I have always wanted to write about the fascinating vignettes of Emergency Department life. This blog is my creative attempt to highlight the ups and downs of life in my busy ED. It is not just a room anymore, it's a department. It is the gateway to the scary world of hospitals. Despite the grim faces of nurses struggling with the increased volume of patients, we find time to celebrate humor and simple joys; this is how we survive.
Five years ago, on March 11, 2020, the World Health Organization officially declared COVID-19 a global pandemic. I remember the day as if it were only yesterday. The memories are vivid in my mind; the heartaches of losing friends and numerous patients leave an emotional scar in our hearts that will haunt us for the rest of our lives. The fear remains that another pandemic might come and change our world again.
I wrote this about my burnout:
At the beginning of April 2020, the Covid-19 pandemic burnt me out.
I remember waking up in bed, physically drained from a fitful sleep and emotionally shattered by the friends and patients we lost. I debated calling out sick that morning because I dreaded hearing the frequent overhead pages for the code team. For the first time in my long nursing career, I was at a crossroads I never thought I could ever be at; I thought of quitting. I wanted to run as far away as I could, away from dying patients, away from the heartaches. But I could not abandon my staff, so I stayed resolute in fighting alongside my courageous staff in that dreadful war.
Five years later, I feel privileged to be part of the army of healthcare staff worldwide who battled the war. Today, I browsed through the photojournals that chronicled our fight.
Yes, we survived. There was a light at the end of the tunnel. It was just taking one day at a time, putting one step ahead, until finally, the vaccine came, and later on, we finally took off our mask.
I am not the only one remembering that day. The burnout and the PTSD that followed were real.
Five years later, these are just distant memories for most. I know that for all the healthcare workers who struggled through the "war," it was an emotional and challenging process to move on to the new normal. May we all support each other as we learn from the past, and hopefully, we will not have to go through this again.I celebrate the resilience of these nurses and all those who continue to make a difference every day.
At the beginning of April 2020, the Covid-19 pandemic burnt me out. At one point, I was ready to quit nursing. I wanted to run as far away as I could, away from dying patients, away from the heartaches.
I remember waking up in bed, physically drained from a fitful sleep, emotionally shattered by the friends and the patients we lost. I debated calling out sick that morning just because I dreaded hearing the frequent overhead pages for the code team.
The Apex of this pandemic that we were preparing for came much too early. Doctors, nurses, and techs were running around responding to calls for intubations, desperately trying to race against time. We were all covered from head to toe with impervious gowns, face shields, double gloves, boots, and surgical caps; the N95 masks would later leave marks on our faces. The scars in our hearts were unseen, PTSD a real threat.
We were protected, we assured ourselves, but how could you be confident about how safe you are when the Covid fatalities keep on rising? The whole hospital (and the whole city) was in a pandemic chokehold.
It took a few minutes of deep breaths before I could summon the courage to rise from my bed. For the first time in my long nursing career, I was at a crossroads I never thought I could ever be at. I considered myself unshakeable. “Been there, done that; nothing can ever make me turn away from Nursing,” or so I thought.
That morning, I felt burnt out, but I went to work. To fortify myself, I looked up onto the heavens and whispered, “My Lord God, take charge of my life.”
ON THE FRONTLINE
The New York streets were empty. The City that Never Sleeps was in total lockdown since March, and only the essential workers were allowed to travel. Along the Cross Bronx Expressway on my way to work, what was once a traffic nightmare looked more like an apocalypse with nary a car nor a truck in sight for miles on end. Times Square was a ghost town. The silence was both eerie and deafening. I felt like I was going to war, but I was scared and helpless. I hated being vulnerable.
I was on the frontline but felt like a spectator. I was not actually at the bedside giving direct care as I wanted to be. The responsibility of being a Director of Nursing in an emergency department amid a healthcare crisis was overwhelming, but not more than what the ED nurses, techs, medical providers, and other ancillary personnel had to go through. I can only imagine the enormous impact of the unending crisis on their psychological well-being when their best efforts sometimes fail.
My nurses forbid me to go into the rooms, even to help prepare the bodies for the Morgue. They wanted me safe. I even joked that I was not that old, that I could fight alongside them. Just like in Imposter Syndrome, I felt inadequate and not quite pulling my own weight on the battlefield.
All I could do was make rounds, check on the staff, order supplies, request the Incident Command for more staffing help, coordinate travel nursing coverage, handle family complaints, and act as a cheerleader and emotional support for the staff. I followed up with my quarantined staff members for Covid exposure and illness. It was difficult to hear their anxiety and I feared that they could hear the quiver in my voice, so I preferred texting to phone calls.
I saw the patients come through the Triage Area, with no family members to sit by their bedside. The patients were whisked directly to the rooms with high-flow oxygen masks to aid in their breathing. I saw patients inside the isolation room as they lay with apprehensive eyes looking at their oxygen saturation numbers on the cardiac monitors.
