Now this is a story…
“All about how my life got twisted and turned upside down.”
If you recall the show Fresh Prince from the early 1990’s, then you will likely recognize these words as part of the opening line from the TV show.
If this doesn’t sound familiar to you, then…
I’d Like For You To Take A Minute…
And just sit right there, and I’ll tell you how I became…”
A nurse in the ER.
It All Started in 2010
(Trigger Warning: This is a true story about a patient that emotionally impacted me in a way that I questioned my entry into this profession.) In 2010, I had been a nurse for a little more than 2 years and in healthcare since 2006. To say I was a “Newb” is an understatement. I had 3 days left of my orientation and I made the comment to my VERY experienced preceptor (30+ years in Emergency Nursing) that I hadn’t had my first code or trauma yet. Yep, I was that orientee. You know, the one that asked question…after question… after question… And I just had to state the obvious, like not having my first code blue or my first trauma patient yet.
And Then The Call Came
2 hours passed by and then the call came that I was eagerly anticipating. The call came across the radio in the Emergency Department.
“Be advised that we are on-scene of a 1 car MVC vs telephone pole. 4 occupants. 1 injured. Prolonged extrication. Will provide further updated on extrication. All patients A&Ox3.”
At this point, we began preparing the team and gathered our supplies. There wasn’t anything else that needed to be done. It was encouraging that the occupants were all appearing to be stable. 15 minutes later a second call came through…
And Then The Second Call
“Be advised, transporting 3 of 4 occupants. Driver is unharmed. 2 pediatric patients from back seat also unharmed. Transporting for further evaluation. The front seat passenger is a 29 year old female, A&Ox3, respirations even and unlabored. Non-rebreather with 15liter per minute. Fully immobilized. Very pregnant.”
“Very pregnant.” What does that mean? I didn’t have any experience with pregnant patients at this point other than my experiences in nursing school. And those experiences were minimal. My experiences taught me, send help from the Women’s Health nursing team and punt the ball to them. Well, not really “punting” anything. In the Emergency Room world, we know our strengths and we know our weaknesses. Babies and Mommies who are ready to have babies are not our top strengths. We just know when to ask for additional help. When we heard the radio say “Very pregnant” many of us became somewhat uncomfortable. These were the words that made everyone in the room get more concerned. This was the moment for which I had been preparing. I had not had my first trauma patient yet. Now was the time.
The Moment of Excitement
Unsure what “very pregnant” meant, we called for OB to be available. The driver, was a 30 year old husband to the front seat passenger and he was unharmed as were the 2 children in the back seat. His wife, “Amanda” (name changed intentionally) was a 29 year old female and mother of the 2 children who were in the back seat. The EMS crew from the local fire department arrived, entered through the EMS entrance (a sliding door that is separate from the normal entrance that the majority of patients enter) and we observe the EMS crew now “bagging” her. This is a term often used in medical circles to indicate that the patient is no longer able to maintain breathing on their own. They require us to use artificial means to breathe for them. The device used has a mask connected to a silicone bag that is squeezed to fill the lungs with air. It is often a sign of deteriorating health conditions. After asking about a pulse, I then palpated her neck, discovered an absent carotid pulse, and then began performing chest compressions — the beginning stage of Cardiopulmonary Resuscitation (aka CPR). We later discovered that Amanda was 40 weeks pregnant.
Performing a Cesarean Section in the Emergency Department
Knowing that Amanda’s baby was at risk for losing its life, the difficult decision to perform a Cesarean Section in the Emergency Department (something that we never attempted prior to or since this event). The OB/GYN was in the hospital and responded to the Emergency Department. After a quick surgical prep of the abdomen with betadine, the baby was delivered. APGAR 0, crushed skull. This image continues to be burned in my mind since this event. Moments after delivery we regained a pulse on Amanda. The provider successfully intubated her. We provided advanced medical support with medication, a rapid infuser to quickly dump IV fluids and blood in her unstable body. A second team continued care on Amanda’s baby in the next door trauma bay. After 30 minutes, the baby didn’t survive it’s injuries. It seemed all hope had been lost. and then…
A Glimpse of Hope
After 3.5 hours of intense medical resuscitative efforts and a c-section in the emergency department, we transferred Amanda to the nearest level 1 trauma center by helicopter. We had continued to have a centralized pulse and a blood pressure with the intensive care measures in place. The amount of care provided was great by any measure and it was looking like Amanda had a chance for a recovery — a grueling recovery nonetheless.
A Feeling of Defeat
Though these efforts were heroic, the impact of this event was too traumatic for Amanda’s body to recover. Upon landing at the nearby transfer center, Amanda lost a pulse again and it was determined that she would not survive further measures. The trauma center medical team decided to cease further care measures. We were then contacted by the team to notify us of the cessation of care. Our efforts felt unsuccessful. We felt defeated. Once we were notified, a somber quiet echoed throughout our rural 24-bed Emergency Department. Her family — including her husband and 2 other children — had already left our facility and would then receive the tragic news that mommy was never coming home. This hit me hard. This event was 12 years ago and I still see it and feel it like it was yesterday. I was a new emergency department nurse and had only been in healthcare for 3-4 years. This event impacted me in a way that I didn’t know was possible. This event changed my life and set the stage for the support I expected throughout my career.
The Traumatic Support
After approximately a week a nursing director was asking me how I was doing. I gave the same proverbial response I had seen others give. You know the one… “I’m ok. Really. I’m just out here living the dream.” Not sure who’s dream…more like a nightmare. I digress. She then asked, “I mean how are you doing after taking care of that MVC the other day.” Notice the words…”that MVC”. Not “person”, “patient”, “mother”, “daughter”, “girl”, etc. “That MVC.” I responded, “I’m not doing well. I haven’t slept well in days and I keep replaying this over and over.” Her next words to me were like nails on a chalkboard. Words I will never forget. “It’s ok. You will just get used to it because it is just part of the job.” These words set me on a path for destruction instead of hope and healing. I praise God that this isn’t the path He chose for me.
Real Problems Require Real Solutions
This event shaped my path forward to help bring awareness of mental health in healthcare and teach others how to respond with #empathy when others are hurting. This event helped me to understand that the answer must be trauma informed evidence based and biblically centered. This also taught me that it takes 1 peer to make a difference — a positive impact. Peer Support is the answer. Organizations that support the well-being of employees see decreases in turnover and additional spending and see increases in retention, health, and the bottom line. A study by Johns Hopkins University indicated that with each peer support utilization, organizations saw a cost savings of $23,000 (using a nurses salary as a figure). Our H.E.R.O Peer Support Team Training addresses this gap and helps offer REAL support for employees. By supporting your employees, you create safer, healthier, and more resilient organizations. As a reminder…1. Escape BURNOUT2. Enjoy life