Sean Brennan submitted 2020-10-03
“Failure should be our teacher, not our undertaker. Failure is delay, not defeat. It is a temporary detour, not a dead end. Failure is something we can avoid only by saying nothing, doing nothing, and being nothing.” - Denis Waitley
I write to you not only with the intention of applying for my first scholarship, but more so with the intent to give myself some long, overdue closure. My wife suggested that I should do this for the opportunity for financial gain to aid with my studies, but perhaps she secretly knows it will help me sleep better at night. You see, I wake up often from some nightmares of patients that I couldn’t save and usually see a trend within most of these vivid dreams. I’m always helpless as a nurse and my inability to react quickly causes bad consequences. My biggest fear is that I don’t do enough. I don’t often think about these night terrors and have become accustomed to them over the past few years.
Perhaps this essay will serve me with a sense of catharsis, however, there is also a chance that my written words will bring upon a volley of tears and memories that I had purposefully repressed. I have seen many traumatizing things that I had never expected to be a part of. My time as a nurse in a busy Emergency Room has been forever imprinted into my mind. Some days were good, other days were really bad. Nevertheless, some of my experiences forever changed how I view those around me. I left the ER when I had because this particular failure had taught me how important it is to take a step back to appreciate what I have today. Life is fragile and can change at any moment.
Summers were always busy in the Emergency Room. Motorcycle accidents, intoxication, cardiac arrests, and drug overdoses were common and wouldn’t scare or intimidate. After two years, I thought I could handle just about any situation. One week in particular was a very humbling experience that taught me that this wasn’t the case. This experience would not be my worst, nor would it be considered the only bad one I can recall. I had many. Regardless, this is one experience that I relive every time I drive by the initial accident site in which my patient flipped his car on the highway. Tears sometimes threaten to spill over my eyelids each time I look at the cross on the side of the road where the accident happened. I try to always look down at the road through this portion as I drive through, since I sometimes feel like a bit of my innocence died from the events that happened at that crash site.
It was the last day of my shift before a long weekend off. It was a beautiful, sunny Friday. I was just coming onto my afternoon shift at three in the afternoon. I was tired from the night before, and I was a little bit late since I had to grab some candy beforehand. I took a sip of my coffee and just placed my snack bars onto the table to get a shift report from the nurse that I was taking over for. I had a really great hazelnut coffee that day with some maple syrup in it. It was delicious.
In the corner of my eye, I saw my charge and triage nurses jogging over in my direction. I thought if I focused on my computer screen while sipping on my delicious coffee, that they would give me a second to wake up and let the caffeine have it’s intended effect. Perhaps they would give a report to one of the other nurses that seemed to not be busy. I was wrong. I hate being wrong.
“Sean, EMS is inbound with a Motor vehicle accident. A new Corvette lost control on the highway at a high rate of speed and flipped over the highway divider at at least 80 miles per hour. He hit a minivan head on, but the passengers of the van are stable at the scene. The driver is about six minutes away and CPR is in progress. We’re calling a Level One Trauma Activation. Tag, you’re it, buddy!.”
“Sounds good. Thanks guys.” I rolled my eyes and took one last swig of my coffee before the longest few hours of my life. We rapidly set up the big trauma room and had a team of staff ready to rock. I’ve run many codes with trauma patients before, and I’ve helped to stabilize many patients previously with excellent outcomes. I was proud of my track record and was well regarded as a very strong nurse among my peers. Either patients came to me dead already, or we shipped them out on a helicopter or the ICU with a pulse and more tubes and lines than you can shake a stick at. I thought I was ready for this event. I’ve pulled dead bodies out of vans before with needle marks all over their arms, but I don’t think I’ve ever really witnessed a traumatic death in person before. I typically accepted that you can’t further hurt someone that is already dead, but you can lose a life if you aren’t quick enough if they have a pulse. I prided myself on my speed and efficiency and took for granted that I hadn’t felt a sense of loss for a patient under my care.
