A Day Away from the ICU

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The Beauty of Birds

Having a chat

Easy breezy. No stress here.

This little fellow showed me how to fly on Pier 60, Clearwater Beach, Florida. August 2021.
Learning to fly with crosswind complications.

Freedom of Choice

As an intensive care nurse, with twenty-seven years in healthcare, I sympathize with the families of those patients for whom I have had to give postmortem care every day at work. Especially if their loved one chose not to wear a mask or get the vaccine to protect themselves and their family during this awful pandemic. I have these thoughts that if you choose not to take any precautions then, at that point, you should probably just go ahead and sign a Do-Not-Resuscitate form and a Comfort-Measures-Only form too, at your doctor’s office.

If you sign the DNR and CMO forms in advance, your death at home will be quick and you will save your loved ones endless hours of agony and suffering – if they did not get infected by you. Not to mention countless prayers and science based efforts on the part of the educated professionals who will be caring for you. Or the life of a veteran who might not get an ICU bed for treatment to save their life from other conditions. Think of the hundreds of people who will pray for your recovery. Prayer is a powerful force, however in my recent experience, the will to prove a point and die doing it is almost as powerful. With what we know about the spread of this virus and how often it replicates in the host, an unvaccinated human body, the choice to refuse the vaccine, in my opinion, should be construed as nothing more than a cavalier death wish. It will cause your loved ones a great amount of pain and sorrow which might otherwise have been avoided.

It seems at least contradictory and at most idiotic, to my mind, that someone would expend valuable energy to denounce medical-factual knowledge (not opinion), by first refusing to wear a mask and then decide to decline the privilege of being offered a vaccine to prevent them getting Covid-19; this in the name of Freedom of Choice! Those same people, and there have been many, once infected with the virus come running to the hospital seeking medical attention. What? We do not exist in your delusional mind until you need help or you want to be cured? Obviously you have not thought this all the way through. You must understand one very important fact, your Freedom of Choice ends when you decide not to wear a mask or get the vaccine. Thereafter, if you get sick, Covid does not care what your politics are. Most likely your loved ones will be making your choices when you are put on life support, and that comes quickly.

You do not get to choose if you will be able to breath on your own, you do not get to choose the size of the ET (endotrachial), tube they insert into your throat and strapped to your face by a tape that winds around the back of your neck. Breathing through an ET tube is like breathing through a straw, but it enables your breathing rate and volume to be controlled by a machine. Go ahead and try this at home to get the idea. You do not get to choose the rate, volume, or model of ventilator you will be hooked onto, to make the gas exchange for you manually in order to save your life.

You do not get to choose which six, of the eight nurses on shift that day, are assigned to turn you onto your belly for 18 hours or flip you back afterward for 6 hours on your back. Everyday we do this to help your lungs cope with the glue-like substance that Covid-19 forms in them. This glue solidifies in the place where the body’s natural gas exchange occurs, where you take in oxygen and blow off carbon dioxide (CO2). This thick, sticky substance prevents your lungs from expanding fully, so it feels like you are drowning and unable to catch your breath. You will end up gasping and contorting like a fish snatched out of the water and abandoned on the beach. The ET tube attached to a ventilator is the only remedy for this.

All of the other organs in your body depend on oxygen to keep working, that means your brain, heart, kidneys, liver, and gut etc are unable to function normally. Over a short period of time, a few days, there is a shift in body chemistry usually CO2 build up, an acidic gas that retains heat, because your lungs are unable to blow it off. Frantic attempts are made to balance it, by infusing sodium bicarbonate into your blood stream, to save your life as the other organs start to shut down. It is neither pretty for the patient nor for their family who call every day and start prayer groups at their church. They make hopeful calls to the intensive care unit daily only to be faced with the dire truth of the matter. No visitors are allowed into Covid rooms. We can face-time with families on secure lines set up by the hospital, but this is hard on everyone.

You do not get to choose which of the many IV drips they infuse into your veins to sedate you, paralyze you, keep your blood from clotting, or your blood pressure and heart rate in a range compatible with life. You will be choosing none of that. Specially educated nurses of many years experience (and some newer ones), and residents with two to three years out of medical school experience, under the direction of the attending MD, will be making your choices for you. Respiratory therapists and bedside nurses will see to your every need in a last ditched effort to pull you back from the edge. It is what we do, what we have always done.

