
trying to save lives,
1618
01:11:43,287 --> 01:11:45,222
desperately trying
to keep patients going.
1619
01:11:45,256 --> 01:11:48,125
For us at St. Joe's, you know,
we serve our community
1620
01:11:48,158 --> 01:11:50,860
and our community is the type
of community that was hit hard,
1621
01:11:50,893 --> 01:11:53,830
and the people that we saw here
were sick,
1622
01:11:53,863 --> 01:11:56,567
sicker than anything
I've ever seen.
1623
01:11:56,600 --> 01:12:00,571
All our rooms were filled,
and that was when we converted
1624
01:12:00,604 --> 01:12:04,807
a whole waiting room
into a treatment space.
1625
01:12:04,841 --> 01:12:09,246
I remembered how it is to work
in a provincial hospital.
1626
01:12:09,280 --> 01:12:12,116
Back home,
patients would be everywhere
1627
01:12:12,149 --> 01:12:14,151
and it would be in
a basketball court.
1628
01:12:14,184 --> 01:12:18,921
So I used that as a form
of guidance for me.
1629
01:12:18,956 --> 01:12:21,058
The fear when it just
didn't seem like anything
1630
01:12:21,091 --> 01:12:22,892
would stabilize these patients.
1631
01:12:22,925 --> 01:12:26,130
Pumps of six, seven, eight
medications running at a time.
1632
01:12:26,163 --> 01:12:29,300
We just did not understand
at the beginning
1633
01:12:29,333 --> 01:12:32,536
how it would weave through
a person's body.
1634
01:12:32,569 --> 01:12:37,074
You know, we spent 16-hour days,
seven days a week.
1635
01:12:37,107 --> 01:12:40,978
We didn't even have time
to think or decompress.
1636
01:12:41,011 --> 01:12:44,381
So I would drive home
and I would stay in my car
1637
01:12:44,415 --> 01:12:46,216
for 30, 40 minutes
1638
01:12:46,250 --> 01:12:48,352
not entering my house
1639
01:12:48,385 --> 01:12:52,156
because I couldn't face
my children.
1640
01:12:52,189 --> 01:12:55,559
I was unprepared
to face my children.
1641
01:12:55,592 --> 01:12:59,596
I knew that if I carried
what I saw,
1642
01:12:59,630 --> 01:13:01,265
the death that I saw,
1643
01:13:01,298 --> 01:13:03,434
it was unfair to put that burden
1644
01:13:03,467 --> 01:13:06,136
on my kids or my husband.
1645
01:13:06,170 --> 01:13:08,372
And then in the morning,
1646
01:13:08,405 --> 01:13:11,141
I knew I'd have to come back in
1647
01:13:11,175 --> 01:13:12,643
and see my staff
1648
01:13:12,676 --> 01:13:16,647
who is already worn down.
1649
01:13:16,680 --> 01:13:19,483
I don't know if their morale
has gone down,
1650
01:13:19,516 --> 01:13:23,120
but then when I see them
conversing with a patient,
1651
01:13:23,153 --> 01:13:25,356
loving them
in the best possible way
1652
01:13:25,389 --> 01:13:28,158
because their families
are not there,
1653
01:13:28,192 --> 01:13:32,229
that, to me, is like my reason
for being here.
1654
01:13:35,999 --> 01:13:37,468
I've been a nurse for 30 years,
1655
01:13:37,501 --> 01:13:41,004
but I've never,
1656
01:13:41,038 --> 01:13:44,441
I've never had
like five patients die
1657
01:13:44,475 --> 01:13:47,944
on the same day.
1658
01:13:47,978 --> 01:13:52,082
There was this one time
that a patient's family
1659
01:13:52,116 --> 01:13:53,684
brought him in because
he couldn't breathe
1660
01:13:53,717 --> 01:13:55,952
and he became unresponsive.
1661
01:13:55,986 --> 01:13:59,189
Our staff began CPR on him.
1662
01:13:59,223 --> 01:14:01,592
So I asked our director,
1663
01:14:01,625 --> 01:14:03,560
"The family's right outside
in the car.
1664
01:14:03,594 --> 01:14:05,195
Can they come in?"
1665
01:14:05,229 --> 01:14:08,898
And she told me, "Unfortunately,
they cannot come in."
1666
01:14:17,274 --> 01:14:20,644
So...
1667
01:14:20,677 --> 01:14:23,046
There was no one there for him.
1668
01:14:28,218 --> 01:14:30,621
I was there for many of them.
1669
01:14:36,059 --> 01:14:39,329
I cried many days.
1670
01:14:39,363 --> 01:14:42,099
I cried many days, 'cause...
1671
01:14:45,769 --> 01:14:48,071
'Cause their families
weren't there.
1672
01:14:48,105 --> 01:14:50,641
So I felt...
