Living On The Edge

It looks so calm outside. The sun is shining. There are cars on the road and people walking around. It looks like any other spring day in Chicago.

It’s not any other day because here I am, at home, feeling like all the worry and anxiety I suppressed about this virus bubble up. I should limit my social media time. Really. The private Facebook group for my fellow nurses at my hospital is informative, but sometimes it takes me down the dark, winding path of despair. Issues are brought to light that are familiar in other institutions across the country, even the globe. The same pressing issues are at my hospital.

Not enough Personal Protective Equipment… Inadequate Personal Protective Equipment… Not enough COVID-19 tests… Not being notified if you take care of a COVID-19 patient… Not being tested after exposure to a possible COVID-19 patient… Changing guidelines from the CDC based on availability of supplies in this country and not because of science… Finding out that someone you worked with was just diagnosed… Worrying you might bring the virus home to your loved ones…

I try not start my day on social media, but then the fear of missing important information sucks me in. Then the stress… Why do I do this to myself? And on my day off no less…

Do nurses ever really get a day off in a crisis even when they are not at work?

I am also in a Facebook group called COVID-19 FOR HEALTHCARE WORKERS. Based on posts from frontline healthcare providers in Italy and other parts of the world, I am anticipating that our situation is about to get worse. I’m gearing up by seeking out Best Practices. It is so sad that I may benefit from the horrific experiences of my fellow nurses. May God have mercy…

I wonder, is everyone awake and ready? I hope so…

Calm Before the Storm

Unprecedented has to be my least favorite word these days. It feels like every news report (over)uses that word. Basically, what I’m hearing is that no one – not our government, the CDC, our hospital administrators – really knows what to do and is figuring it out on a day-by-day, hour-by-hour, minute-by-minute basis. I was hoping was that, at the very least, our elected officials had an emergency plan in place. Makes sense, right? There has been sufficient warning by epidemiologists in the past about possible global pandemics. When I am in a procedure, I have a plan for emergencies like a cardiac arrest, excessive loss of blood, etc. The likelihood in most cases is low, but I am always ready. Why aren’t our elected officials held to the same standard when their decisions affect the lives of many?

I am frustrated and frightened by the whole situation….but I press on.

Over the last week, I have tried to stay as updated as possible by trying to find reliable sources about the prevention, diagnosis, and treatment of COVID-19, the challenges shared by frontline healthcare workers all over the world, and the developing situation in my home city. Needless to say, it is difficult and completely overwhelming. And !@#$-ing scary.

The first time I heard about COVID-19 in a work e-mail was in late February. At that time, no alarms were going off. It felt more like a head’s up than a warning. Then information went from a slow trickle to a continuous flow. Currently, e-mails are packed with paragraph after paragraph of what the hospital is doing, what the city is doing, what we should do in various scenarios, what numbers to call, etc. All this makes my head spin. Ugh. How am I managing all this information? I created a COVID-19 folder in my work account just so that I could track the updates and make sure I know what’s what.

Needless to say, there has been confusion, anger, and anxiety among my fellow staff members in the OR. Totally understandable. We are accustomed to knowing what to do, even when a trauma comes in. We are used to seeing the worst of the worst. We are at a Level I Trauma and Research Center on the south side of Chicago, for Pete’s sake! Our preparation for COVID-19 was nothing like our Trauma Readiness Training two years ago. The hospital was all over it. But now? Why is this different?

Go ahead… Say it… UNPRECEDENTED.

So there have been a lot of What If discussions floating around the unit. Personally, I try not to participate. It is not helpful unless the What If’s are followed by a plan. I want to hear a plan.

Can someone PLEASE give us a plan???

Last Tuesday, St. Patrick’s Day, was the first day of the cancellation of elective surgeries. Our whole Ambulatory Surgery OR was shut down and the staff sent home on Low Census with a possible re-open date of April 15th. It was a shock that rippled through every OR (and we have 3 different OR units – Adult, Pediatrics, and Ambulatory). So many question followed… I still have questions.

The cancellation of elective surgeries also impacted the Adult OR (the Main OR) where I work. It has slowed down so much, that adjustments have been made to our schedules to low census some of us on different days. Still, we are “on reserve.” All of us in the OR know that it is just a matter of time before there is a need to float us to other areas of the hospital. Already some of our surgical techs have been asked to go to the units to monitor providers while they don and doff (put on and take off) Personal Protective Equipment (PPE).

