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.
In 1990, the first time I stepped into a city hospital
Emergency Department (ED) and saw nurses and doctors rushing by what I thought
was a frenzied scene, I almost threw up and ran away back to the chronic care
facility I came from. The noise from the monitors, the sirens wailing on the
ramp, the ringing of the telephones, and the curses from the intoxicated
patients. “This is not my world,” or so
I thought.
After one perceptive nurse noticed my pale face, she tapped
my shoulder and made me sit by her side at the Ambulance Triage while I waited
for the nurse recruiter to return from an urgent phone call. She gave me a
glass of water and entertained me with funny stories about the ED. “You haven’t
seen anything yet.”, she teased me in her slight Indian accent, “but you will
love it here. And you will never leave Emergency Nursing.”
“Sanni” was absolutely right. It is difficult to believe
that I survived thirty-two years in emergency nursing. And loved the
hurly-burly and exciting life of an ER nurse. And appreciated my colleagues through the years.
Like an arrow to the heart, emergency nursing lodged itself in my
heart refusing to let go despite the adversities. I loved the staff and even
craved the chaos. I stayed at Elmhurst Hospital for 21 years. Then, I worked in
other urban EDs where life was never placid, never dull, and the word “Quiet” jinxes
everything. My stay at Maimonides Medical Center and Mount Sinai Morningside
provided me with a plentitude of stories and a lifetime of memories that
strengthened me more as a nurse and as a person.
Never did it occur to me to leave the scary world of
emergency nursing. The nursing, medical and ancillary staff in the ED stood
resilient through the vagaries of demands from the patients in agony and
despair. It was a world with emotional rewards because we made a difference. My
career brought me from the bedside to several leadership positions, and I can
honestly say that I enjoyed leaving a legacy of hard work, integrity, and
fairness, I try.
Then the Covid-19 pandemic wrought emotional scars that
brought me to the crossroads of my career. I almost walked away from nursing. I
was emotionally bruised from feeling helpless and staying strong was a challenge.
My body was keeping score.
According to the book by Bessel van der Kolk, the effects of
trauma affect the emotions, the mind, and the physical body. He described hypervigilance
and hyperarousal as causing physical ailments manifesting in the bodies of
those who continue to suffer under stress. The constant adrenaline rush was wearing
me down. My body was definitely keeping score, and it was giving me dire
warnings to slow down, maintain my work-life balance, and do my self-care.
Life presented many trials on top of all the stressors we
suffered with Covid. Realizing that I have to love myself first, I gave myself time
to heal. My worth as a nurse and as a person is not tied to the insincere approvals
from anybody, but to the overwhelming support and love from those who matter:
the nurses whom I work with.
In 2021, I published my book “ER Nurse: The Warrior Within, Bruised but still standing". This year 2022, the Emergency Nurses Association is
formally celebrating Emergency Nurses Week on October 9 through October 15. It
seems surreal that this year’s theme is “Standing Strong”.
I looked back at the pictures I collected over the thirty-two
years and I smile with pride for having worked with my sisters and brothers on
the battlefields. There are many psychological land mines in this profession. We
have survived the storms and we will continue to weather the unpredictable and
unprecedented challenges that come our way.
I cherish the camaraderie with the staff. I remember the fun
moments and the simple pleasures that lightened our load. I treasure the hugs
after a difficult day. I celebrate the lives we have saved and the thanks from
patients and families for whom we made a difference. And most of all, I honor
my fellow nurses on the front lines who inspire with their courage and
resilience against all odds.
So, let’s continue to take care of ourselves first, find the
time to enjoy our co-workers, and rejoice for the grace and blessings of caring
for the sick and the injured. To the new nurses, especially those that I have
personally taught in a nurse residency course in my new job, please hang in
there. I hope that, many years later, you will look at these memories with
fondness in your heart and gratitude for having touched countless lives.
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.
About 20 years ago, a 70-year-old man was admitted as a Trauma Team to our hospital, after a brutal assault and robbery on the streets. The patient was a frail-looking Vietnamese man who was just collecting plastic bottles to help out his family. He tried to hold on to his money. His assailants pummeled him several times. They ran away with only $5.00 and left the man bruised with a leg fracture. He was forever traumatized.
