Tag: Nursing

Goodbye, ICU

On By Tribal QueenIn Uncategorized

Tomorrow is my last day as a bedside nurse.

And today is Nurses Day, or more legalistically, Florence Nightengale’s birthday. Her official title when you google her is Statistician. And yeah, that’s accurate, but she was a nursing statistician. She brought statistics, empirical data, and the scientific method into the nursing field, and her actions bettered the world you live in today.

Tonight, I came home after my shift to find my face covered in zits. Well, maybe not covered, but a significant outbreak has occurred, folks. Red alert. I repeat: Red. Alert. Puberty HAS RETURNED. All in a 12 hour span.

In the last 2.5 months (yes, that’s pre-pandemic for those of you counting), I have gained 20 lbs.

On average, on the nights surrounding work, I get about 5 hours of sleep. That’s mostly from anxiety. Some of you closer friends may know, but I do fight both depression and anxiety. (See The Pokey Green Monster series earlier in my blog.) Anxiety manifests in me as tension and inability sleep, bitterness, sharp and hateful words, and at times, difficulty breathing. Depression manifests as an inability to move. Like, I’m lucky if I can get up to go to the bathroom. Now you’re starting to understand the 20 lbs and lack of sleep. Alcohol helps, but when you use it as a dependency and evasion tactic, that’s called alcoholism.

Tomorrow is my last day as a bedside nurse.

I have worked in the Operating Room on the urology team during the day and transplant team at night. I have worked the Burn ICU. I have worked in 9 different states as a travel nurse. I have worked in every ICU except neonatal. (Every one needs a hero, and NICU nurses are mine. Ain’t no way I’m touchin’ a baby that small with an IV needle.) I have worked in the Emergency Department. I have worked in union hospitals and non-union hospitals. (Believe me, you get better care as a patient in union hospitals.)

I’ve held hands of people as they died and then put their body into a bag. I have told mothers their sons were alive. I have seen a burn patient take their first walk in new skin. I have seen a patient drain the orange from their skin in a matter of minutes after a liver transplant. I have consoled families. I have broken ribs during CPR. I have been kicked in the chest, punched, scratched, groped, stalked, and threatened. I have walked out of a newly dead patient’s room and next door rejoiced with the other patient that her biopsy was negative. I watched a Disney movie with my patient when his mother couldn’t be there because of a pandemic.

There are some patients from last week whose name I can’t remember. But there are others I will never forget and I truly hope to see them in the afterlife. There are some that I pray for every day. And there are some that I still struggle to forgive.

Tomorrow is my last day as a bedside nurse.

I am so grateful for the knowledge this career has given me. I am so grateful for the empathy and experience which it has graced me. And I am so done, so tired, so burned, so exhausted, so muddled. I don’t function well anymore. My priorities have altered, my relationships suffered. I am hardened. I am harsh. I am bitter and judgmental. I am not the person I want to be. I used to be joyful, childlike. I want that back. Is that return possible? I think so. Look at people like Fr. Roman Braga; he told the silliest jokes to me as a child. And yet, he spent some horrifying years in Romanian Communist camps.

Monday I begin a new job as a clinical coordinator for a kidney transplant team. I’ll be working with the living kidney donors. Benevolent, healthy people willing to give an organ to another. Healthy, happy, kind people: not exactly the people I’m used to caring for. And here I am, in the middle of a respiratory pandemic, leaving the ICU. There’s a lot of guilt about that. From myself, but also from other nurses. We’ve all got to walk away at some point, even Flo did. (Literally, she was bedridden towards the end of her career and suffered from depression.) I have hit my breaking point in that I feel I’m no longer doing my patients any good. I can physically do the job, but humans don’t need a robot completing tasks, they need another human to care about them. And that requires empathy and energy. I am surprisingly low on the first, and running on empty with the second. A large part of that is working through the first round of this pandemic, but let’s be honest, I’ve been worn by this job since day one. A horribly painful and virulent disease exposing our entire nation’s healthcare system as a house of cards…that didn’t help, but it’s not the primary reason I’m leaving.

More on my experience working with COViD patients later, but for now, I have to get up for work in the morning.