Instead of sending us home, why don’t they set up training for other possible roles? Why aren’t they taking inventory of skills? They should be asking the OR Nurses who have experience in the ER, ICU, or MedSurg Floor. Unfortunately, I have no such skills, but I am willing to learn. How about organizational and management skills? Isn’t that good for crisis management? I’m just wondering…

Practicality Not Panic

These are strange times…

As I was getting ready for work this morning, it dawned on me that I was one of the few residents that would actually leave this 40 unit low-rise condo building to go to WORK. This gave me a sense of purpose that I hadn’t felt in a long time. Or was it just a heavier weight on my shoulders?  Yeah, that’s probably it.  Since COVID-19 started making its way through my city, my neighbors, family, and friends have been working from home, even having to self-quarantine after an exposure to the virus.

Not me.  Not yet.  I’m a nurse.  This crazy pandemic is calling.

Hello, Nurse…  I’m waiting for you.

When I arrived at the hospital, it felt like I was in a new world.  The vibe was intense.  The normal glut of visitors at the security desk were missing.  No medical students rushing past me running late for rounds.  It was almost like a lockdown.  Almost.

As of today, our ambulatory surgery center was officially CLOSED.  All those nurses and surgical techs sent home until April 15th.  What the…..???  Our main operating room OR (where I work) cancelled all elective surgeries per the recommendation of the American College of Surgeons and our government (I’m assuming).  The monitor with our status board was depleted of its normally extensive list of cases.  Instead, a teeny tiny list.  It was so surreal.  We are talking a BIG surgery department that typically performs a lot of procedures now down to a select few.

Makes you want to rub your eyes to make sure you’re not seeing things…  But no…  Hands away from your face!

Because of the small number of cases, some nurses and techs had already been asked to stay home.  We called this “being low censused”.  Basically, this means that there isn’t enough work for them so they are being mandated to stay home, and use their vacation time if they want to get paid.  One day here and there isn’t bad…  But what if the hospital does the same thing to us as our ambulatory surgery colleagues who are off for a whole month?  I hate to even think about this…

I was assigned to circulate three orthopedic cases which kept me busy most of the day.  During slower moments, my mind kept spinning different scenarios on what would happen to me and my co-workers should the number of COVID-19 patients rise in our institution.  It is too soon to say.  Many nurses want answers as if this virus was planned or as if our administrators had been through this kind of crisis before.

NO ONE HAS EXPERIENCED THIS BEFORE.

What a scary thought.  We are looking for guidance, but sometimes those above us cannot figure out the best course of action fast enough.  I would like to believe that everyone is doing the best that they can.  The only thing any of us can do it take it one day at a time, be practical and not panic. 

I know in my heart, we will get through this…  We just need to hang on to hope and find a way to be kind to each other through this frightening time.

 

A Heartfelt Letter

Recently, the nurses at the University of Chicago Medical Center (“UCMC”) have called for a one day strike for the second time this year.  This is the result of unsuccessful bargaining between the unionized nurses and hospital administration over safer staffing, safe working conditions, and benefits.  A hospital-wide e-mail was sent out by one of the administrators depicting the nurses as cold and heartless.

The message made its intended impact as UCMC nurses expressed hurt, upset, and outrage on social media.  One nurse posted a response on Facebook which activated overwhelming support from her fellow RNs.

Here is that eye-opening, heartfelt letter from the UCMC PICU Nurse….

********************************

WRITTEN BY A PICU (PEDIATRIC INTENSIVE CARE UNIT) NURSE AT THE UNIVERSITY OF CHICAGO MEDICAL CENTER IN RESPONSE TO AN INSTITUTION-WIDE E-MAIL FROM A HOSPITAL ADMINISTRATOR.
Dr. Polonsky,

We’ve never met, but I recently heard you speak at the service awards in October. I was there celebrating my five year anniversary at UCMC. It was quite a celebration for me; I’ve worked at UCMC for five years, I’ve been a nurse for five years, I’ve lived in Chicago for five years. That night, I thought the University of Chicago did an incredible job of making me feel valued, appreciated, and immensely proud of the work I do, and the place where I do it.

Tonight, receiving your email has undone all those feelings. I am a dedicated employee of this organization; I am a natural rule-follower, I hate being in trouble, and I hate conflict. However, I feel compelled to write to you, someone I’ve never directly met, and someone who sits well above me in status (and pay) at our organization, in order to convey some sentiments and facts that I feel you have grossly misrepresented in your earlier email.