According to some bystanders, two teenagers were calling him racial slurs which the old man did not understand. The family, through the interpreter, tried to get NYPD to arrest the teenagers, who were known to the community, but the police dismissed the case as a simple robbery, not a hate crime. Because they were juveniles, they got away scot-free.
Twenty years later, Asian hate still strikes fear amongst us. Microaggressions, outright harassment, and blatant racisms exist.
After the Covid-19 pandemic, Anti-Asian violence quadrupled last year. Assaults on Asians, especially the women and the elderly continue to rise. The deaths of Michelle Go, Christina Yuna Lee, Yao Pan Ma, and GuiYing Ma are senseless and horrifying.
How many more vulnerable individuals are harassed who look like me? How many
times will NYPD refuse to consider or even quick to dismiss the assaults as
hate crimes? How many murders have to happen before tougher measures are enforced, especially in keeping those perpetrators in jail where they belong and not released to be a menace to society again?
Many bystanders refuse to intervene for fear for their
own lives. Last week, a Filipino man was assaulted in a McDonald's restaurant. The video showed another tall and burly customer just turning his back to the violence behind him.
And then there were heroes; good Samaritans. A selfless act of heroism that is commendable at this time when people choose not to defend a person in need.
Two weeks ago, the father-and-son duo of Cazim and Louie Suljovic
dared to help out an Asian woman who was being assaulted and robbed outside of
their pizza parlor (Louie's Pizzeria) in Elmhurst, Queens. Both men were
stabbed several times but they managed to bring down two of the assailants
until NYPD arrived. Both men were hospitalized at Elmhurst Hospital and
fortunately, are recovering well.
The Go-Fund-Me page that was organized by a
friend has raised $696,610 (as of this writing). The money will pay for their
medical expenses and to support their workers while the restaurant is closed. The outpouring of support indicated the community's gratitude for the courage that almost cost them the Suljovics' lives.
It begs the question that
many of us will probably be grappling with when faced with the same incident:
what will we do? To be honest, I am not sure. If I am physically able, I know I will not be able to ignore a plea for help. I know I will call for assistance. I hope that I have a weapon with me, or maybe I can distract an assailant, and hopefully, some able-bodied men can step up and take our community back again and prevent evil-minded people from hurting innocent people whose only "mistake" is being somebody that does not look like them.
Racism, against anyone, whatever the color of their skin, is unconscionable and inhumane.
The past year affected all of us in immeasurable ways. What began as a promise of recovery from the horrors of 2020 with the Covid-19 vaccine fizzled out, like a New Year’s Eve sparkler dying out. In January 2021, I was hopeful that I would be able to travel soon to see my family in the Philippines. It was not to be. The US is on its 5th Covid wave with Omicron threatening to infect one and all.
As I prepared for our church’s Year-end Thanksgiving for 2021, I cleared my mind in grateful reflection. I can proudly say that I am blessed. Last Dec. 25-26, the Church of Christ (Iglesia ni Cristo) members celebrated our year-end Thanksgiving in person, instead of on Webex as we did last year.
INC Hymn #134
Oh my Father, I now deeply meditate
On the blessings, You give day by day
Truly You have never failed to care for me
And You provide my every need
It is my duty, Lord, to praise and worship You.
Ever worshipping your name faithfully;
It is my duty, Lord, to offer all to You
Oh, the very life You give to me.
Despite this year being still challenging in many other ways, there is still so much to be thankful for.
The Gift of Life
Family and friends
Work
My new book
For all these, I am thankful.
I am grateful to be an educator and a nurse leader.
When I left my previous job and started another journey, I was extremely gratified by the overwhelming support and love from my nursing staff, as well as all those who I have worked with. Their words are precious to me and have given me strength, inspiration, and determination. Their validation of my work meant to me more than I can ever express. I will forever hold them close to my heart.
I would like to share some of their thoughts:
“You have been an exemplary role model for me. Many times over the past year, I have felt overwhelmed and hapless. You were always available to listen to our complaints- even when you knew that there was nothing you could do. You displayed continuous optimism, even in the midst of what seemed like a never-ending nightmare during the COVID peak last year. You are the primary reason that I kept coming back to work and picking up extra shifts when I could. Thank you for that.
