STRESS?

Yesterday I had the (dubious) pleasure of answering a health-questionnaire. The lady administering it was asking all the normal questions and then got to this one:
“Are you under any stress?”

I stopped and had to think. Am I?
It’s true that I work long hours (but only 3 times a week)
It’s true that I have a husband with cancer (but in remission)
It’s true that I have money worries ( don’t we all?  )
It’s true that I have a teenager and a 20 year old (but they are both good kids)

Nah, I thought. I am really happy with where I am in my life.
I work hard, but it’s my dream job, and its something I am good at. I love my family, I adore my kids and the money stuff is always going be there. Long gone are the days when $100 had to stretch for a week. I opened my mouth to say “No” and before I could, the (misguided but earnest) lady said “Oh of course you are! You’re a nurse and you work long hours! I don’t know how you can do that, and in the Emergency Room no less! Oh yes, you are under LOTS of stress!”
She not only circled the ‘yes’ answer, she underlined it several times.
I was flummoxed.
I <em>guess<em> its a stressful job. I know that I go to work sometimes more tired than when I came home the night before. I know that I deal with a lot of things in the course of my workday that would likely make others cringe or vomit.I’ve seen people at their best and at their worst. The truth is, though, that my job is the ED is the LEAST stressful of any nursing job I’ve had. Sure, there are lots of quick decisions to be made, and there is always the hovering potential of disaster. Yet this busy place is so much better than floor nursing.

The Docs, NP’s, PA’s are always right there. No more must I page an unknown doc, only to wait for a call back and getting it, be told (crankily, more often than not) that I paged the wrong person.No longer do I have to try to decipher strange orders and strange handwriting, and then page the doc. I can just ask since the provider is generally right there. Along those lines, no longer do I have to check, recheck, triple check and then just simply rewrite the orders that have been mis-transcribed. We don’t have MAR’s, we just have order sheets. Written by the provider and handed directly to the nurse.
In the ED, we have more autonomy than I ever had on the floor. If I paged a doc when I was a floor nurse because I felt a patient needed something, I would have to wait for the doctor to come, evaluate the patient, and write the order. Sometimes they would give me a verbal order, but more often than not, they’d want to see the patient as well. And if a patient requested to speak to her provider, it was the same rigamarole of paging and waiting.In the ED, I just walk up to the provider and tell him or her if I think the patient would benefit from something. More often then not, I am told “Ok, what do you think they need?”

Imagine that–being treated as a peer! One of the Attendings recently told me that he trusts the ED nurses implicitly and if one of us tells him a patient might need this, that, or the other, he listens and generally agrees.
So stress because I am a nurse?
Nah, not so much.

Stress from the gym I just joined however, (the reason for the health questionnaire), well, that’s a different story…

It just never gets easier. Every situation is different, but every outcome the same.

I hate those stupid surveys that float around email that always ask “Have you ever seen a dead person”

Actually, I have, and I have seen more than I wish. It’s not some thrilling bit of info for an asinine survey. It’s a real event, with real people and real emotions.
You want to know what it’s  REALLY like? Think of this:

The family is sobbing in the hallway while the person to whom you spoke a day ago is now a discarded shell, the actual person having escaped to places Other.

The feeling of shutting off an IV and taking out the IV catheter from a vein that does not have any blood pressure.

The sound of the “death rattle” when the dying person loses their gag reflex.

The feeling of utter helplessness when you know you can’t do anything to make anyone feel better.

The fleeting feeling of fear when you give the dying person just a little more morphine because even though they are non-verbal, they are grimacing, and the hope that you didn’t give enough to kill them but just enough to comfort them. While at the same time the rational thought that even if you DID give them enough to suppress their respirations, your INTENT is to provide pain relief, and therefore you did nothing wrong so you give the morphine.

The sound of the shroud when you unfold it from the bag.

The fear in the families faces when they come to say “I think you’d better come….” and can’t finish the sentence.

The sadness in your own voice when you tell them that you cannot hear their loved one’s heart beat, and that you cannot hear their loved one breathing.

The difficulty in watching other grownups cry.

Having to call a doc and say “I need you to come pronounce my patient”
The heavy feeling of walking into the supply room and getting out the morgue kit.

After all their pain…all their tears….they thank you.  The family who loses a cherished loved one thanks you.

You go home, and hug your children and cuddle up to your spouse, trying not to remember the sounds of grief that echoed down the hallway as you punched out and left work.

I have a patient who went on hospice care a few days ago. She appears fine. She is not fine. And she knows it. She is just waiting in a small hospital room watching reruns of CSI and whatever junk they have on TV these days, making herself happy in small ways with the food she can tolerate, complaining about things that she can control when she feels overwhelmed by the things she can’t.

Oh my God, how humbling. What would I do in that position?
What would you do?

Imagine this. You are sick but trying so very hard to beat it. You go to the hospital for a stomach ache. You are told that you have an intestinal blockage and it’s a tumor recurrence. Furthermore, there is nothing more they can do.”I’m sorry, there is nothing more I can do. I can make you comfortable, and keep your pain to a minimum…but there is nothing medically I can do to stop the progression of your disease. You most likely have about 2 weeks left.”

Oh my god. What if that were you? What if you only had two freaking weeks left and you are too sick to go home, too sick to do much, but well enough to be aware and to understand. Well enough to realize “Damn. The writer’s strike doesn’t matter to me because I am not going to be around to see the new episodes of The Office. Christmas ads mean nothing to me because I won’t be home for Christmas this year. I won’t see my cat or dog again. Ever.” It just goes on. No more summer corn on the cob. No more Valentine’s day candy. No more fireworks. You don’t need to worry about taking next year’s summer clothes out of storage and trying them on to see if they still fit.You can cancel your dental checkup and your next haircut. Any appointments you have…you aren’t keeping them.All of life’s special things, and all of life’s mundane things will continue on, but they will continue on without you. You won’t be there.

How would you feel? How would you handle it? You can talk, eat, drink, and have minimal pain. You are tired but not exhausted. You are alert, you are in your right mind, but within 2 weeks - FOURTEEN DAYS - You will become progressively more and more ill. Then you will die.Nothing we can do about it…. Would you cry? Complain? Retreat inward? Would you change anything? Would you mend relationships? Would you rebuild bridges knowing that your particular bridge is going into the great beyond? Would you confess your love for someone whom you’ve never told? Would you confess your hate for someone whom you’ve never told?

Put yourself there. It’s a scary place.