“Once again, rather than stay at the table and engage in the hard work of reaching the compromises that will produce a new contract, the Union is ordering nurses to walk out on their patients and their co-workers during a holiday.”

This is simply false. The union has called a strike on Tuesday, November 26th. Thanksgiving is Thursday, November 28th. While the union has called for a one-day strike, it is hospital administration that is choosing to lock the nursing staff out for the Thanksgiving holiday. Additionally, “walking out on their patients” is hyperbole, and spins a narrative that paints the nurses, the backbone of your organization as heartless and unprofessional. I can assure you that no patients were walked out on during the last strike. I can promise you, it broke every single RN’s heart to leave that building, knowing that unqualified, inferior and, at times, incompetent replacements were going to be attempting to deliver the unmatched quality care we provide at UCMC. As a PICU nurse, I didn’t have any patients to walk out on! I worked the night before the strike, completely alone in an empty unit, because the hospital administration had shipped out every last PICU child to a different hospital. So, you’ll understand if I take offense to this comment.

“This is not a strike against a nameless, faceless institution.”

This comment is quite ironic: You are correct; this strike is not against a nameless, faceless institution. However, I’ve been a nurse at UCMC for five years, and your email has made me feel like a nameless, faceless pawn in this organization’s bottom line. I know your name, I know Sharon O’Keefe’s name, and I know Deb Albert’s name, but I’m sure none of you know mine. The nameless and faceless members of society are not typically the ones whose paychecks end with seven 0s.

“This is a strike against our patients and their families. This is a strike against our community — one of the most vulnerable in Chicago where residents face high rates of serious conditions and life-threatening diseases. This is a strike against neighborhoods that rely on us for life-saving emergency and trauma care.”

Trust me, the people at UCMC who truly understand how vulnerable and critical our patients are are your nurses. If we didn’t care about our patients, we wouldn’t want more nurses, more IV pumps, more resources, and a safer work environment. The people who care the most about our patients are the ones who are willing to lose money to defend them. On September 20th, I walked out to picket line to find many former patients and their family members earnestly supporting their nurses at the strike. We are the face of this organization. We are what makes the care at UCMC excellent. Our patients and their families know that better than anyone.

What personal sacrifices have you made recently in service to the patient population at UCMC? When our PICU patients were shipped away to hospitals throughout the Chicagoland area, I went and visited one of our patients who didn’t have family members in the area. Each time I went, I stopped to pick up his favorite toys and coloring books and movies. I was out of work, not receiving a paycheck, but I didn’t care. In fact, my coworkers often bring clothes, food, and toys to work for their patients, using their own money. Can you honestly say you have a similar connection and responsibility to the patients we serve? If not, maybe you shouldn’t have included these comments in your email.

Finally, the heart of your email was read as an expression of frustration that you, as well as other hospital leaders and middle-managers, may now be forced to work more than you were planning around the holidays. Dr. Polonsky, I have worked 4 holidays at UCMC every year for five years. I am not from Chicago. It is an eight hour drive for me to get home to see my family. I have missed Thanksgivings. I have missed Christmases. I have missed funerals and birthdays. I have family members who are ill. I have family members that are elderly. And until now, I have never really complained or resented this aspect of my job. Nursing is a 24/7, 365 profession. I’m sorry you are now having to experience ¼ of what 2200 of your nurses experience every year in the rescheduling or cancelling of holiday plans. Maybe this will be beneficial to you and your colleagues; you may walk away with a greater appreciation of the sacrifices your nurses make for our patients and our organization, and a greater understanding of how valuable our profession is (and why we deserve to be valued and appreciated in the manner in which the Union is asking). The reality is that every holiday where you are home spending time with your family, thousands of employees are at UCMC away from theirs. Attempting to belittle my profession and my character by making me feel responsible for “robbing” you of one Thanksgiving with your family has opened my eyes to how out of touch you must be in your current role with the reality of your employees.

I understand that you are also in a difficult position. You are a leader at an organization that has to deal with a strong union that is pushing their agenda against yours. That can’t be easy. I imagine the past eight months have been stressful for you as well, trying to negotiate a fair contract for 2200 nurses. Well, take a moment and put yourself in my shoes. I work in the PICU; I do CPR on infants. I help police officers take pictures of beaten and battered babies. I sing Frozen songs to frightened 5 year-olds while trying to put in an IV. I hug parents after the doctors give them the devastating test results. I guess we both have tough jobs.

