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In the beginning, I was like, "It'll be okay,"
trying to reassure myself and my family.
But then, as the days grew longer,
it was very clear:
No, it wasn't okay
and it was gonna get worse.
I found that over the past weeks that
I've needed this moment in the morning
just to be quiet
and to think about what's happening.
You know, you take a little moment like,
it's okay to cry right now, 'cause, you know,
my kids aren't gonna see me and be upset, but also,
my colleagues aren't gonna see me,
because I feel like I have to be strong at work too,
for them and for me.
So it's nice to be home and to be
a little bit vulnerable sometimes,
and that's okay, 'cause, uh...
you know, I think everybody has lived through a lot,
no matter where you are.
So it's a precious moment in the morning to be quiet
and to have a few minutes just by myself.
You always know in the back of your mind
something terrible could happen.
A terrible event that you might be involved in
as a healthcare professional,
I think that looms in our minds, we know that.
And yet, everything that's happened has been
sort of surreal.
Even though we knew that COVID was
in other parts of the world,
I don't know that we really understood
how overwhelming this was going to be.
As emergency nurses, we are on the front line,
and when a patient arrives in the hospital,
we're gonna do everything we can
in this moment of time to save their lives.
What brings you to the hospital today?
How's your pain now, on a scale of 0 to 10?
New patient, room 12,
new triage patient, room 12.
Do you feel like you're having difficulty breathing?
Rate's like 25.
126 over 89, pulse 160.
Truly, your ability to care for another
in their greatest moment of need
is in an emergency department.
I have three children, and they'll say,
"Mom, what did you do at work today?"
And I'll say, "Well...
took care of some patients."
I can't explain to them that I had a 46-year-old male
that came in with a gunshot wound to the head.
You know, I can't explain to them
that I held a patient's face against my hand,
and she leaned into me as she was dying.
It's about as real-life as you get.
We are the mirror of society.
If there's an Ebola scare,
if there's a bus that turns over,
if there's the flu season, where do they go?
They come here. We are the safety net.
The trauma surgeon is saying, "Get the patient to OR, now."
The care is not based on whether you're insured or not.
We're the ones that connect with the patients first,
and then we're the ones that advocate for them.
A lot of stuff that comes in here,
you wish you don't see again.
The traumatic events, the gunshot wounds.
I walk in here,
and we'll have had another overdose death.
This opioid epidemic is a crisis.
There is no other place for them to turn,
and so they come to us.
I think most of us are very drawn to the adrenaline.
We're drawn to the fast pace.
We're drawn to the unexpected.
Either it fits your soul or it doesn't.
Emergency medicine's a very young specialty.
It didn't always exist.
Before, it was the accident ward.
The accident ward was really run by the nurses.
They pulled it all together.
You would come up and you would ring the doorbell
and the nurse would open up the door,
and you would hope they found a team
to take care of the issue.
Everybody says ER,
and technically, actually, it's an emergency department.
We're not just a little room anymore.
I'm very drawn to a large emergency department.
I was attracted to the trauma,
and when we moved to this area,
I'd been stalking St. Joseph's for three years,
'cause I really wanted to come to this hospital.
We are the third busiest emergency department...
freestanding emergency department in the U.S.
So on average, we see between 450 and 500 patients per day.
That's crazy busy.
Begum?
Hello there.
I'm here for translate.
Translate? My name is Kim, I'm one of the nurses.
What brings you in today?
It's like almost three months, right?
That finger, she can't even move,
and it hurts a lot.
A lot of what we do in emergency medicine
comes from the military.
Triage is exactly one of those things
that we've brought to the civilian world.
The triage nurse intercepts every single person
who's coming through the front door,
and that nurse, in our department,
she might see 100 patients in six hours.
All right, I'm just gonna check your blood pressure, okay?
Where in your back is the pain?
- Sciatica... - Sciatica.
...and...
My job is to look at the patient and say,
"Is this patient gonna die if I don't intervene
in the next 10 minutes?"
Who is the most sick, who's gonna use the most resources,
and what level of care does this patient need?
On a scale of 0 to 10,
how would you rate your pain right now?
- Eight. - An eight.
Okay, so you can have a seat back over there,
they're gonna call you from one of the back doors.
You take that with you, okay?
Is there a long wait?
Um, I can't say how long it's gonna be.
It's not too bad right now, though, okay?
I'm gonna do it right here.
You're gonna feel a big pinch, okay?
All right.
It happened so fast, just like,
soon as I hopped outta my truck,
the dog just came at me and bit me.
I've been having a pain
for, like, five... three days,
since Tuesday to now.
Since it's getting worse instead of getting better,
I came here to see what's going on.
All right, you ready?
Okay, you can go ahead and lie back.
We're just gonna put you on a cardiac monitor, okay?
It's not just the high-powered trauma,
it's not just about cardiac,
it's everything from your earache and your sore throat
to having a stroke.
Tech to the trauma room, tech to the trauma room!
Sorry, lot of things are gonna happen right now, okay?
- 132 on 98. - Open your eyes for me.
Can we just call for an EKG stat?
Gimme a good cardiac emergency,
a good respiratory emergency!
I am... I love that.
You know where you are right now?
In the hospital, okay.
Okay, what's wrong with this patient?
What do we need to do? What do they need immediately?
What do they need in the next hour?
Can you lift this arm up?
Okay, put it down.
All right, we'll call it a stroke code to make sure...
Lift up this leg.
Your attention, please.
Code stroke, emergency department,
code stroke, emergency department.
You're just constantly with one patient after the other,
and very seldom, it's something very simple.
Every patient has their own complicated story.
Rate's like 25.
I didn't start in the emergency department.
I never actually thought I would end up here.
I was a little nervous at first.
The turnover of patients,
the acuity of patients, I wasn't used to that,
and it just quickly became everything that I loved.
What happened?
Your mom died? I'm sorry to hear that.
You were drinkin' today?
You were trying to detox yourself?
Yeah.
When was the last time you drank?
Alcohol. It's always that.
I tried to detox on my own,
and I thought I was having a seizure.
Just... it's stupid.
I thought I could do it.
I got him... I got this one.
My name's Angel, I'm one of the techs, honey.
We're gonna do an EKG,
we're gonna take a look at your heart really fast,
- okay? - Are you gonna take blood too?
Oh yeah! All that good jazz.
I don't like hospitals too much.
Yeah. Well, after today, I'm done.
I'm too old for this.
Do you have any allergies to food or medicines?
No?
How tall are you?
Five... with heels, 5'2".
With heels? What about without heels?
When I was younger, I was sick
and in and out of the hospital a lot.
The nurses were just such a huge part of my life.
I never liked IVs.
There was one nurse that always was able to get my IVs,
and I wouldn't let anyone touch me but him.
Thanks for choosing me.
Oh, you're welcome!
My lucky day.
Night.
- It is your lucky night. - Yep.
You just missed me.
- I have to come back. - You just wanted
to come see me, yeah.
