You’re a funny creature, you know, frantically requesting lactulose for a patient with no bum. I review for you a normal stomal output, a healthy post-op patient. He’s equally as confused as I am about why you believe his bowels are misbehaving. I begin my quest to seek out the patient notes, which are probably hidden behind a secret door in the sluice room that will only open if you utter some secret nurse-mantra. I end my quest to seek out said infernal notes after finding myself halfway down some derelict, buried passage to hell. We’re always playing hide and seek with patient notes; I really don’t like that game.
To top it off, when I return to the ward to find you you’ve gone off for break. Why are you always on break? I don’t think I’ve ever asked for you when you’ve not been on break. What is break? Where do you do it? Can I come? It sounds fun. Please. I need friends.
Eventually I do find you and you’re extracting drugs from the robot-drug-machine, asking me not to disturb you, but I do so anyway. It turns out the lactulose 10mL once daily PRN was on the patient’s regular medication list and you wanted to make sure all regular medications were not missed. How vigilant. How observant. They have no bum though, dear nurse, and we laugh it off. They don’t need laxatives, because they have no bum. They have a stoma now, the stoma is working well. It has a good output. This is their new bum, a bum that currently doesn’t need our lactulose.
How funny. We laugh together. This is why I come to work. This was fun.
*Bleep bleep* my pager announces itself, *bleep bleep* like nails across the chalkboard of my soul, *bleep bleep* as I contemplate drowning this nightmare attached to my belt in a puddle of toilet water. It’s 3:59pm on Friday. It’s a privilege to treat people. I don’t want to see my friends at the pub across the road, no sir. A service to those in need is honourable, and I must embrace my role as a humble provider
Please end me. End me now.
But honestly, dear nurse, all satire aside I know I must come and help you, I want you to never be afraid to call me. I know the danger in that. I know that without you I am lost. You’re my lifeline to the ward and to the patient. You see them, care for them, cry for them, laugh with them, and mourn with them. You listen to their complaints, and you bundle these complaints up into a neat little package for me to handle. Nobody wants to call someone up with requests that are either banal or burdensome, but we all end up doing so if we know that it would be the safest option for the patient. I take this time to thank you, dear nurse, to thank you for being everything that you are.
What brings this on? Why the sentiments? Well, let me tell you a story…
Imagine the setting: I’m settling down to a fine fish-mulch and soggy vegetable dinner with the
family team; scrutinising a crinkled up and scribbled-upon piece of paper called “the list.” The registrar, you know the badass surgical reg who’s also super nice and everyone has a slight crush on them? Yep, that one. They’re telling the team about a great job I did with that arterial blood gas (that I almost accidentally took with an IV cannula needle). I’m feeling warm and fuzzy inside – a feeling not wholly attributable to the expired milk I put in my coffee.
And then there’s the phone call:
“Hi this is the on call house officer, how may I be of service?”
“Hey can you please come to the ward… I need a little help.”
“Oh my God. It’s the ABG, isn’t it? I messed it up. Did their arm fall off? Oh NO he’s DEAD and you’re asking me to sign the DEATH certificate. I killed them. Their whole family is dead. Everyone is dead. The HDC is going to hang me. I’m so sorry.”
“What? No… the ABG was fine. Nobody is dead. Look just come up here when you have a moment.”
Curious, slightly anxious, and a whole lot embarrassed because my team is looking at me as if I just grew an extra eyeball – I set off for the ward. I spied you there, dear nurse, and boy were you in a tight spot. Surrounded by two irate family members and backed up against a wall you looked around for a way to steer the tension to a safe place. You pointed at me; “ah! There’s the doctor. The doctor will help,” and with a sheepish look you ushered us all into a room for “de-escalation,” and “mediation.”
It turns out the family had been ruthlessly tearing apart the nursing staff for a miscommunication error that essentially resulted in a drug being administered that wasn’t in the plan. Funnily enough that drug had absolutely no effect on the overall outcome and was, for all intents and purposes, at a near-homeopathic dose. Nevertheless the family members were infuriated. For a whole hour they hurled abuse at you, even with me in the room trying to calm them down and explain the situation. Mind you these people were intelligent and professional folk that for some reason or another had devolved into consecrated rage-demons. I was bewildered, not because of what was being said, but the way you took it.
You stood against the wolf at the door and you held your own. When the family members called you stupid, incompetent, and uncaring – you offered nothing but apologies, you offered to give more than you already could. You shook their hands and patted their shoulders. You smiled at them, you took upon all their frustrations and insecurities, you never spoke out in anger – even when they questioned your integrity.
After they left you walked away a little and found a quiet, dark corner. There you sat down on the floor, hugged your knees, and began to shake. Watching you in your moment of weakness nearly broke me, dear nurse, it very nearly did. I stood there awkwardly for a couple moments, walked patted your shoulder for a few seconds, and finally amongst the bitter silence broken only by your ragged breathing I let out a vicious sneeze. (I don’t know. It’s a visceral reaction okay? If I come across an emotionally high strung situation I… I sneeze. It’s my thing.) For some reason this made you laugh, and for some reason, my stupid sneeze brought us back from our solemnity.
Later on when I asked you why you didn’t speak out you said,
“… they were hurting, doctor, their father is dying and they can’t help take away the poor man’s suffering. They’re scared, and when people are scared they become children – they lash out and try make their hurt into something tangible. The hurt becomes their anger at me, and it’s always easier to run with anger than to run with hurt. This is the their way of trying to do something. Today the pain targeted me, and tomorrow they’ll probably turn it in on themselves… I guess until they find a way to accept that this tragic time is no-one’s fault. Maybe I cry so that they don’t have to, at least not for today.”
I must confess, dear nurse, that sometimes on the board I don’t see a person and instead see a problem: a pending admission, an unfinished discharge summary, a CT scan to chase up, a urology phone referral to be berated about, or some other arduous task that takes away my time. I think that’s okay though – it’s okay to feel that way because we’re only human, aren’t we? It’s how we deal with this eventual, paroxysmal grievance that matters – we mustn’t let it turn into rancor or resentment.
Despite the demands and frustrations I’ve only seen you hold your head high, dear nurse, and I thank you for that. Thank you for your care and attention, your guidance, and your companionship. Thank you for being everything that you are, and more. You play a pivotal role in health care, and without you the system crumbles. I hope you hear those two words often enough, I know I’ve neglected to say it a few times.
Some dipstick housie
You’re still logged into med-chart.