Something is on the Tracks

On By Tribal QueenIn Uncategorized

I don’t open up much to my patients. Three, to be exact, in my eight years of nursing, that I’ve shared with personally, who I’ve opened up to show my own humanity. Today, I had the honor to meet that third patient. She is kind. She is smart. She is engaging. She is helpful. She is gracious. She’s also a Nationals Fan. So, even on the night the Cards were swept out of our Series run, I sat by her bed talking about Frank Robinson and exclaiming at stellar pitches or close calls.

We bonded over Little Toot, our favorite children’s book, and our mutual experiences (and love!) of working in libraries. We swapped stories of meeting famous broadway stars and New York Times writers. We spoke of beauty. We spoke of awe-inspiring experiences. We shared our lives with each other. We shared our humanity with each other.

On my drive home, I wept for this woman. I wept for the connection we made, the humanity we shared. I wept over her decision to buy plane tickets to Barcelona instead of buying chemo treatment. I wept tears of gratitude for her.

As I crawled into bed with an episode of Downton Abby, I came across a scene in which Mrs Crawley exclaims at Mary’s new nursing skills while taking care of Matthew. Mary responds with a general, oh, he’s family, it’s nothing. And Mrs. Crawley responds with, “It’s the opposite of nothing.”

And here I am, weeping again. Because human connection is exactly that, the opposite of nothing, it is everything. It is worth giving up everything. It is paramount to our existence. It is, in fact, the only way towards survival.

Joy and heartbreak come together as railroad tracks, running along side each other, while our lives travel on top towards our destination.

Alignment

On By Tribal QueenIn Uncategorized2 Comments

Travel nursing is great. Like really great. And know, when I say this, that includes the fact that I don’t actually like being a nurse. There are pros and cons to the job, but overarchingly, I’m not a fan. If I could redo my career, I’d study ecology or forestry. But travel nursing makes an OK career great. It allows me to do, not all, but a good chunk of things I love and my life is balanced once again.

One of the downsides to traveling is that your life is rather hectic. If you want a calm, predictable lifestyle, agency and travel nursing is not for you. Deadlines, competency testing, drugs tests, moving, living out of your car, and change, constant change with no consistency becomes your life. The focus becomes on survival. And I love it. It keeps me on my toes. It keeps me in the zone.

But sometimes Survival is arduous.

My goals. My beliefs. My standards. They all suffer when Survival becomes priority. I took this past week to refocus on those. I had to dig deep to figure out both the Survival part and the GBS part (Goals Beliefs Standards).

When I’m not travel nursing my life away, I quickly feel stuck in a rut, in a box, a box with walls I both don’t want in the first place and also can’t break. But I knew the longer my focus remained on the survival, sooner than later, I would be stuck in a similar box with similar unbreakable walls.

So while these are personal and I am honestly not looking for feedback or affirmation from any of my limited readers, here is my statement of alignment. Here I am, placing the Survival inside the GBS. The alignment of beliefs and actions. I write them down to make them real. I publish this to hold myself accountable to my beliefs.

Stabilize My Life

1. My relationship with God:
-Pray formally at least twice a day.
-Remember God more often.
-Thank God for food, life, good things.
-Read the Bible daily.

2. My relationship with others:
–See people for who they are, not what they can do for me physically or emotionally.
-Help someone daily. Help them with something THEY need or want, not what I think is good for them.

3. My relationship with myself:
-Practice and cultivate gratitude.
-Practice and cultivate joy.
-Make healthier decisions for my body and for my soul

Within these new stabilizers I have given up beef and other red meat. I have stopped drinking alcohol. I read during my lunch breaks instead of scrolling through my phone. I wake up at the same time every day. I finish my day by writing at least three things I’m grateful for. I pray. I go to the gym after work. I hike and rock climb every day I’m off work.

Within the two weeks of working on these, and I am more alert and aware. I am happier. I interact with others more honestly. I understand my own needs and wants more clearly. I am able to focus on the GBS more acutely. I am more me. I am more of the me I want to be.

My Grandmother’s Education and Mine.

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My paternal grandmother studied nutrition. In the 1930s and 1940s, teaching, homemaking, and nursing, were really the only options. My aunt, also a nurse, mentioned to me recently that she didn’t know until she helped her mother write her memoirs, just how much of her life, all of her life, it seemed to my aunt, revolved around clothes and food. She made the clothes for her children. She fed her family, and damn, she was going to make sure they ate as healthy as modern science could teach us. Unfortunately for my Dad, that meant liver at least once a week. Thankfully, we’ve figured out how to get our iron efficiently enough without my parents’ generation overcooking liver once a week and I am grateful for that scientific knowledge.