- I knew it. - I needed a fix.
What a pain in the neck am I.
You're not a pain in the neck.
Okay.
Your veins are really tiny, though.
They always have trouble.
My mom...
we both had such tiny veins.
Mm-hm.
Oh, you got it in?
I did! Look at that.
- Yeah, buddy. - Yeah, buddy!
- Was it the first shot? - First shot.
- Thank you, hon. - You're welcome.
The feeling that I had when the nurses took care of me?
That is what I wanted to...
that's what I want to do with somebody's life.
Dr. Shelty, dial 3225...
Patients allow nurses into their lives
in a way they wouldn't let anybody else.
We are given this window of opportunity
to care for them.
Do you have any medical problems that you know of?
Nope! Just depression.
So what happened today that brought you
to the emergency department?
I never thought about trying to commit suicide before,
and it wasn't really trying to commit suicide,
it was kinda just proving a point.
My dad kinda freaked out and that's why we're here.
Okay.
Are you still having these feelings now?
Not at all.
What about feelings of harming other people?
- No. - No?
Are you seeing or hearing anything that's not here?
Nope.
In general, emergency departments are not good venues
to care for somebody who is struggling with
a behavioral health issue.
A lot going on,
competing demands of other patients
that are really, really sick as well.
We often do not have enough physical beds
to accommodate their care needs,
and our nurses don't have probably enough training
in the care of this patient population.
There's many pieces to this puzzle.
I think we need more resources in the communities
so we can keep them out of hospital.
I mean, my arm is good.
All I wanna do is go home and sleep.
The emergency department is a safety net.
We catch them when they fall.
But we can't be their primary service provider.
There's got to be more for them.
The people in this community,
they don't have healthcare.
They don't have primary care physicians.
They don't have a psychiatrist who's gonna take care of them
in the community.
We are their primary healthcare,
and that is something that we're really seeing
in all of our emergency departments
across the U.S.
It's so much bigger than us here.
We're just the starting point.
One of the hardest challenges in Kentucky
that I've come to face
is the big lack of primary care,
and whether it's the patients don't have insurance
or there's not enough primary care providers,
we will prescribe a medication for a chronic disease,
and then we'll say, "Follow up,"
and then they're back in the ER in two weeks.
So it's kinda like we put Band-Aids on
a lot of the big issues that we can't fix.
We want to get people to feel better.
We want them to recover.
It is distressing to a lot of us
when patients come in day after day.
One of the very challenging parts is
seeing those same patients over and over again,
and keeping the smile, keeping the compassion,
and not judging.
I think a big problem is, people don't understand
the choices they make, how they impact their life.
A lot of times, they don't realize how sick they are.
They just know they just wanna go smoke,
and you're trying to let them know, like,
"If you go smoke,
you might just pass out and die out there."
We give them temporary solutions.
But there has to be other resources out there
for ongoing care in the community.
We have over 100 patients in the department,
at some times, and, you know, we have our fast track,
which is the small things that are going on,
and then you have super-sick patients
that are waiting in the waiting room,
and you're having to go out and say, "I'm sorry,
it's gonna be a little bit."
It's my job as an emergency care nurse
to take care of you no matter what,
and it's one patient every single time.
I think people think that being a nurse is
exciting, because you get to save lives,
you kind of think what the movies are.
"You're gonna marry a doctor" is a thing that everybody...
everybody says.
That's probably the opposite of what it actually is,
but for me, it's the meaningful relationships
that I've made.
- Any family? - Uh, son is on his way.
All right, thank you.
Hey, hon, my name's Michelle, I'm gonna be one of the nurses
- working with you, okay? - Okay.
There's gonna be lots of people in here.
We have to cut your shirt to make sure you don't have
anything broken, I'm sorry.
I hope these weren't your favorite clothes.
- Not hardly. - 'Kay, good.
I'm just gonna feel the pulse on your right foot, okay?
I'll try not to hurt you or move it.
Can you wiggle your toes?
Okay. Go ahead and pull.
Sorry, sweetie... okay.
Okay, we got it out, okay?
Does that feel a little bit better?
Whew! Okay.
What's hurting right now?
- The right hip? - Yeah.
Okay. I'm gonna give you some pain medication.
It should hopefully help with your leg.
- Yeah, and hurry up. - 'Kay! I'm giving it right now.
This should hopefully take the edge off
for them to take that x-ray, okay?
- Okay. - All right? I'll be back.
When you have those moments, those good moments,
it's something you'll never get anywhere else.
All right, hon, I got you the new warm ones, okay?
Okay.
- Does that feel better? - Yeah, that feels good.
At least that's a little warm.
I'm gonna pull these other ones down
so that the warms ones are next to your body.
It's like being in a cocoon.
- How's that? - That's good.
Is that better? Okay.
I had a patient that was here for a heart transplant,
and I asked, you know, "Do you need pain meds,
do you," you know, "do you need a blanket?
Like, what do you need right now?"
And he said, "Is there any way that I can get a card?"
And I was like, "Why do you need a card?"
And he said, "Well, it's our sixth anniversary,
wedding anniversary, and we're homeless,"
and his wife had been sleeping on the stretcher next to him,
and he said, "I always give her a card.
That's one thing that I always do."
So I got the time to run up to the gift shop
and I bought a card and I brought it down to him,
and he started crying.
You know, I wrote in the card for him,
'cause his hand was too weak to write.
And giving that to him and doing that for him was,
you know, something that you would never think
would be part of nursing.
You can't... I mean, nobody tells you that
at nursing school.
Did they give you pain meds?
- No. - Have they... no, they haven't
- done any of that? - No.
Okay. They just gave you the tetanus shot?
- Yes. - Okay.
All right. Lemme go check.
I was at the shop.
I was filling one of the tires up.
It blew up and the rim flew off
and it hurt... hit my hand.
Is your pain a little bit better?
Okay, good. I'll be back.
They're ready for you.
X-ray, yeah.
And I've heard of this happening with tires,
I just never seen it happen.
Got the first... what do they say, front-row seats?
Usually, I don't go to the hospital.
Even if it's bad...
I didn't even wanna come for this.
Yeah, insurance is... it's too high, you know?
It is too high.
That's why you can't get sick or hurt, you know?
You're better off to try to patch it yourself.
If this gets all fixed up, bandaged, everything,
maybe it costs me three grand, four grand.
It's still cheaper to pay the medical bill
than it is to pay for insurance.
It's just how we are in the U.S.,
you know, we don't have enough insurance for everybody,
and if you do, that doesn't mean
that you don't have a $100 co-pay when you come to the ER,
and that's something that a lot of people can't afford.
Right here... 79, guys.
Sometimes, you'll see 15 to 20 patients in one night,
and there's a very, very fine line
between getting to do everything quickly,
because you need to do everything quickly,
there's time frames that we need to meet,
but at the same time,
you don't wanna make the patient feel like
I don't have time for you, I'm too busy.