I also remember the eyes of the ER staff beyond the masks and their face shields. Eyes that were sad and worried. Eyes haunted by the final goodbyes between the patients and their loved ones on the iPAD. Eyes filled with despair because of the unprecedented challenge wrought by the coronavirus onslaught. These were our darkest times.
I tried to be transparent with my information to the staff. But I grappled with what I could share. So, in my emails and our daily huddles, I talked about the nurse travelers coming in, the other non-clinical activities, and non-emergent procedures that were put on hold to deploy the staff to the ED and the other patient units. My news was upbeat and hopeful as I could possibly communicate to my already disheartened staff. I told them of the other surge capacity activities that the hospital leadership initiated to accommodate the influx of Covid-19 patients.
I did not share my concerns about the grim statistics and the dwindling supplies and equipment (since we compete with other hospitals for resources). I did not share that the Morgue was full and that there were Medical Examiner trailers on our campus. I did not confess that I wanted to quit nursing.
I did not want to stop and answer questions about my state of mind for fear that the tenuous hold on my fragile emotions would break. I did not want anyone to see me ugly-cry because of the sadness in my heart. So, I cried behind the doors.
My priority was that my staff would feel supported so they could take care of the patients who needed their expert help. I had to be the leader that they deserved. I learned how to look confident on the outside, although I was frazzled on the inside. I could not afford to be weak.
EPIPHANY: SELF-CARE
The staff needed mental PPE. We corroborated with the Mental Health Liaison psychologists, who offered counseling and other options for the team to de-stress, decompress, and start healing our broken hearts. My epiphany was that I had to do self-care. How could I help my staff when I was running on empty?
In my personal life, through all life’s ups and downs, I relied on my family and friends, my church, and my writing to endure. I knew I was strong enough to survive my personal travails, but I was unsure if I could remain a nurse amid the challenges that had brought down my other colleagues. I resolved to look for my joy triggers at work. I knew I had to heal myself first before I could lead others.
One day, one nurse asked to speak with me. That nurse broke down crying as soon as we got into my office. The words of pain and despair poured out, and the repressed emotions from the past months finally tumbled out. The nurse was not suicidal but was profoundly sad and depressed. We talked for a long time, but mostly, I just listened. I called one of the mental health counselors and arranged an emergency visit. Then, we hugged, and the nurse thanked me for listening, and for being there. I am glad to report that today, that nurse is now healthy and is thriving well.
FINDING MY JOY
Covid-19 would not be my downfall. Having witnessed the heroism and fortitude displayed by all healthcare personnel during these uncertain times made me realize how much I love the nursing profession. In my little way, I am privileged to have made a difference. That moment of indecision in my nursing career, that short period of burn-out, that temporary insanity is no longer. I have recovered my self-worth. I found my joy and my “why.”
What turned me around? What prevented me from leaving my profession? My healing came as I continued working as a nurse. I poured out my emotions into my daily journal, a catharsis to help me exorcise my negative feelings. My writing brought everything into perspective. Much as there were so many heartaches, I found comfort in our small triumphs. As a nurse, I was part of the army against this virus.
There were numerous things to celebrate. Let me count the reasons why we persevered:
The clapping and appreciation from the hospital neighborhood and other heroes like the firemen and the cops.
The outpouring of support from the community with unsolicited food deliveries (which both fed our bodies and our souls)
The staff working as a team and caring for each other
The staff comes in extra days so their peers will not work short-handed.
The deployed staff working in unfamiliar places and doing their very best to help
Dancing to the music “Call on Me” whenever a patient was discharged.
Getting a Thank You from a patient and his family
The staff rising to the challenge, despite the threat of Covid-19
The knowledge that every single hospital employee was doing their best under the direst of circumstances
The realization that we were doing God's work
I created a Facebook photo album of pictures from the staff to celebrate the resilient group that they are. It was a way to pay tribute and highlight this particular group on the frontlines of this war. I wanted to preserve in posterity the faces of the brave ones who came to fight the battle against Covid-19.
The FB photo album grew into a photo journal. It was to chronicle the moments of levity captured in-between moments of heartbreak; just before they rush back to the unit to save more lives. Frozen in time, the pictures showed the ED team taking a much-deserved break, a respite from the hard work. Just a little breather. There was a spirit of camaraderie, of having bonded as we worked together. As time went on, the staff started to SMIZE, they smiled with their eyes.
These healthcare workers, heroes of my time, were simply inspiring.
Last May 2020, the hospital managed to celebrate the Year Of The Nurse creatively despite the constraints of social distancing and face masks. We danced on the streets, gave out cookies and cupcakes, published our virtual nursing journal, enjoyed the gifts from numerous sponsors, and were treated to an aerial display from the US Air Force and the Navy. The festivities were a harbinger of hope that we would survive. The end of the pandemic would come. And then we prayed for the vaccine, our fighting chance.
In 2022, the American Nurses Association chose the theme, “You Make A Difference.” Nurses in all disciplines and sectors truly matter as we give our patients a chance for a better life. Every Day. Our strength is rooted in determination and dedication to serving those who need help and fortified by the challenges and disruptions of the past years.