Dr. Polonsky, you have the privilege of earning a lot of money to make decisions that impact thousands of people’s livelihoods. The next time you find yourself at the bargaining table with NNU, I hope you can remember your own words. We are not nameless, faceless nurses. We have names, and faces, and families and friends and lives outside of work.

We do this for our patients. We do this for our patients’ families.

That’s why I come to work. Why do you?

Happy Thanksgiving.

A Not-So-Routine Routine

During the Monday through Friday work week, I work four ten-hour shifts.  On those work days, my alarm goes off at 5:00 AM.  And the routine starts…

5:00 AM – Jump out of bed and get ready for work.  Brush my teeth, blah, blah, blah.

5:30 AM – Feed the Doggie and take her out.

6:00 AM – Drive like a bat out of hell to the hospital.  [CUE:  Upbeat dance music.]

6:25 AM – Arrive at work, throw lunch box in one of the overstuffed refrigerators, get scrubs from the scrub machine, change into scrubs and OR-use-only Sanita clogs, put my hair up and put on one of my cute scrub caps.

6:40 AM – Grab a quick coffee in the lounge with my co-workers.

6:53 AM – Clock in and head down to the OR.

7:00 AM – Check for my assignment at the Command Center/Charge Desk.

And this is where the routine ends.

Operating Room Nurses are typically assigned to one room where there are several cases scheduled.  These are usually procedures that fall under their primary specialty (e.g., Orthopedics, General Surgery, Urology, etc.).  However, most operating room nurses are cross-trained in the other specialties, therefore, the assignment may not be in the primary specialty.  Or maybe it’s a room with a variety of procedures that fall under a variety of specialties.

Not only does the assignment vary in specialty, but it varies in role.  There are two staff members needed to set up for a procedure:  A Circulating Nurse and a Scrub Nurse/Surgical Technician (a.k.a. “Scrub Tech).  Operating Room Nurses can either be a Circulator or a Scrub.  A Surgical Technician can only perform in the scrub role due to their training and licensure.

Scrub Nurses/Scrub Techs are responsible for preparing the sterile field.  She or He performs a surgical scrub on both hands and arms at a scrub sink (just like on TV), then puts on a gown and gloves with proper aseptic technique.  The sterile field consists of a sterile drape covering a large table with a setup of items that are needed to perform the procedure (supplies and instrument). The Scrub sets it up so that instruments and supplies can be passed to the surgeons when they need it.  Knowing how to set up for a variety of procedures is a skill learned on the job – starting with an intense orientation.

In the role of Circulator, the nurse performs a patient assessment in the pre-op holding area.  It involves a checklist of questions that have also been asked by other providers.  It is our version of Checks and Balances.  Patients get an overview of what they can expect when they are brought to the OR.  Family and friends of the patient can also ask questions.  I call this, for my readers of a certain age, my “Julie McCoy, your Cruise Director” moment. In the OR, the Circulating Nurse’s work continues with helping the Scrub, sometimes the Anesthesiologist/CRNA, and works around the sterile field (circulator = circulate = circle = around) supporting the surgical team throughout the case.   Eyes and ears are always alert.  Circulating means helping coordinate and facilitate case progress, documentation, and whatever else is needed to provide safe patient care.

Anyway, back to getting my assignment…

Wait, what am I doing?

Every day, my assignment is a surprise to me. The Charge Nurse/Manager/Team Leaders put together the initial draft of the assignment sheet the day before, but it always seems to change the morning of, based on call-offs and schedule changes.  I have learned my lesson to avoid checking the day before because I don’t want to get myself unnecessarily upset or excited about the next day.  Pointless, really.

On the days I am in my specialty, I am in my comfort zone:  Orthopedic Surgery.    In the Main OR of my hospital, the procedures we perform the most are total hip or knee replacements, repairing broken bones, fixing someone’s spine, and even taking out cancerous bone and tissue.  I work with the surgeons and residents that I know well and my partner is usually someone from my specialty team (nurse or scrub tech).  When you have the “regular team” together, there is a flow that is like….a symphony.  I love that feeling.

Outside of my specialty, I am fine, but I am on extra alert for any nuances that are unfamiliar.  While this sounds scary to some people, the beautiful thing about working in surgery is the amazing teamwork we have with our staff.  My co-workers are excellent resources when I am in a bind or when I just want just-in-case information.  It is reassuring to know that someone has my back!