And sometimes, it's really hard to do,
especially when you have a patient that's upset.
They're hurting, they're grumpy,
not wanting to be in the hospital...
like, who wants to be at the hospital?
Mm-hm, next one down.
Can you wiggle your toes for me one more time?
Is that good right there,
or do you want the pillow a little higher?
Okay.
Okay. How's that?
That's okay? Okay.
What hurts the most right now, your head?
No, my... my leg.
Your leg... the left leg?
- Yeah. - Okay.
Do you have somebody that's taking care
of your children right now?
Do you know her phone number, can I call her?
They'll have to make a plan alongside medicine
on whether or not they wanna do surgery
and when to do surgery.
And hopefully, we'll get you up and moving
pretty quickly after surgery
and go from there.
All right, sir.
Little poke.
So if you spend a little time in Kentucky,
there's... I call them Kentucky roads.
These roads are just narrow roads,
one car goes one way each way,
and they swerve around.
Sometimes you have four or five ambulances that come
that were all motorcycle accidents, car accidents.
They're all here at the same time.
Everybody ready? One, two, three.
You have any family members who are coming?
- I'm not sure. - Okay, have we...
did they contact anybody for you?
- Yeah. - They did? Okay.
On my way back home,
a deer darted in front of me
and I went through a metal pole
in the middle of about a ten-foot embankment
and hit into water.
What's your pain at, 0 to 10,
ten being the worst?
- It's ten. - Ten, okay.
They told me that I fractured my spine
or something like that.
The back surgery was so complex,
they couldn't handle it, so I had to come here.
Just try to hold still,
since you've had this back fracture, okay?
It just hurts so...
Push down for me. Pull up.
Good.
Okay.
I'm a first generation American here.
I was a refugee in Thailand after the Vietnam War.
Honey, I got some pain medicine for you, okay?
I'm the only one in my whole family
who has finished high school
gone on to get a college degree,
so, you know,
all my little nieces and nephews
have someone to look up to.
I'm the divisional charge nurse on the weekends.
That's when all the action happens.
People in the general public don't know
what we're going through as emergency nurses.
You see these very intense situations,
and it eats away at you.
Emergency nurses are known
to not really talk about their feelings
when something sad happens.
I'm gonna get emotional!
I remember one time, I had a six-week baby code,
and...
I had to hold it together, 'cause I was the team leader.
And I did, and the nurses came,
the other nurses that took care of the code.
We're crying, and I still held it together,
but when I got to my car, I lost it.
I just... just lost it.
And then you just kinda take a deep breath and... move on.
We had this patient that had a devastating head bleed
that he was gonna die from.
The family was there, it was beautiful,
you know, we had a pastor there, we just...
it was as perfect of a situation
as you could possibly have for a death,
if that makes sense.
I came back out and just started bawling,
and I was so embarrassed.
And I remember my preceptor saying, "You'll be okay.
The fact that this makes you cry,
you'll be okay."
I had a child who was shot by her uncle,
who was 12 years old.
He just received a brand-new shotgun
as a Christmas gift.
That day, I helped care for three children
who had passed away.
I helped clean up the body,
prepare the body for the parents to come see the children.
I provided care to one child who
was left in the care of a boyfriend,
'cause the mother had to go work.
The child was shaken to death and beaten to death.
For the next two weeks, I went home,
I woke up having nightmares.
You know, as a nurse,
that has the impact and the struggle
that everybody deals with.
When you're at work, you're at work,
and when you leave, you try to leave it at work.
'Cause the things that we're seeing
and the things that we're dealing with sometimes,
if you bring it home with you, it's exhausting.
You're not gonna be able to go home
and explain to your mom or your dad
or your family member
exactly what you did today, they're not gonna get it.
It's very hard to explain to anybody else what we do.
Um, it just doesn't seem imaginable sometimes, does it?
I expect my staff to call me if they're having a tough day
and they've had something just horrendous
that they've had to go through,
because I want them to verbalize it
and work through it if they need to.
We all care for each other.
Nurses who work in these high-intensity areas,
if we don't find ways of maintaining
our own balance, of being resilient,
uh, nurses will burn out in these areas very quickly.
It's hard, it's tough nursing.
We are in the beautiful state of Vermont.
The geographic nature of our state
proves challenging.
We're the only level one trauma center in Vermont,
so we do see a fair amount of trauma.
I remember being a young nurse
and loving anything that just was, you know,
highly acute.
The traumas, and the GI bleeds,
and the cardiac arrests and those kinds of patients
were the ones that I gravitated to,
that I just, ohh, couldn't wait to get my hands into,
literally, sometimes.
Now, I'm gravitating a little bit more towards
the little old lady who has the dwindles
and who needs some loving.
No day is the same.
It's a wild lens to look at the world through.
You know, you can have a baby born one minute
and a code come in the next minute.
The whole spectrum, from life to death,
and everything in between.
There are some days that really blow my socks off, though.
The high that you get when you start somebody's heart?
That's what carries you through.
Lie straight back.
You can leave your shoes on if you'd like, or...
- No, very comfortable. - There you go.
The ER sits in a really interesting place
between inpatient and outpatient medicine.
How long have you been short of breath for?
Couple of days.
We're involved in sorting out the mystery
of what is wrong.
Have you had any recent medication changes?
Uh... yeah, bronchodilator for the...
- Started a new one? - Yeah, about two weeks ago,
$160 co-pay is a little steep,
so it made me choose an alternate medication,
and I've had some bouts with bronchitis before,
but this one was at another level.
Well, after last night,
I was happy to wake up this morning.
- It was pretty brutal. - Mm-hm.
I don't think there's much scarier in this world
than not being able to breathe.
We're gonna make sure that you can get up and walk around
today before you leave here.
Excellent.
- Sounds good, thank you. - You're welcome.
You cherish the times when people are
thankful and appreciative,
because over the 10 years I've been a nurse,
the environment has become more aggressive.
We have become a society of immediate gratification.
I think that has a lot to do with our technology.
The elderly generation is just very grateful
that they are being taken care of.
- Take your time and have a seat. - I can't move too fast.
That's a nice dressing, who put that together?
- Me and the wife. - Excellent.
Me and the wife.
She did most of it,
but I told her wrap it good and tight.
How'd you do this?
- Snow blower. - Aye yi yi yi yi!
Blower itself was in neutral,
put my hand in the chute and I thought it was off.
Oh!
There's a lot of why,
where you roll your eyes and go, "Really?
At what time did you ever think
that this was a good idea?
- Shouldn't have had my hand... - ..in there in the first place,
- yes, sir. - That's number one.
Probably gonna go for x-ray, 'cause they're gonna wanna see
what's going on underneath there.
You could pull that one right out.
No, let's not pull... we'll leave it in place for right now.
Having been in the game for a long time,
I have found that sitting and chatting
just with a patient,
stunning what you'll find out.
So what do you do for Christmas,
with grandchildren great-grandchildren,
- and great-greats? - Well, we send 'em
birthday cards and all that stuff.