1673
01:14:50,674 --> 01:14:53,544
I knew how the family
would feel.
1674
01:15:03,687 --> 01:15:06,056
What I want the families to know
more than anything
1675
01:15:06,089 --> 01:15:07,691
is their loved one wasn't alone,
1676
01:15:07,724 --> 01:15:10,160
that I sat with them
and held their hand
1677
01:15:10,194 --> 01:15:12,129
and we were caring for them
and we were present,
1678
01:15:12,162 --> 01:15:14,264
all of us were, all of us were.
1679
01:15:14,298 --> 01:15:17,434
And so I hope family members
can take some comfort in that,
1680
01:15:17,468 --> 01:15:19,436
knowing that the people
they loved were never alone,
1681
01:15:19,470 --> 01:15:21,538
that we were there for them.
1682
01:15:33,250 --> 01:15:34,785
At the end of the day,
I have to remind myself,
1683
01:15:34,818 --> 01:15:36,720
"Be present, be here, be now."
1684
01:15:36,753 --> 01:15:39,022
Particularly when that question
always comes back,
1685
01:15:39,056 --> 01:15:40,257
"Mom, what happened
at work today?
1686
01:15:40,290 --> 01:15:41,725
What'd you do?"
1687
01:15:46,530 --> 01:15:49,433
And this, um,
1688
01:15:49,466 --> 01:15:51,235
I'm not talking to them about.
1689
01:15:51,268 --> 01:15:53,270
They know what
we're dealing with,
1690
01:15:53,303 --> 01:15:55,205
but I try to shelter them
a little bit,
1691
01:15:55,239 --> 01:15:57,441
because it's...
1692
01:15:57,474 --> 01:15:59,510
I don't want them to know
how bad it's been.
1693
01:15:59,543 --> 01:16:01,645
I don't want them to know.
1694
01:16:03,714 --> 01:16:07,518
You know, you can't explain
to your kid
1695
01:16:07,551 --> 01:16:09,052
what it's like
to see somebody die
1696
01:16:09,086 --> 01:16:11,788
or to see somebody so distressed
or in agony.
1697
01:16:11,822 --> 01:16:14,291
And, you know,
to hold somebody's hand
1698
01:16:14,324 --> 01:16:15,292
as their heart stops beating
1699
01:16:15,325 --> 01:16:18,262
is a very hard thing to describe
to anybody else.
1700
01:16:28,872 --> 01:16:31,308
That feeling of being
completely overwhelmed
1701
01:16:31,341 --> 01:16:33,143
and people
needing you desperately
1702
01:16:33,176 --> 01:16:35,212
and not knowing
when to stop your day
1703
01:16:35,245 --> 01:16:37,714
and just emotionally
being in absolute turmoil.
1704
01:16:39,650 --> 01:16:41,318
You know, it's really...
it's just below the surface
1705
01:16:41,351 --> 01:16:45,188
a fair bit of the time,
yeah, so.
1706
01:16:45,222 --> 01:16:47,090
It is a very, very strange time.
1707
01:16:47,124 --> 01:16:49,092
A lot of questions,
a lot of uncertainty,
1708
01:16:49,126 --> 01:16:50,427
because every week
is a new story
1709
01:16:50,460 --> 01:16:51,862
that we're trying to unfold.
1710
01:16:51,895 --> 01:16:53,764
Right now we feel like
we've got a cliffhanger,
1711
01:16:53,797 --> 01:16:57,401
because we don't know what
the next phase is gonna bring.
1712
01:17:01,471 --> 01:17:03,440
I think that the mental wear
and tear on us
1713
01:17:03,473 --> 01:17:06,276
from the past weeks
has been enormous,
1714
01:17:06,310 --> 01:17:08,111
and I wonder about what will be
1715
01:17:08,145 --> 01:17:09,546
the long-term repercussions
for us.
1716
01:17:09,580 --> 01:17:11,281
Will we have more
post-traumatic stress?
1717
01:17:11,315 --> 01:17:13,450
Will there be more levels
of higher anxiety,
1718
01:17:13,483 --> 01:17:15,285
higher amounts of depression?
1719
01:17:15,319 --> 01:17:19,156
When you have a nurse
in their assignment for one day
1720
01:17:19,189 --> 01:17:21,391
have four patients die
in a 12-hour period,
1721
01:17:21,425 --> 01:17:23,293
it does take its toll.
1722
01:17:23,327 --> 01:17:25,228
And yet, if you were
to ask the nurse
1723
01:17:25,262 --> 01:17:26,563
would they be anywhere else,
they'd probably say,
1724
01:17:26,597 --> 01:17:27,864
"No, I'd be right here.
1725
01:17:27,898 --> 01:17:30,334
This is my job,
this is what I'm meant to do."