Today is my day off which means I return to work tomorrow.  What will I be doing?

I have absolutely no idea.

All I know is that there definitely will be coffee in the morning.

 

Healing

Since my last post, I have been on a search to find healing in this crazy messed up world. I knew I needed help when I found it difficult to talk about the trauma without my eyes welling up with tears. It was then that I decided to open myself up to different ways to recover from all the terrible things that I see on the job.

I started meditating and practicing yoga. I also started planning more gatherings with family and friends. Improvements in diet and sleep have helped, although this is more challenging to do. If I focus on why I am doing this, it becomes an easier task. Baby steps…

Months later I am not completely “fixed”, but it’s not like I will ever be. Life is messy. I have acknowledged this fact for a long time, but yet it is still a difficult pill to swallow. Our experiences make a lifelong impact. The only thing I can control is how I choose to handle it.

So here I am. Still trying to balance work life and personal life. The messiness continues. At work the traumas keep coming in and so do the really sick people. At home, I am supporting my significant other as he tries to find his way in a new industry at a startup company. In the last week, my dad just had open heart surgery. He is doing great, but it’s a long road to recovery. On top of this, my aunt is in kidney failure and is receiving hospice care. And now, one of my childhood friends is facing the fact that her mom might not survive after a bad fall.

It’s a lot. But I know things could be worse.

I could drown in negative thoughts, but what always brings me back to the surface is gratitude. The first thing that comes to mind is how lucky I am to have so much love in my life. I truly mean this. When shit is hitting the fan, the reinforcements appear – my family and friends! Even though I am so independent, they allow me….no, they remind me….to lean on them. I don’t have to hold back tears, force a cheerful hello, or hide my feelings. How lucky can one person be?

My experiences over the last year have reminded me that healing is an ongoing job. I am reminded by something an old boss said to me when I was feeling overwhelmed:

“How do you eat an elephant?

One bite at a time.”

Bon appétit!!!

I Want To Forget

I am a Trauma Nurse and I think something is wrong with me.

Lately, I wake up in the middle of the night, sometimes to go to the bathroom, but mostly just because I can’t sleep.  Tears flow very easily these days when I hear a touching story on a podcast, witness tender moments on television, or expose myself to the world tragedies broadcast on the evening news.  Eventually, it stops.  Eventually.

I don’t know when I got to be so sensitive.  Or perhaps I have been sensitive this whole time.

Other things in my life seem normal like eating, drinking, and socializing with friends and family.  I find ways to have fun and connect with the people I love.  It makes me feel almost normal.

But then the sadness strikes when I am alone, or even just feeling alone around other people.

Can it be that my return to working in surgical trauma has reminded me of how heartbreaking this world can be?

I have been in operating room nursing for 13 years with over half of those spent at a Level I Trauma Center.  I can’t remember feeling this way.  I can’t remember crying like this.  There is a distinct possibility that I have done what I usually do:  compartmentalize my feelings until I am ready to confront them.

And so here I am.  Dealing with This.  Now.

The emotions emerged after caring for a trauma patient.  He was a gunshot wound victim.  Just a kid barely in his teens.  The entire surgical team worked together to save his life.  We really tried.  We did everything humanly possible that we could do.  Everything.  We tried everything.  He didn’t make it.

His life ended in front of our eyes.

And he was just a kid.

I have been an operating room nurse for 13 years with over half spent in trauma and that was the first time I ever had a patient pass away on my watch.

It was the first time I had to clean the body of my patient, a victim of gun violence, and make him presentable so that his family could view him.  My friend, another trauma nurse, had to show me how to do it.  With tenderness and compassion, the two of us wiped away blood and betadine prep solution from his torso.  She gently cleaned his baby face, covered him in a fresh green gown and blankets, then positioned his hands so he looked like he was sleeping. The learning continued as she walked me through the finer points of hiding the body bag under his body with some bedsheets because how terrible would it be for his family to see that.

How terrible it felt to do all this…

We waited and hoped his family was somewhere in the hospital.  We hoped that they would get to see him before his body was sent to the morgue.

But they weren’t there.

And so, for the first time, I closed the body bag of a teenage boy who died of a gunshot wound.  And, with my friends, helped move him onto the unpadded, cold, steel-framed morgue cart.

This night…  I want to forget.