So do you have any grandkids around
that could do the snow blowing for you?
- No. - All kinda like went "poof"?
- All over the place. - Go forth and multiply,
did they do that?
There's a huge difference as to what nursing was
31 years ago compared to now.
Patients stayed in the hospital for months,
where you actually became intimately acquainted
with their families,
and now, it's day surgery.
Hey, sir! They want me to bring you down
to x-ray your fingers. You're 92?
- Yes, sir. - You look fantastic.
- Well, thank you. - I'm super impressed.
All right, here we roll, my friend.
Where emergency nursing started, you know,
I think it progressed.
From Florence Nightingale,
probably got a huge boost with all the wars.
Look at MASH.
I bet you that Hot Lips Houlihan
wasn't called an emergency nurse in those days,
but that's damn well what she was doing.
Excuse me, darn well.
I'm Deb. I'd shake your hand, but...
We'll try that one!
So I'm gonna numb just the fingers, yeah.
And she's gonna make those fingers not hurt.
- She is going to? - Yes, sir.
Well, that'll be something.
I know... it burns.
Somewhere in the last 20 years,
the concept of pain has changed.
This nail will come off, probably.
Well, usually what we do,
we'd sew 'em in there,
and then usually, that'll push the old nail out.
- You doing okay? - Feeling better.
Excellent.
They just feel numb now, that's that.
Perfect.
- They feel numb. - Perfect.
- Numb is good. - Like when they're froze, right?
I remember when the pain scale came out.
Every nurse in this hospital had to go to a special session
where we were educated on the pain scale,
and any pain over 4 needs to be treated.
When you ask a patient in the emergency department,
"What's your pain?",
it's always 8 or 9.
I think a lot of times, people will think
that if they have a higher pain scale,
they'll get treated faster.
- Burns. - Burns? But tolerable?
Not too bad.
Don't look. We won't either.
I'm kidding.
You have to respect the patient.
It's not my perception, it is their perception.
You have an old Vermont farmer who's having a heart attack,
but you have to ask that pain scale.
"So, sir, on a scale from 0 to 10,
0 no pain, 10 the worst pain,
where are you right now?", as you're wheeling them,
you know, through the door.
"Oh, honey, it's just some heartburn, it's a 4,"
I'm like, geez.
We're gonna put some dressings on
that are gonna stay on for the next two days.
So you're off of dish duty, snow blowing duty.
I'll put in a special order, no more snow.
There.
I'll make a bow for the holidays for you.
Here, what we're gonna do is we're gonna put
the hurt hand in first.
Every time you take care of a patient,
you're trying to give something from yourself,
you're trying to give respect and give kindness
and your knowledge, you know.
And if it just is always taking, taking, taking, taking,
same as with anything in life,
then you run out of steam.
So a patient that stops you on the street and says,
"Oh, thank you so much,"
that's why I've been doing it for 31 years.
ER nurses have to know a little bit about...
about everything,
from OB, trauma, psychiatric health problems.
About everything, a little bit about everything.
Children are, you know... it's my focus,
and I feel like I'm helping them most
to be their voice.
I love the geriatric population.
They're sometimes the forgotten population,
so somebody has to advocate for them.
I just know the people we talk to,
people from different nationalities,
people from different cultures.
Lot of refugees in Dallas, and they come to see us.
It is a challenge with communication,
but I have these patients who see the world differently,
and I kind of get a glimpse into that.
Don't just think because you don't speak the language,
nobody is gonna help you.
I came from Peru,
I did not speak the language.
So, helping is like a gratitude to me.
I'm from Peru originally,
and I decided to come to the States.
People think sometimes that it's easy to do
that transition.
But when you get here, it's totally different.
You get here and you see, "I don't speak English.
What am I gonna do?
I don't have a car.
I don't have money."
- Okay. - Okay?
My mom used to work as a nurse assistant,
so I would look at her as a model.
I said, "She went to school, work, and take care of us?"
I can do it.
I enrolled to a school,
I finished my English,
and when I was ready, I got my license.
I've been working for Texas Health Dallas
for about 12 years.
One time, we had a patient who
was having a miscarriage.
And we saw the little fetus.
Arms and legs and head.
I can't imagine how she felt.
She only spoke also Spanish,
so we have to be sure she stopped bleeding,
you give the appropriate care, appropriate follow-up,
and, you know, giving support, emotional support,
is very important.
Twenty years old, her first baby, pregnant,
and now, she had a miscarriage,
so I said, "Oh my gosh, if nobody was there,
who will help... who's gonna help them?"
I'm glad I was there.
One, two, three.
Can you tell me your name?
- Jose. - Jose, do you know
what happened?
Yeah, I had a car accident.
Do you remember why you got in an accident?
- I don't know... - Can you raise this arm up?
Keep it up, don't let it fall, keep it up, up.
Touch my hand.
We have this stroke scale that we do.
Smile. Raise your eyebrows.
Raise your arms, raise your legs.
Tell me these words.
Move your toes... wiggle your toes.
Your toes.
This one, this leg.
One, two, three.
- Ready? - One, two, three.
He said he was driving okay and he made a U-turn
and he didn't see a car,
but he's having some double vision.
I wonder if the car came from the left side.
Maybe. Also, he's diabetic
and he has not been taking his medicines.
He ran out for three to five days.
I always tell my co-workers,
"I'm a qualified bi-lingual interpreter
for the hospital, and I'm here
if you need me to talk to anybody.
You want me to translate for consent, for surgery?
Any little thing, if you feel like you need me
to talk to face-to-face, personally, I'm here.
The patient has a right
to have their language to explain.
Ready now for the infusion.
- Okay? - Okay.
I'm trying always my best to take care of them,
but sometimes it's hard,
'cause you gotta... you gotta move to a new patient
that's coming, who's sicker, who's critical.
This is such a fast-paced environment.
There's seven in the lobby.
We have pending discharges, pending admits,
so we basically manage flow.
We're the epicenter of the ER,
so the goal is to minimize our wait times,
our ED wait times.
And people can sometimes feel herded,
like, you know, cattle, you know,
you're moving them along,
so you still have to remember to treat the person
like a human being, that...
that you have to care.
It's not that we're
desensitized to what's going on.
'Cause I've cried with parents,
I've cried with patients,
but you just know that that's what you thrive on,
that's what you're... you're there to do.
We have varied roles in the ED,
so I'll do charge, and I'm also part of...
I do trauma, and I love it.
As soon as somebody says,
"There's a trauma coming in," it's like, your juices...
you get excited.
Because that's an opportunity to kind of save a life.
If he's got a fracture through the facet,
let's use the slide board
and let him come over gently, please.
All right, cross your arms, bud, we've got you.
One, two...
Let's get a pillow here.
Or a couple of blankets, maybe?
We're gonna get a second IV over here, sir.
I really chose to work in the ER
because of the variety of things I would see.