Clothes and Food.

I don’t think I can claim either of those interests alongside my grandma. Knowing her later in life, she was well-read, well-spoken on numerous topics like education, music, politics. She was active on boards of nonprofits. She helped form music programs for both children and adults. She’d travelled all over the world. And that is one of the attributes I really clung to of my grandmother. She travelled so she could learn. She wanted to learn about people, get to know the people, their culture, and their thoughts.

Clothes and Food.

I wish I could ask her, “was there something else you wanted to study in college?”

Part of this question comes simply because I am reading Virginia Woolf’s A Room of One’s Own for the first time. She posits the theory that historically, women have not had financial or physical freedom to gain an education and have uninterrupted time to develop their gifts, such as writing or painting.

My mother’s office is the thoroughfare to my parents’ bedroom. My dad used to use that as his office, but when the kids slowly moved out, he commandeered one of our old rooms as his office. My mother could do that. No one would blink if she did. I know she usually reads my blog though, so watch out for a comment below. There may be a good reason for it. But it seems a hectic place, it seems a place that one can’t close the door and think or study.

As a parent, either male or female, I think you lose that ability, the space, the room of one’s own.  But I also believe it’s important to fight for and maintain that space for ourselves. A place to think, to work, to write, to create.

One of the struggles in my relationship with my now deceased grandparents, was that when I announced I would be studying music history after highschool, they told my parents to make me major in something “useful.” After ending with a degree in music business, I went to nursing school. I think that’s what they meant. Something useful. I think music is more than useful, but that’s another blog post. I am grateful my parents stood by my side both literally and financially in my musical studies. I am a better person because of that training and education. I truly believe the experience makes me a better nurse. Read that again. Music and liberal arts training has made me a better nurse.

But I still wonder, given the financial backing, the emotional backing, by her parents and by society, would my grandmother have studied something differently? How many women would have studied something differently?

My brother made an interesting comment about the scouting experience of his children recently, in that through scouts, they see other options for careers than teacher, mailman, accountant. (The teachers at their school, my brother works for the post office, and his wife is an accountant.) What someone is exposed to makes their decisions for them. It truly is a cycle. After my music degree, I felt lost. I looked around at people in my life, friends, family, who were happy, and most of them were nurses. I’m grateful for my medical training and the experiences I’ve had as a nurse, but if I knew then what I know about myself now, I wouldn’t have gone to nursing school. I would study ecology or biology. (Part of that is my insecurity with math and science throughout college. I always thought I was “bad at math” when in reality, I think about numbers differently than most teachers teach about numbers. This began in 1st, I repeat, 1st grade. I remember having panic attacks thinking about math class as early as age 7. And this spread through math and science and lasted well in to my adult life. I love science and math. I am actually good at it. And if I had realized that at a younger age, my life would look very different. Encourage girls in STEM. We need all the help we can get.)  

What we see around us is normal and accepting. What we are encouraged in, we thrive in. Those freedoms are very much founded in the physical and financial abilities such as having a place to study in uninterrupted.  Provide and encourage—our world will be better because of it.

Life Lessons from Nursing

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1. Doctors are humans too. Every member of the team can make a mistake, so be vocal when you’re confused or have a concern. You’ll either learn something new or catch a potential problem. Patient safety is my priority at all times. (Sorry, hospital administrators, but it’s not patient satisfaction. Safety will always trump satisfaction.) And the best way to prioritize that is by double checks, expert advice, and allowing everyone a voice. My resident the other night caught something I’d missed. The next night, I caught something he’d missed. It’s a team effort. Neither of those misses caused harm to the patient because the other team member caught them before they reached the patient. 

I had a patient years ago with a low hemoglobin. No one could figure out why and it got low enough that we had to transfuse at least two units of blood. The day after the transfusions, the lady who cleaned the rooms came to me with a trashcan from the patient’s room. She told me she thought I’d like to see what was in it. Piles and piles of bloody Kleenex. The patient had been throwing them in a trashcan on the side of the room I rarely walked to, and we’d all missed the now obvious problem of chronic nose bleeds that the patient hadn’t thought important enough to bother us about. All members of your team are important. 