Nurses are taught to stay objective about their patients, but I know from working in a team of nurses that every once in a while a particular patient will touch the heart of a nurse. We care for people in the scientific sense. We give care, we do nor take care of patients. Taking care of someone is a codependent pursuit and normally occurs in a family setting. Nurses give science based care derived from data. We replace body fluids, electrolytes, and blood working from labs drawn by phlebotomists. We treat pain, wounds, bedside dialysis and drains. We monitor our interventions and we follow hospital policy for how to do certain things. We document everything and report back to residents, physician assistants, nurse leaders, and nurse managers. A twelve hour shift can go by in a flash because we are so very busy all day long. We take new doctor’s orders and carry them out. We take calls from family and get them the information they need. We are patient advocates who converse on your behalf with all the other departments in the hospital.

If you happen to be the nurse of that one patient who touched your heart, (whether they are twenty-something years-old to eighty-something years-old), Covid does not care. When things start to go south, it can be devastating. Then there are the last ever face-time calls which can be brutal for everyone except the non-responsive patient. You stand there at the bedside holding up the phone, out of view of the family who want to desperately feast on what crumbs are left of their loved one. That’s a good time to cry, right there. But you have to get it together quickly to respectfully do postmortem care and get arrangements made to get the room flipped so you can run to the ED to bring back your next patient into that room.

Maybe you will be lucky and not get COVID, but if you do get it or carry it and unintentionally give it to someone you love, this is what happens. Think about that for a minute. I believe in freedom of choice too. However, my choice is to protect my family, from the very young members to the very old, my friends, my neighbors, and my co-workers. What you do with your freedom is your business, that I agree with one hundred percent, but when you are making important choices it is best to first be informed, right? This is friendly information from inside the hospital that I am sharing with you here that you might not get to see anywhere else. Use your freedom to choose carefully. That’s all. ♥️

A Neuro ICU Nurse’s Prayer

What an absolute priveledge to be in the middle of this love affair between a man and a woman. There lies my patient, in desperate need of my professional care while being thick in love with this woman by his bedside, his wife. Her anguish is palpable to me while the blood inside his head has removed him from the stark reality she faces alone right now.

Please God allow him the comfort of your precious time and gracious healing. Please help me to find words to comfort her. Help me find the interventions to pull him back to her. The neurosurgeon has performed his work with God’s hands, champion of learning, archangel of life’s greatest dream. He has wielded his magic one more time. Pulling together all the years of sleepless nights, learning and sacrifice to perfect his lonely magnificence; to save a life.

Please God help me to use my twelve hours today to bring my patient home – home to his consolidated family, built on love. His kids, her kids and the baby they made together about to start college this fall. Dear God help me to give that part of me you gave to me to make this family whole again. Un-break all our hearts.

Amen.

The Soul of a Nurse

So grateful to have my little itty bitty article published in the biggest nursing magazine in the USA. 💜x

The soul of a nurse

By Kathleen Sullivan, BSN, RN

In the beginning

What is that first spark of desire in the mind of an ordinary person to become a nurse and where does it come from? Could it simply be the desire to help others, in a more definitive way, or is it a nudge from the divine? Maybe, it’s purely the natural evolution of an essence, present in a child, to guide them toward their destiny, just like in the evolution of life itself?

Many of today’s nurses have never known any other career and were fortunate to fall into the profession early on. Some of us took a more convoluted path toward our ultimate destination. Statistics show us that hospitals all over the world continually mix new hopeful grads, who know nothing of the “good old days” of nursing with long-timers. This mix of fresh novices with seasoned nurses could easily equate to an artist’s palette that yields a variety of textures and colors bursting to create a great masterpiece.

In the beginning, there may only be a vague idea in the mind of a nurse as to how they want their career to turn out. This would be similar to when a poet sits down to commit to paper multiple phrases circling around them. The first steps in a career of nursing could also be compared to the first few stumbling notes on a piano when a composer sets out to write a symphony. Nursing is all of this and more. Whatever drew us into it, we all share the same burning desire to help the sick, the weary and the worn amongst us. Disease comes in many forms as do our valued nurses and support staff in any hospital. 

Sacrifice

What, you may ask, is required by society for a person with good intentions to become a nurse? The attainment of the dreaded college degree lies in wait for those brave souls who would dare to become a nurse. In hallowed halls that reek of austerity and lined with portraits of past honorees of phi theta kappa and magna cum laude, they trek a solitary path towards personal greatness. The prelude to this would have been the achievement of a high-school diploma, or in the absence of such, a couple of years of prerequisite classes followed by an associate of science degree at a local community college.

It’s the work of a nursing college professor to mold, or in some cases rebuild, the applicant into the well-rounded professional they aspireto become. This includes endless hours of self-study and homework assignments. Anyone who has worked hard for something in their life can relate to the effort required to achieve this kind of dream. The sacrifices made are enormous. 