My last summer of college,
I was teaching English through conversation,
and one of my students was a Karenni refugee
who was teaching me about this cloth called a pakuma,
just a square cloth.
You can use it for many different reasons...
to wash, to wear as clothes.
And then he started casually telling me how
you use it as a tourniquet when your friend
steps on a land mine.
Or you can throw your child on your back
and wrap her up with that pakuma
and run away with her when your village is under attack.
And he was so casual about it, I... I was haunted, shocked by it.
I want to know what to do when terrible things happen.
Okay, sir, so right now, we got some fractures on you,
so you can't be moving your neck, okay?
That's why they gave you that collar.
Just hold real still for us.
You hurting anywhere?
It's a very vulnerable space
for people to be in the emergency room.
People come in physically hurt, emotionally hurt,
even people who wear a smile, they're hurt some way.
I just feel like sharing these emotions
and these stories to your loved ones sometimes,
it helps you to be stronger.
You know? To keep going.
Sometimes, we forget to say "I love you,"
or "Thank you for this, thank you for that."
'Cause you never know if you're going to see
your loved ones again.
Every day, you gotta be thankful.
Look at the sky and say, "What a beautiful morning."
We're lucky... to breathe.
To have food.
To come home and see your kids.
Yes.
Sometimes we have patients that really, really stick with us
and stories that probably will never, ever leave us,
and in one of the hospitals that I worked in,
we had a call from the pre-hospital crew
that a two-year-old in cardiac arrest was coming in.
And I remember as I kind of leaned down to him
that I caught a whiff of baby powder,
'cause he was still in a diaper,
and he was this beautiful little blonde boy.
Right after he arrived, his mother arrived,
and we really believe as nurses in family presence
during invasive procedures and resuscitation.
So we welcomed his mother into the room with us,
and the rule with family presence is you don't just
let somebody sit in the corner and watch what we're doing.
No, the mother or the father or the important person
in the patient's lives must have a person.
So I was the mom's person.
And we were doing CPR and everything that we could
to resuscitate this little boy.
And at the time when the child came in, I knew he was gone,
but we worked on this little boy for a very long time.
Unfortunately, we were not able to revive him.
I got the mom and I got her into the stretcher with the baby,
and I wrapped him in warm blankets
and I tucked him into her arms, and I said,
"You hold him, you hold him and you be with him now."
You know, as a team, you walk away and go,
"Ah, what just happened there?"
You know, could we have done anything else?
No, there was nothing we could've done.
We did the very best we could.
And you feel like, "Oh boy,
this was not what we were supposed to see today."
After we have a patient die in the emergency department,
we will do something called "the pause"
and we gather as a team around the bedside,
we cover the patient to make sure
that they are dignified and cared for,
we take a moment of silence to acknowledge their life
and to respect them.
It's not religious, it's not a prayer.
It is an acknowledgement of somebody's life
and respecting them as a person
and acknowledging them as a person.
It's a brief minute, but it helps us to stop
and reset and take a breath,
and then we say, "Thank you for everything you've done today.
You were this patient's best chance.
Let's move on with our day.
The next patient needs you."
I grew up just south of Des Moines, Iowa.
Raised on a small, small farm.
I was the dairy princess, three titles.
Woot, woot.
I remember like it was yesterday.
We pulled over and somebody helped me get my dad down
from the car and we started CPR on him
on the side of the road.
Nothing mattered, everything was just right here
trying to get my dad back,
and we get him to the ER,
and after two hours,
they got a heartbeat back,
but he was gone.
And so when my dad passed away,
right before they turned off the machines,
I told him that I would take care of my mom
and that he could go because it was gonna be okay.
I was in the ER the whole time as they were working on him,
and I just saw how hard they were doing everything,
and I was already a nurse at the time,
but I remember thinking, "This is so far
from what I could do.
I wanna do that."
You're just not feeling good at all, are ya?
It's basically like the same signs from last time.
The cough and the throwing up.
And last time he was diagnosed with just bronchitis?
Overall, he's just been diagnosed with bronchitis.
Okay.
All right, he's really wheezy.
See how he's breathing so much and it's really pulling in?
That means he's working really, really hard.
How long has he been doing this for?
I wanna say it's been just today.
Just today, perfect.
What time, like this morning or...
- Mm-hm. - Yeah, okay, it's okay.
We're gonna give him a breathing treatment, okay?
I know, honey, I know.
We'll get him okay.
All right, buddy.
We have that special mask with that extra special medicine
that goes in your lungs, okay?
- Can we do that, yeah? - Alrighty.
I'm just gonna go like this, okay?
Just hold it right there.
You take nice, big, deep breaths, pumpkin.
- Nice deep breaths. - Good job.
I know it's scary, I know it's scary,
but already his oxygen's better
and he's breathing better, okay?
We'll get him on the right stuff.
You are probably my best patient all day.
Did you know that?
Yeah, yeah?
Can I fist bump?
Ouch!
How'd you get so strong, huh?
When you have a patient where you as a nurse can identify
that they're struggling with something right now
and you can talk to them and be on their level,
eye to eye, the only difference between me and you
is that I'm on this side of the bed and you're on that side.
That's that human component that really...
it makes all the difference.
All right, one, two, three, young lady.
Just gonna draw the blood off so you don't have to
get poked again and then I'll flush it
and we'll have an IV site, okay?
I come from a big family.
There was 10 children.
We lived on a farm.
Bringing the cows in and milk them,
and feed the chickens, and you name it.
She's just tough.
I mean, she's a breast cancer survivor.
It's hard for her to accept care,
'cause she's always been the caregiver with eight kids.
She was always making sure all of us were taken care of.
That's what she does.
Years ago, it used to be... when we lived on the farm...
if somebody needed help, you just automatically
went and helped them and charged 'em nothing.
But then if you needed help back, they were there.
We have to be in this together.
We all have those same desires, aspirations,
frustrations and everything,
and when you can acknowledge that and be present with someone
and they realize they're not alone,
it can be life-changing.
Is it really sore on your leg?
- Yeah. - Yeah?
Okay, you take the door.
Got it, I'm here, I got ya.
Does this leg hurt more or does this leg hurt more?
This leg hurts more and it hurts from here to here?
- Yeah. - Okay.
So we're gonna draw a bunch of labs
and kinda go from there.
I'm gonna take another look here.
It's okay.
Should we sing a song?
Would that make it better?
Should we make it a country song?
Almost Heaven
West Virginia
Blue Ridge Mountains
Shenandoah River
Life is old there
Older than the trees
Blowin' like a breeze
Country roads
Take me home
To the place I belong
West Virginia
Mountain mama
Take me home
Country roads
I walk in the hospital and it smells right,
it feels right, the energy's good.
I see the nurses that are around me,
the physicians I work with, the team that's here,
and they're like a family and you feel like you're home.
In a very strange way you feel like you're home.
And so when you're here, it's almost like another life.
I am a clinical education specialist.
I train nurses, and I can tell very quickly
if someone is going to be successful here.