2. Look at your patients.  Like actually look at them. Don’t just look at the labs or the monitor. Really look at them. Listen to what they’re saying, verbally, with body language, and their breathing. Half of your head to toe assessment is done between the door and the bed.

Don’t just listen to what someone says to you. HEAR what they’re saying to you. Be present and available when you interact with anyone. Be honest with the people around you, be real, be open, because you may need someone to truly hear what you’re saying some day too.

3. The day you stop studying is the day you should think about switching careers. This world is amazing. The scientific world alone is so detailed, so intricate, you can spend your entire life learning about it, and never come to an end. And that’s just science. Add literature, art, music, social sciences, and you’ll never be bored. Learn. Dig deep to understand something new. Study for that new certification. Someone prescribe a new medication? Read up on it before you administer it. Ask for explanations. Research the answers from a reputable source. Never stop asking questions. Never stop learning. 

4. Inpatient care is important. Give bedside care a shot. Learning how to care for someone completely reliant on you is eye opening. Their food, their movement, their water, their breathing, their basics of all functionality, rests on you. But if it’s not the right fit, move on. Take the experience, then find something that works for YOU. Nursing has this amazing plethora of options to experience, and they’re all wonderful. SANE and forensics nursing, insurance, education, clinic, research, public health, flight nursing, hospice, legal consultant, dialysis, case manager, academic writing…pick something. But give inpatient nursing a shot. Even if it’s not right for you, it’ll teach you important skills and perspectives that will help in your life and your career.

5. Know the drugs you’re dealing.  Know the generic and the brand names of the drugs you’re working with regularly. Peeps in America use them interchangeably and patients may know one name, but not the other. Always look up unfamiliar drugs before administering them. The one time you don’t, will be the time the patient or family has 10 questions and if you can’t answer them all–you’ve lost their faith, which is rarely retrievable. But more importantly, the one time you don’t look up the unfamiliar, is the time you miss some detail like, it worsens liver failure and your patient is already jaundiced. Refer to number 1. Every member of the team is important because patient safety relies on the Swiss cheese holes mismatching enough that nothing falls through.

6. Hire a CPA.  My life supposedly “slowed down” this past year. I still worked in 4 different states, and had two different state residencies, one state which I never actually worked in. My taxes are complicated. I study regularly to keep up my nursing skills. I can save someone’s life, but I cannot interpret tax forms and questions from the IRS if my own life depended on it. And that’s ok. Be OK with what you don’t know and ask for help. If that’s with your taxes, OK. If that’s with a healthy diet or how to exercise, or how to change a tire, that’s OK. We can’t know everything in life, but we should know how to find the answer, and that usually involves asking an expert in the area.

7. Get the hell outta Dodge every once in a while. As much as I advocate throwing yourself into your career through study, time, energy, and passion–take breaks, and take them regularly. Find a hobby, an outside passion, something to remove you from your day to day. Monotony will kill you emotionally and mentally, kill your passion for your career, and those two combined could physically kill a patient. I hike. My free time consists of hiking, preparing to hike, and writing. I spend time studying every day, but if I don’t mix it up, change my scenery regularly, and give my brain a break, I won’t be functioning well at work soon enough. In the ICU, the lights, the beeps, the constant monitoring, causes anxiety. It’s hard to come down from that most days. Won’t lie, a couple glasses of wine after work usually help, but so does being in the woods and climbing a mountain. Replacing heart monitors and ventilator alarms with running water and birds chirping recharges me. Find what recharges you and purposefully schedule regular time for that activity and only that activity. Put away your email, your phone, and embrace whatever it is you’ve chosen as your recharger. You’ll be a better nurse and a better person for it.

Angels Who Cuss

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“You’re the real hero!” That’s sweet.

But wrong. I’m tired of being called a hero. I’m not an angel in scrubs. I cuss. (A lot some days.) I have strong, and at times harsh judgements on other people, even my patients and their family members. I get things wrong. I forget your requests sometimes. Others times, even though I return shortly with a smile on my face, I simply didn’t want to do it and I internally grumbled the entire way. Sometimes, I make up answers to your questions because I’d rather get the info wrong than you lose faith in my care.

Maybe that story of the hairdresser and her picture of the nurse’s sneakers post shift got me thinking about this. I see those articles fairly regularly. I’ve always shrugged my shoulders at them because I never related to them. What is it about my job that makes me superhuman or heroic? Training the average layperson lacks? Willingness to get gross by changing a wound dressing or by doing high intensity tasks such as CPR? Eduction and personality.