Personal free time has to be ditched while friends go out to party and live life. Family gatherings are missed and holidays are left uncelebrated as the burning desire to become a nurse leads the person to burn through textbooks and lecture notes, in pursuit of that Holy Grail—the nursing degree. Students are taught that nursing is an art and a science. The science part comes in the shape of a 4-year baccalaureate degree from an approved college or university. The art comes after the absorption and ownership of the knowledge in the subsequent application of it. There is no education for the art. It has to be an entirely individual creative expression of the science. Each nurse will find their own personal style and create a unique piece of art just like any other artist in the world might do. 

A day in the life

Punching-in on the time clock might seem like an ordinary thing to do, like an assembly line worker at a car plant up in the northern states. However, a nurse who punches in is committing to the belief that, within that measured amount of time, a difference will be made in the life of another human being. The difference may be slight or life changing. No one knows at that precise moment what will unfold during one 12-hour shift. The possibilities are infinite. 

From the moment a nurse awakens in the morning to when they punch their number into that time clock, deep-rooted preparations inside a soul are being made. A fresh page of desire and fortitude has opened inside that heart. During the drive in to work, some say prayers, others meditate, and still others blast music and sing along. They do whatever it takes to get to the mindset needed to unleash every drop of courage for the battle ahead. 

Hope, respect, knowledge, gratitude, confidence, and technical abilities rush to the surface. Nurses bring all these gifts into the hospital daily in the pockets of their uniforms and in the deeper pockets of their souls. Also rising are the endless amounts of wisdom accumulated through generations of nurturing and love from their upbringing and the life experiences of parents, grandparents, great grandparents, and beyond. Through the scientific study of human chromosomes we know that, in part, our ancestors are us and we are them. Might this molecular information allude to where nurses are really prepared for their day and their career choice? Could this be the blueprint right here? 

The battle

The magic happens when nursing staff on any unit, on any given day, come together to save lives with other medical professionals and support staff. An example of this is when the code-blue alarm rings and we run to take a stand at the bedside of that patient. We are present in the moment to follow policies and protocols as defined by hospital administration and national governing bodies. We gather at the bedside of a patient who is failing and not responding to treatment. One or more of their vital organs is not working. What each of us does, during those 20 minutes or so, will profoundly affect the patient and their family for years to come.

This is where the science comes to the forefront, but there is also a spiritual component to be found in the art or application of that science. There is awareness that each of us has a soul that answers to a higher countenance. Nurses give their whole selves every day in mind, body, and spirit. It isn’t just a job on a production line. Nursing is a total commitment to a way of life, a vocation, a calling to which not everyone gets the call or text.

Who or what are we fighting with? Some may say they are fighting illness and widespread disease in the community where they tirelessly work. Others may say they are fighting against a political system in which some easily survive while others suffer greatly. Those of us who have been doing it for a while know that what we are actually fighting is time! There is never enough of it—nor staff, nor stuff—to do the job in the way we were trained to do. We do our best with what we have in the battle against an out-of-control pandemic. We are all of us chasing snowballs down a vast and unforgiving slope.

History and future

Where break rooms once echoed with stories of legends from another time, there is only silence punctuated by the sounds of grab bags and lunch pails being rifled. There is no time to talk anymore. Nurses must eat quickly within the designated 30-minute break and return to work immediately. 

Twenty years ago, the average age of an intensive care RN was 45years old. It might have slipped lower now with the influx of new grads into the critical care arena. What these new nurses lack in experience is compensated by the backpacks they bring loaded with new and efficient ways of doing things, higher energy, and good intentions. Some are a force to be reckoned with and shine light on the future of nursing. Many are fast tracking upwards in the education domain toward attaining master’s degrees with hopes of making it all the way to nurse practitioner status, just like many before them. 

Older nurses, with a high ability to adapt and teach from the experience amassed during countless years at the bedside are fading out. This is all part of the cycle of evolution as it pertains to any profession. Who will be at the bedside when they are all gone? That is the emerging question for hospital administrators all over this great country of ours, as the middle age-range of nurses have gone off in search of better working conditions elsewhere. Many of them took off from regular jobs in local hospitals to work in corona virus cluster areas around the country. 

Nursing colleges are reporting a boom in applications for admission because people were inspired by images of bravery and devotion when they saw nurses on the television during the early days of the current pandemic. There is new hope for the profession as each new generation brings with it current learning in scientific breakthroughs and also the up-to-date application of it. Nursing is both a science and an art form. In the United States, the nursing profession is currently composed of the soul of many nurses—four million strong. 

Despite the current chaos and drama in hospitals brought about by the pandemic and nursing shortages, it remains our hope as nurses that the whole will represent more than the sum of all of its parts. Every touch of love and act of science-based care should be counted toward victory in the end. 

Kathleen Sullivan works as a neuro ICU nurse in St. Petersburg, Florida.