Like every single nurse standing strong despite being bruised and shaken by our pandemic ordeal, I am still here. I am proud to be a nurse.
My nurse-friend in Florida called me in tears. She was overwhelmed.
“I am tired. I am tired of seeing so many patients die. I see the fear in their eyes as they gasp for air, as they start calling for their loved ones. And I am helpless. The Covid patients keep coming.” she said with a sigh. The sound of exhaustion.
I remember back in April last year when I heard the same
words from my nursing staff in the ED. New York was the epicenter then. I could only listen as they poured their
hearts out. I was helpless as my nurses broke down in tears. These were strong
nurses who’ve seen them all, but how could you remain stoic when patients die
in horrifying numbers?
I swallowed my own fears because my staff needed me to
be strong for them. I could only offer
my shoulders to cry on. I could only listen.
I have referred many of my staff to psychologists. I gave
them some time off to unwind and be with their family and friends.
So that they can be healthy, physically, emotionally, and mentally. In these tough times, to survive, I actively sought my moments of joy.
Somehow, through our shared grief for those we lost, we
found the strength to keep moving on. The staff bonded over the feasts of donated
food. We enjoyed the 7pm clapping from our community and the firemen and the police.
We danced when a Covid-19 patient was discharged. We cheered when the Covid
numbers started to decrease.
Last December, I felt overjoyed when I received my first
dose of the Pfizer vaccine. I was hopeful that the end is in sight. I was
certain that every single person who went through the nightmarish pandemic
would embrace the vaccine as I did. I prayed that in a few months, I would
finally be able to travel and see my mom after two years.
But the promise of freedom from masks did not come. We are
in the 4th surge of Covid and who knows how many more variants will there be?
Here in New York, it is not as intense as it was last year, but other states
are reporting of hospitals overwhelmed by sick patients, mostly unvaccinated.
I
cannot comprehend the resistance against the vaccines, I am frustrated that the
other countries around the world remain in the chokehold of this pandemic because
they do not get the vaccines that others have declined. I am heartbroken that
I have not seen my mother in two years.
Post-traumatic Stress Disorder (PTSD) is real among healthcare workers. Every sniffle, body
ache, and headache cause concern. Fever and cough trigger anxiety attacks. The angst is a visceral reaction that conjures
images of intubation. For a nurse who has seen the worst, it is traumatic to envision oneself going through the same thing.
There is a staffing shortage. The healthcare staff is tired and exhausted. The vaccine mandate is
divisive and controversial. How do you balance freedom of choice versus public health safety? In my honest opinion, it is necessary and maybe the only way we can get out of this torture.
Just a few days ago, I heard of a friend in the Philippines
who died of Covid-19. When will this nightmare end?
I am a service animal. My human is who I am loyal to. Please do not make fun of him because he is disabled. He is trying to make the most of what he’s got. I am the only one who can understand him. I go with him everywhere, even to the hospitals. As long as I behave, I can stay at the bedside.
I am his seeing-eye dog. He can see shapes with his right eye. He lost his left eye several years ago in Afghanistan. As he walks by my side, he feels for the tug of my leash to warn him of danger in the path ahead. He responds to my subtle moves. Step to the left, step to the right. When I stop, he stops. After four years together, he trusts me. I once saved us both when I warned him of a car who whizzed by without regard to the blind man and his dog.
Yesterday, my human had to go to the hospital. The security officer tried to block me from coming into the emergency department and wanted me chained to a corner. I did not growl at him, but I was tempted to. It's good that the nurse came right on time to lecture the security officer of my human's rights.
I guess the officer was just too eager. There are a few people who try to pass off their pets as service animal. If the dog is just for emotional support, that is not enough to qualify as a service dog. My human told me of Mrs. Harris, our next-door neighbor, who tried to smuggle Rosita into the hospital. That chihuahua could not stay quiet at all. She even tried to bite the nurse. Ahem, then there is Senor Diaz, his pet ferret is not a service animal even though he claims he need Chester for emotional support.
My human suffers from what he calls PTSD. When there are these loud things in the distance that he calls “damn fireworks”, he cowers in the corner, just like me. We hold each other, and I try to calm myself so that he can stop shaking.
My human said that the American with Disabilities Act protects his rights as a disabled person. The public cannot discriminate against a person with a disability. He said that nobody can demand proof that I am a service dog especially since it’s obvious that he is disabled. I don’t have to have a license or a certificate. Sometimes, I wear my special vest except during the hot summer months.
When my human meets up with his old friends from his old platoon, that is when I also bond with the other service dogs. One German shepherd barks when his human’s blood sugar is getting low. A golden Labrador warns his human before he gets a seizure. I am a beagle and I am the most experienced dog in my group.
Oh, have you heard that miniature horses can also serve as service animals? I would love to meet one someday.
ADDENDUM: 2/7/18
An artist was prevented from boarding a United Airlines flight with her "emotional support" animal. Not a dog or a miniature pony as allowed by the American Disabilities Act. She tried to bring a PEACOCK on the plane. Really?