I’m doing my job. That’s it. Sometimes I’m better at my job than other times. Sometimes I want to be at my job. Sometimes I don’t. I am getting paid to do what I do. And I enjoy it. I don’t do it out of empathy or compassion, I enjoy it. I understand those aren’t mutually exclusive. The majority of nurses, and other healthcare providers, use empathy and compassion with every patient. But that doesn’t make us saints. It makes us human. Or shouldn’t that be a human trait?

Teachers, construction workers, CEOs, graphic designers, bartenders, Uber drivers, cops, gas station attendants, journalists, computer programers, bankers, chefs, we’re all human. We all have empathy and compassion. We all have gut instincts. We all have mercy. Let’s bring it out a bit more. I’m a nurse, but I’m not in the only career field that needs mercy and compassion. And no one’s career choice should limit or define their humanity. Don’t be the basic bad guy from an 80s film. Be better than basic. Be merciful. Be kind. Be a human.


Also, stop calling nurses angels. We like to drink and we like to cuss. Among many vices.

Tug of War for a Code Cart

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I love circulating and scrubbing liver transplants. Kidneys/pancs at great too, but the livers are fascinating. The organ does so much for our bodies and when it fails or is damaged, the multi system consequences are disastrously….fascinating? Yeah, that’s the word. I’ve learned my sickenly morbid enthrallment with pathophys is almost an industry standard. At least, most other RNs and MDs don’t give the sketchy side-eye when I mention how much I love things like HIV and liver failure.

I’m on call over night for the transplant team with my favorite scrub tech, and really my favorite team from anesthetist to residents to surgeons. Notified at 9pm, set up at 3am, roll back at 5am. Of course we’re delayed. Most are, due to either the donor liver transport if it’s out of house, or the recipient arrival, cooperation, or labs.

The week prior, this same team had run the smoothest code I’ve ever seen in any situation. It was beautiful, a work of healthcare art. And we were proud of it. The experience had brought the whole tam together in a way unparalleled throughout the unit. The transplant room is also one of the trauma rooms, so it houses a code cart 24/7. We check all code carts every 24 hours, regardless of use. Prior to a transplant, I double check the daily check. Another way the OR allowed me to release all OCD tendencies I might have ever had.

At 6am, my patient rolls back. This guy has active LBBB (left bundle branch block, which means his electrical part of the heart is slow in critical places) and lives in afib (a wonky rhythm that drastically increases your risk of clots and hence heart attacks, strokes, and pulmonary embolisms). Regardless of the patient’s heart history, the most dangerous part of most surgeries is intubation and extubation. With livers, repurfusion beats them out, but only barely. Anesthesia resident, propofol given, blade in hand to intubate, is disrupted as the OR door flies open. One of the night nurses, an overweight woman who will pay cash to other nurses to take her surgeries so she can continue sitting in the lounge, walks in and begins to unplug the code cart. She says nothing, makes no eye contact.

“Tom,” I said, holding my hand up to pause the confused resident. “Hold on and bag him for a minute.” He breaths for my completely sedated and now paralyzed patient. I ask The nurse what she needs from the cart and inform her of the obvious, our impending intubation. She ignores me and begins to wheel the code cart out of the room.

I run across the room, intercepting her and stand between the cart and the door.

“The manager wanted the cart brought into the core.” I point out the three other carts we keep in the OR and relay my patient’s heart history. She seems unphased and repeats the managers request, pushing the cart past me. At this point, the phrase, “pry it from my cold, dead hands” might have exited my mouth, but it all became a haze. I ended up physically removing her hands from the cart, plugging it back in to the wall, adding an emphatic, “it stays. If the manager has a problem with that, she can come speak to me herself.”

She left. We intubated.

Shortly after, while anesthesia placed the large IV lines in the neck and the arterial lines in the wrist, I was inserting the catheter. Doing so left handed, I left my back to the door. So when I hear the door open, I make eyes toward my scrub and he interprets it correctly to keep an eye on the code cart. My manager walks up behind me.

Our manager always wears hospital scrubs, but I’ve never seen her scrub or circulate a case. Rumor has it she did open hearts about 15 years ago. Since then, she has suffered from the middle-management curse of forgetting all the knowledge one learned at the bedside, but being forced by upper management to act as if they hadn’t.