Okay, it's gonna be a busy night.
I remember being a new nurse and I look back now
and I realize how little I knew.
Open it up... now the way these...
blood can always be hung in here,
but you need to be on the lowest level.
You know, you push yourself to grow,
you push yourself to learn.
I have memories of some of those first patients I cared for.
We had a man that came in and he was gray, and sweating,
and panicked, and he had this horrible feeing in his chest.
And I remember throwing IVs in him.
It was a big step for me to be able to put IVs in very quickly
in those critical moments, and I remember I said,
"I've got the line in here," and the other nurse is like,
"I'm getting the fluids for you, hang on!"
But I had gotten it in so fast and I remember thinking,
"Oh, I can do this now."
And one of the nurses who was probably...
you know, probably my age now,
she looked at me, she said, "You'll be fine down here."
Now what are the things you think I'm looking for
to make sure that I can effectively
resuscitate a patient?
What am I looking for? What do you think?
- Enema bag. - An enema bag is one thing.
I laugh when I talk to my new nurses
and I tell them I've been a nurse
for longer than they have been alive.
I've certainly seen within the past five years
a change in what patients are presenting with.
One of the things that all of you are going to encounter
at some point in your practice here
is an opioid overdose.
The reality of the opioid epidemic,
it is all across the U.S.,
it is every race, every age group.
It is your 55-year-old grandmother,
it is your 12-year-old child in elementary school.
It is pervasive, opioids don't discriminate.
So one of the best tools that we have is the ability
to reverse an overdose using Narcan.
You need to be able to give it quickly.
So we use something called a MAD device, okay?
So if they are actually having an overdose,
you're probably already having to open their airway
because they're probably not breathing on their own.
Breathe normal.
I almost died today.
When I opened my eyes and I saw paramedics,
I didn't even really have any sense of where I was
or how I had sort of gotten to where I was.
But the by the grace of God, somebody saw me
and called them in.
My dad was diagnosed with multiple myeloma
and my mom had a stroke and a seizure
when I came home one day.
The oxys, more so than the pain aspect of things
or even getting high, it was emotionally numbing.
It got out of control, so I tried to stop
and that was when I started experiencing withdrawal.
That's like getting hit with a bomb.
I ended up going into a program, detoxing,
and I've been clean since.
Unfortunately, sort of back to square one.
It's a beast.
The success rates of keeping somebody clean,
it depends on having follow-up,
and otherwise, it's a revolving door, guys.
We had one patient that overdosed five times in one day
until finally we committed him,
because he was gonna kill himself.
I can't even imagine
what this would've done to my family.
I'm supposed to sort of try and be rock in this situation
when Mom and Dad are having tough times.
So, I'm very grateful for that,
that I'm still here.
You know, people don't wake up instantaneously from Narcan.
If it's IV, it'll be faster,
but the first thing you can say to them is,
"You almost died today, we just saved your life.
Are you ready for treatment?
Are you ready to get clean?"
And that's something we can help them with.
We have this idea called a warm hand-off
where we're not just sort of
sending somebody off on their own.
A warm hand-off means I'm handing you
to somebody else who's gonna continue your care.
Thirty-something-year-old male who was found in his car today.
If someone has an overdose, we have the opportunity
to have a counselor, who is a recovering addict,
come from Eva's Village, talk to the patient,
intercept them to get them into rehab.
I'm Anthony, I'm an addict.
- Hi, Anthony. - Hi, Anthony.
Practicing gratitude.
Eva's Village is a pretty extraordinary organization
within the Paterson community.
They have had tremendous success rates
of getting people into rehab and keeping them clean.
One guy came up to me and said, "You saved my life.
You gave me some Narcan and you got me here into recovery."
I said to him, "Well, how did you get addicted to opioids?"
And he says, "You know what, it's a funny story, doc.
I came in with a shoulder injury and you gave me
a prescription for Percocet and I never stopped."
Emergency physicians only prescribe eight percent
of the opioids that are prescribed in the country,
but many of the first doses are given
in the emergency department.
Our ALTO program is designed
to treat people with acute pain
without using addictive drugs like opioids.
We use all sorts of other medications
people aren't thinking about, because sometimes
an opioid is not the best choice.
Maybe a muscle relaxant is a better choice.
We will use these drugs, but we're careful
and we educate our patients as a result.
We are seeing too many young people die,
and the ripple effect of having a loss of a young person,
it's tragic, it's tragic, and it's preventable.
You have to do what you're trained to do.
The training just kicks in.
I always do think about my own family,
but you just put it away,
put it in the back of your head and get it done.
I've been doing flight nursing for about 18 years.
I was introduced to flight nursing
when I was first a young nurse,
and I just begged and begged and begged
to go on a flight.
People don't have access to healthcare,
'cause they're living in areas that are
hundreds of miles away from care.
Some places don't even have a little clinic to go to.
I was born in Oregon and my father worked at a saw mill.
One of the logs busted through the saw box
and this huge log smashed his whole left side.
His collarbone was fractured and his arm was shattered.
He's out in the middle of frontier Oregon, really.
So they throw him into the back of a pickup...
...and they travel for four hours to get to care.
Okay, that's 50 years ago.
That happens today,
and if there was not some kind of air medical service,
they would be stuck out there,
no pain meds, no blood products,
no medications.
Those people deserve care.
AirLink 1, go ahead.
We're being asked to activate to Station 102.
This will be a trauma patient, over.
AirLink, your patient's going to be a 28-year-old male,
suffered a traumatic head injury
after taking a ground level fall onto concrete.
Patient's currently got a GCS of 13,
a pulse of 103, respiration's 18.
AirCom, AirLink 1 has landed on the scene.
You want to move that patient as quickly as you can,
because time is muscle, time is brain.
Departing 102 for St. Charles Bend,
10 minutes, en route.
And here we go.
It would be easy to just go through the ABCs of care...
airway, breathing, circulation...
but it's really about communicating with that person
and looking at them and connecting with them.
We connect with our eyes and often touch their hand,
and that has tremendous healing in itself.
Sometimes on the monitor
you can see their heart rate decrease.
It's kind of a combination of the physical
and the emotional care.
And I'm on a stabilized approach.
As far as flight nursing goes,
I think there has to come with that person
a sense of hardiness.
You see the worst of the worst,
and you see it in its raw state.
We also see super great things.
We see people healed from traumatic injuries.
We get to see peoples' lives changed.
At night, we have to wear night vision goggles.
Every time I put those on,
I don't just see the stars that you guys are seeing.
I see a tremendous amount.
It reminds me every time
that there's a lot more out there than me.
You try to pick out the silver lining, right?
You thank the coworker that came and helped you,
helped save this patient.
If you don't see it, you don't understand
the depth and the breadth of what goes on
in a department this big.
Seeing the people you work with, seeing the influence
they have on you every day to do better,
that's the reason you keep going.
Every morning we have a list of traumas that come through,
and gunshot, gunshot.