You will be the standard that I will compare others to in the future. I hope that wherever you go, you will continue to show others the light when it seems so dark.”
“Thank you for everything you have done for me and the department. You were with us every day fighting on the frontlines as we fought our first pandemic. Your encouragement and support helped me get out of bed in the morning to come to work. Although I was scared every day coming to work while pregnant, I always knew you were there to support me. For that, I will always be grateful.
You always encouraged us to be the best version of ourselves and to further our education. I always enjoyed your CEN questions in your weekly email, an email I looked forward to. I appreciated your transparency on department initiatives and staffing. I always knew you were fighting for us every day. You were an extraordinary leader and I hope one day I can strive to be a leader like you."
“I feel so lucky to have had you throughout the pandemic, We could not have done it without you.”
"Please know
how grateful I am that we had you as our leader, especially this past year. I
will never forget you."
New nurses: passing the torch
Today was the last day of class in 2021 for the new graduate nurses in the nursing residency program that I was consulting with. Knowing the challenges that they will be facing as they start their career as ER nurses, I shared with them how I survived the psychological land mines in a complicated but emotionally rewarding profession. In a way, I felt I was passing the torch and I felt compelled to encourage them as much as I could.
Gratitude journal. Finding my joy. Work-life balance. Self-care. Knowing that I made a difference. Sharing my love of nursing. Grateful meditation. All these fortified me and kept me standing through the years.
I asked the new nurses to reflect on what things they are grateful for. They recounted those special moments when patients thanked them for their compassionate care. Some even said that even if their patients forgot to thank them at times, they feel empowered to have made a difference in their patients' lives. It was an emotional exercise for all of us, and I tried to hold back my tears. I am proud of them.
They ALL expressed their gratitude for the opportunity to serve as a nurse, despite this Omicron threat and the short-staffing.Then they thanked all the other instructors and me for guiding them and preparing them for this career.
Hearing the words of praise from these new nurses was a gift I didn't know I needed to hear.
Here comes 2022. Happy New Year, everyone. Be safe. God bless.
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?
Today is a moment of reflection for all of us. I wrote this in my journal, not knowing that Covid would still persist as a menace a year later. The loss of lives is still staggering and so emotional. Two more losses, one was an agency companion/sitter at work and another a church member in the prime of her life. When will this end? I did not expect to hear sad news so close to home when we're almost on the home stretch.
Today, we gathered in the Resus Room to pay respects and
remember our co-worker. Although she was not an MSM employee, we claimed her
as our own because she was assigned to the ED for 4 years. June was an agency
employee sent to watch patients who were emotionally disturbed, suicidal or
patients who are Fall and elopement risks. It was not an easy job; the patients
were challenging, but she persevered and tried to help as much as they could when she was sometimes sick herself.
The room was filled with nurses, techs, and other ancillary
workers. It started slow but soon the staff was sharing their memories of her.
The chaplain led us in prayer. It was difficult to hold back the tears because
I did not think that one year later, we would still be mourning the deaths of
people we know. I didn't know that I needed the hug. The staff had a good cry then we dried our tears as we went
back to work.
This second wave of Covid was not as intense as the first
wave, but what is unrelenting is the slow road to recovery. Maybe it is our
impatience to return back to normal. Maybe it's the frustration that people
still die, despite everything we have learned.
One year later, my son is still safe and we have been indulging in our food trips, mask, and all. My 90 y/o mom is socially distanced in our home, with all her needs catered to by my family. We did her birthday celebration via Zoom on February 14th. And I had my vaccine.
In reflection, I realized that coming out of this terrible
period is doable. There is light at the end of this tunnel. We have to take
care of ourselves, still seek those things that give joy to our lives, hold on
for those moments of triumph, celebrate the lives we have saved, give thanks
for the science of the vaccine, and rejoice for the grace and blessings of
having survived through it all. Simply put, just keep on hanging in there. I
look forward to the future of hope.
Alicia Keys’ “Good Job” By
One Voice Children’s Choir