“Are you ok?” she asks. I pick up my patient’s penis in my right hand, holding it upright and refusing to make eye contact. The last thing this patient needs is a UTI from breaking sterile technique.

“I’m good. My patient’s pretty sick, but I’m good.” Still no eye contact as I twist the catheter until it pushes into the urethra.

“I heard there was a misunderstanding over a code cart.” I hit the prostate. More twisting of the catheter.

“No misunderstanding. She tried to take the cart, I explained the severity of my patient’s condition, and I kept my cart.” Up to the hub, no urine out. I take my non-sterile hand and push on the bladder.

“Oh. I knew the team had used this code cart last week.” Healthcare art. Word had gotten around. “And I wanted to make sure it was ready for the next transplant.” Seven days of scheduled surgeries and now she’s worried about it. What about the hip replacements all day yesterday? Those can bleed almost as much as a gunshot wound to the spleen.

“In all respect,” more bladder pushing, “we check those code carts every day.” Finally! Urine! It’s gross, thick and red-tinged, but urine. I hate to think what this guy’s creatinine is. “It’s been checked seven times since the last code, plus an 8th time by me this morning before the patient rolled back.” I secure the catheter to the leg, bend down to hang the bag on the table, and stand back up to finally make eye contact. “And we don’t have to move a code cart to check them.”

She looks at me. She looks at the catheter. The room is silent; everyone’s eyes down to whatever they’re working on. Her face morphs from chastisement to fake bubbliness. I get more nauseous from that than the smell of the new liver being prepped. “Ok! Looks like you’ve got everything under control here!” Yes, now leave us alone, I say, internally impersonating Grumpy Cat.

As the door closes behind her, a slow whistle comes from the surgeon’s prepping the liver. “Oh shut up, Schmitty.”

No code that day.

Two Minute Increments

On By Tribal QueenIn Uncategorized1 Comment

I lost a patient today.

I didn’t even know his name, which seems like the first thing you should have when you’re trying to find someone.

In the hospital, we use trauma names. Tango, Tango. Last name comma first name. Which sounds like a fun night out in red heels that hurt my feet. Or Bravo, Bravo. Last name comma first name. Which sounds like we’re applauding something. But we’re not. You just didn’t have ID on your body when the cops or EMS found you.

I lost a patient today and I didn’t even know his name. He spoke to me in slurs when the ER nurse wheeled him up on the stretcher to my ICU. But it was all just slurs. His belly was distended, but not like the adorable beer gut on your favorite middle-aged uncle, more like when an alien’s about to bust out. His skin was orange and I didn’t need his lab results to tell me he was in full-blown liver failure. This was Mr. No ID Foxtrot, Foxtrot. He smiled at me when I made a joke. He started vomiting blood shortly after that.

There are two groups of people in this world, nurses and parents, who know the difference between vomit and projectile vomit. The first gets on your shirt, the second—hits the wall. This was the second kind. He passed out while I called for help and suctioned all the blood out of his mouth. Passed out is the nice way of saying he lost a pulse. Which is a nice way of saying his heart stopped. Which is a nice way of saying he died.

But have no fear, Mr. No ID Echo, Echo! I’m really great at breaking ribs. I’ll pump your heart for you! You laughed at my joke; it’s the least I could do.

Two minutes. Two minutes of CPR is worse than anything a former East German Olympic coach could throw at you in a HIIT cardio class.

I can’t remember the joke he laughed at. I remember his smile though. That’s how I keep doing the chest compressions even when the blood starts spurting on to my face and scrubs. Every compression. More blood. I remember his smile.

Epi. Intubate.

Epi. A bag a fluid and bicarb.

More epi. Bicarb.

Bicarb again.

We’re out of bicarb. Someone grabs another code car from another ICU. The room is trashed. A flood of people both in the room and outside the door. I want to scream at them. YOU DIDN’T SEE HIS LAUGH. YOU DON’T KNOW HIS NAME EITHER.

But two hours of two-minute increments later, the doctor tells us to stop. I yell, “FUCK” at the top of my lungs, throwing an unused syringe to the ground.

I didn’t know his name. He laughed at my joke and I didn’t even know his name.

_____________________________________________

*The author is not writing about one particular patient. This is a representation of multiple combined experiences throughout her career as an OR, ICU, an ER nurse.