I think we all have some sort of post-traumatic stress
from the things we see every day.
You see things as basic as dental pain,
but then you see things as complicated
as a young girl coming in here for dental pain
but really the issue is sexual trafficking.
You have to change your mindset that,
"I'm a mom, I'm a person,"
to, "I'm an evidence technician."
You just have to be ready on an everyday basis.
You know, reflect in the mirror and make sure
this is what you really wanna do every day.
Just breathe normally, you don't have to hold your breath.
If you could reach even a few people,
everybody needs help regardless of what zip code or nationality.
You can strip away the fancy technology,
you can strip away the CPR,
you can strip away the medication.
It really comes down to a conversation, right,
and understanding what that person needs.
St. John's emergency room, please go ahead.
St. John's emergency room,
84 Bravo 113, medic 13,
en route to facility, priority one trauma.
Honestly, the ER is a landing pad.
The nurses have to be sort of a Jack and Jill of all trades.
You have to know a little bit about everything.
We triage patients according to what we call
an emergency severity index.
Level one meaning they're the most severe patients.
I think we all start sort of like trauma troopers.
We all love trauma patients.
Bed two, please.
We can see lungs and hearts and deliver babies
and we like that immediate stuff that we can see and fix.
So, 34-year-old female, dog bite.
Several puncture marks throughout her body.
She's got several larger wounds to the upper arms
as well as the lower legs.
- Can I get a doppler? - Right behind bed two.
- Dopplers. - I got it, I got it.
Where are we getting pulses?
- Bilateral feet, no pulse? - No pulse.
I have a femoral pulse.
Big poke over here on the side, okay?
Big poke here.
I would just go ahead and activate.
You wanna activate?
Three to four centimeter laceration.
You know, it's always fast, fast, fast.
We're cut off from our emotion.
Okay, so I've got right AC,
left ankle, right calf.
Oh, that hurts!
I've got medicine for you, love.
Patients are scared.
They don't understand why there's 17 people
standing around them, cutting off their clothes,
and putting needles in their arm,
and it takes presence of mind in the situation you're in
to talk to a person.
"Do you understand?
I know you're scared.
Are you in pain?"
Stephanie, we got you, all right?
I'm gonna get you covered up, okay?
- Okay. - My name's Bonnie.
I'm one of the nurses in the ER, okay?
You're gonna go for a lot of tests.
Even something little will change their perspective
of their trauma.
Open.
How's that feel?
We have to shut down a little bit,
because there's always
someone new coming in and a new trauma coming in,
and I think we're so bombarded with the day to day,
it's hard to think of the long game.
We see an escalation in
behavioral health patients or gunshot wounds.
What are we gonna do to help this in the future?
When you listen to the news and you hear what happens
in the city of Detroit with gun violence,
you wanna do all that you can.
Nursing kind of chose me at an early age
of say, five years old.
If I had a second choice of a career it would be a teacher.
So I'm getting a chance to do that now.
I'm teaching in the community
about injury and violence prevention.
Hi, everybody.
So when you guys come in to the ER,
if you are a victim of trauma,
you get rushed right into our trauma bay, which is over here.
The injury prevention program is attached
to most level one hospital centers.
Gun violence is very, very big in the city of Detroit
and the surrounding areas.
82% of violent crimes
are committed with guns.
The violence has to be interrupted.
How do we do that, how do we interrupt violence?
By people getting involved like myself, going out to speak.
I'm 48 years old.
Been a wheelchair user for 30 years,
due to gang violence.
I look at this as bittersweet, what happened to me.
I was 18, kicked out of all Detroit public schools.
It took for me to get shot to be like, "You know what?
This is something serious.
I gotta get my stuff together."
At the end of a class, someone will walk up to me and say,
"You know, I really want to talk to you
because my brother was killed last week,"
or, "My next-door neighbor was shot."
They always have a story to tell.
Something in their lives touched by gun violence.
I think of the 22-year-old kid that comes in,
where we really pretty much gotta filet his chest
and rip him open just to squeeze his heart
to make sure he keeps breathing.
That's gun violence to me.
And it gets to be difficult,
but we're kind of a support for one another.
We see people here sometimes
more than we see our own families.
It's an extended family.
I didn't really set out to be,
"Okay, I want to be a ER nurse."
Taking care of my parents and my family
was kind of a natural cultural thing to do,
and got inspired from there, really.
My wife, she's an engineer.
Engineering is such a male dominated field
and nursing is such a female dominated field.
So we kind of chuckle at that once in a while.
I've been doing night shift here for close to six years now,
and it's very raw here, right?
It's very in your face.
The traumatic events, the gunshot wounds.
You just accept it, really.
You, you have to accept it, right?
You got a job to do.
That's a level one.
- Level one trauma. - You're good, bro.
- Hey, hey, hey. - Gotta take this off, okay?
We're going to take care of you, okay?
Just lay down, just lay down.
- I got a kid, man. - It's okay, you're good, bro.
- Any medication? - No, no medication.
Do we have a blood pressure yet?
Yup, it's coming right now.
I got your wife, she's all right.
Okay, she's safe, and she's good.
He has a 14, right upper bicep.
When was your last tetanus shot?
I don't know.
I'm just in panic mode, that's all.
You're doing real good, okay?
- How many kids you got, man? - One.
- Girl, boy? - A girl.
- Nice, man, what's her name? - Allison.
Most of the individuals that come here,
they really need someone just to listen to them,
and make decisions from there.
Because a lot of times what you see on paper
is not what you're walking into that room.
Ahhh.
Pain meds and some antibiotics going in, okay?
- Okay. - You're doing a good job.
- Doing good, man. - I just wanna know if I'm okay.
You're doing okay, are you a little cold?
Would you like some warm blankets?
- So scared. - Okay.
We gotta get a chest x-ray from you, okay?
- Okay. - Try not to slide down.
My name's Renee, that's Katie.
We're going to be taking your x-rays.
I gotta give you some pain medicine though, okay?
- I'm just scared, I'm sorry. - I understand.
I just wanna know if I'm okay.
You're doing very well right now.
We just want to make sure that
there's no internal bleeding going on, that's all.
Okay.
You're gonna see your kid again, I promise.
- Okay? - Most definitely, man.
- Most definitely. - Okay.
X-ray.
I lost my parents at a young age.
My mama to cancer.
My daddy was, was murdered.
He got robbed, somebody shot him and killed him.
I just can't believe this happened to me.
Hey, what happened?
All I know is a fight broke out, and I was just trying to leave.
It was a bunch of people.
Wanna give me a setup real quick?
I just... when I heard the shot, I just fell,
and I was like... I noticed, I'm like, "It's me, I'm shot,"
and I just got up.
I started checking myself, 'cause when I heard the gunshot
I just fell, you know, got low to the ground.
Saw the blood on my hand.
I'm like, "I'm shot."
We want to make sure you don't get
any nasty infections, all right?
I got you, I'm right here for you.
We don't close these up, okay?
We just clean 'em out real good.
Long as I know I'm gonna see my daughter again, I'm okay.
I gotta see her turn 18, I got to.
So I'll get you cleaned up, I'll get you some fresh sheets.
Make you look presentable so your girl can come in here
to see you, okay?
- Okay. - All right.
You ask me about how to fix gun violence.
I don't, I don't even know where to begin.
Everything you see in the news today, you get in this ER.
But we're not just a reflecting mirror.
There's deeper issues in the community
that have to be dealt with,
and it starts with the ER being a bridge.
Sometimes change comes out of necessity.
And I think more and more,
our leadership are really listening
to the emergency nurses to find out what their needs are
so that they can better serve their patients.
Nurses have to find a way to have their voice heard.
Welcome, everyone, to the Nurse Practitioner Show
on Doctor Radio.
I am really excited to have you join me today.
We're gonna be talking about emergency nursing.
We have a call already,
so I wanna jump to the phone to Dana.
Hello, so many years ago, I started as a paramedic
and I noticed that the population
does not truly understand
the real purpose of the emergency department.
The hospital is bombarded with things
that really could've been taken care of at the doctor's office.
I think one of the mandates of any nurse,
quite honestly, is education.
When our patients are lucky enough to go home,
it is really our responsibility to ensure that
they know how to care for themselves
or their family member at home.
But the other reality too is that patients and families
do not have primary healthcare in the community.
They don't have insurance.
Sometimes it is the emergency department
that's the only place that they can go to receive care.
Our communities are struggling, our people are struggling.
I think it comes down to soliciting
the leaders in our communities,
and really insisting that there is adequate
health insurance for all.
Patients are so sick by the time they get to us
that we are just chasing our tail.
If we could have caught them in the community
with resources and support,
then we would have been able to avoid
this visit to the emergency department,
and probably a hospital admission.
We see everybody, with or without insurance.
Whether it is that skinned knee,
because the mom and dad don't know quite what to do with it,
or whether it's that person in their last moments
of living with cancer.
We are kind of the catchall for people
who have nowhere else to go.
I don't know that society really understands
what we're seeing, what we're experiencing.
But I think if people did,
much more attention would be paid
to these huge dilemmas that our society's facing.
What we have been through has been extremely trying.
We have seen so much suffering.
We have seen so much death.
I know I've been very distracted.
I think that's the easiest way to describe it.
Distracted by what we've seen throughout the day
and my worry about what the next day is gonna bring.
How much worse can this get?
There has to be better solutions.
We need a little bit of an overarching umbrella
to guide us through these terrible, terrible
and challenging events.
I just think that we have to be open
to looking outside of what the structure
and the framework has been
traditionally in this country,
because it's not working and COVID just amplified
where it doesn't work.
If you have not told Maria or Cat
what the size of your masks are,
I know there's a list going around.
There's a variety of brands of N95s
and you need to make sure whatever brand
you're wearing today fits you properly.
Just a few huddle topics.
What's been happening is body bags are ripping
and if they have bile or any secretions from the patient,
the security officers will get contaminated.
So please make sure all the belongings
are attached to the bag.
When we first started encountering patients
who were having COVID-like symptoms, you know,
we did our best to get them into the department.
We were trying to make sure they were consolidated,
that they were in one place or in isolation rooms.
When it first hit me was when we received a patient,
she was demanding oxygen.
"I can't breathe, I can't breathe,"
and she just snatched the oxygen from me.
A couple minutes later we intubated her,
then we did the chest x-ray
and very suspicious for the COVID virus.
And then it was like a tsunami.
It just totally took over.
People were just desperately trying to save lives,
desperately trying to keep patients going.
For us at St. Joe's, you know, we serve our community
and our community is the type of community that was hit hard,
and the people that we saw here were sick,
sicker than anything I've ever seen.
All our rooms were filled, and that was when we converted
a whole waiting room into a treatment space.
I remembered how it is to work in a provincial hospital.
Back home, patients would be everywhere
and it would be in a basketball court.
So I used that as a form of guidance for me.
The fear when it just didn't seem like anything
would stabilize these patients.
Pumps of six, seven, eight medications running at a time.
We just did not understand at the beginning
how it would weave through a person's body.
You know, we spent 16-hour days, seven days a week.
We didn't even have time to think or decompress.
So I would drive home and I would stay in my car
for 30, 40 minutes
not entering my house
because I couldn't face my children.
I was unprepared to face my children.
I knew that if I carried what I saw,
the death that I saw,
it was unfair to put that burden
on my kids or my husband.
And then in the morning,
I knew I'd have to come back in
and see my staff
who is already worn down.
I don't know if their morale has gone down,
but then when I see them conversing with a patient,
loving them in the best possible way
because their families are not there,
that, to me, is like my reason for being here.
I've been a nurse for 30 years,
but I've never,
I've never had like five patients die
on the same day.
There was this one time that a patient's family
brought him in because he couldn't breathe
and he became unresponsive.
Our staff began CPR on him.
So I asked our director,
"The family's right outside in the car.
Can they come in?"
And she told me, "Unfortunately, they cannot come in."
So...
There was no one there for him.
I was there for many of them.
I cried many days.
I cried many days, 'cause...
'Cause their families weren't there.
So I felt...
I knew how the family would feel.
What I want the families to know more than anything
is their loved one wasn't alone,
that I sat with them and held their hand
and we were caring for them and we were present,
all of us were, all of us were.
And so I hope family members can take some comfort in that,
knowing that the people they loved were never alone,
that we were there for them.
At the end of the day, I have to remind myself,
"Be present, be here, be now."
Particularly when that question always comes back,
"Mom, what happened at work today?
What'd you do?"
And this, um,
I'm not talking to them about.
They know what we're dealing with,
but I try to shelter them a little bit,
because it's...
I don't want them to know how bad it's been.
I don't want them to know.
You know, you can't explain to your kid
what it's like to see somebody die
or to see somebody so distressed or in agony.
And, you know, to hold somebody's hand
as their heart stops beating
is a very hard thing to describe to anybody else.
That feeling of being completely overwhelmed
and people needing you desperately
and not knowing when to stop your day
and just emotionally being in absolute turmoil.
You know, it's really... it's just below the surface
a fair bit of the time, yeah, so.
It is a very, very strange time.
A lot of questions, a lot of uncertainty,
because every week is a new story
that we're trying to unfold.
Right now we feel like we've got a cliffhanger,
because we don't know what the next phase is gonna bring.
I think that the mental wear and tear on us
from the past weeks has been enormous,
and I wonder about what will be
the long-term repercussions for us.
Will we have more post-traumatic stress?
Will there be more levels of higher anxiety,
higher amounts of depression?
When you have a nurse in their assignment for one day
have four patients die in a 12-hour period,
it does take its toll.
And yet, if you were to ask the nurse
would they be anywhere else, they'd probably say,
"No, I'd be right here.
This is my job, this is what I'm meant to do."