This patient came blasting through the ambulance bay doors with an EMS worker on the stretcher performing CPR and counting loudly. We received a verbal report from emergency services and immediately transferred him to the bed on the board with a cervical collar tightly in place. By the time we got him onto the ER stretcher, he had a pulse and a blood pressure. Great! We threw many tubes and lines in him to support his airway and stabilize everything that we could have. We ran our code like a well-oiled machine. It was amazing and we would reflect on this efficiency for weeks to follow. Heck, another nurse and I earned ourselves an award in our department following this event. We infused blood products and utilized blood pressure medication. I felt like we were going to send this guy off in no time for a rapid recovery to see his family and loved ones once again. To be honest, perhaps I felt a little bit cocky upon reflection.
There was one constant thing that bothered me. No matter what we were doing “by the book”, our patient’s oxygen level remained at 80%, which was weird considering he had a tube of 100% oxygen pumping directly into his lungs. Everything was placed correctly. Regardless, we still needed to bring him to the CT scanner to see how bad the damage to his body was. We started with abdominal and chest scans first to ensure there was no massive bleeding or failure of vital organs. The first scans were normal and we quickly paused a massive blood transfusion protocol, per direction of the surgeon. This was great news. Next, we scanned his head. His brain was intact and we saw no evidence of a brain bleed. Excellent! Now we’re getting somewhere. Just then, my charge nurse called my communicator and asked how we were doing.
“We’re doing great, no more blood is needed and he seems pretty stable except we can’t get his oxygen up where we want it. Go ahead and clear the helicopter to land, this guy is still going for a ride over the lake to Vermont.” I was told that the helicopter crew would be seven minutes out and I was thrilled to give the “go ahead”. This was good news as I felt like I would have time to document everything once we got this guy in the air so that i could get back to that sweet coffee, which was probably lukewarm by now. I gave our team a few strong high fives and patted myself on the back for our progress thus far.
The final scan of the cervical spine was coming up on screen to visualize. I had to look at it for some time. Perhaps I needed an anatomy refresher, or maybe I was in a brief state of shock. I’m sure I glanced at it for a brief second before realizing what I was looking at, but it felt like an hour. It appeared that the skull was completely detached from the spine. It was a clear internal decapitation. My stomach entered my mouth as I tried to struggle for words and relearn the art of human language. I couldn’t form them yet. I looked at some of my team as we all glanced at one another without moving our lips. We all knew what we were looking at. Words wouldn’t really matter, anyway. We wouldn’t slow down any of our efforts. This body was going to get onto the helicopter anyway. Our mission transitioned from a resuscitation effort into an organ harvesting mission since we still had all the resources available.
We left the CT room and headed back into the main trauma room in which we would meet the helicopter crew to get this body ready to fly shortly after scans. I was met by seven New York State Troopers on top of what felt like 20 other people. No one knew of the patient’s status outside of our team, and we weren’t about to divulge that we were now transporting an expired body in front of a hallway of officers that were laughing and calling this man names which I blocked from memory.
“Hey, nurse! You’re the nurse in charge of this jerk, right? I need you to draw some blood for us so we can measure his alcohol level. This guy was probably loaded.” This man’s girlfriend was in the hallway. I know she heard the state trooper. “Are you going to draw this or what?” “With all due respect, I need to get this man on the helicopter right now and I don’t have time for this. Please let me do my job.” I had no clue what I was saying, but all I could think about was how I didn’t want to tarnish the reputation of a dead man in front of his lover as she struggled to keep her composure. That’s not my job, since this will clearly be evaluated during an autopsy after the organs are harvested.
The state trooper continued to request a blood draw and was relentless. His constant harassment and efforts even got another nurse involved to pressure me for just five milliliters of blood into a dreary, gray glass tube. I begrudgingly grabbed my supplies in preparation to waste a few precious minutes.
“You better make sure you don’t use an alcohol wipe to skew the lab results, we want to nail this guy when he heals up!”
Tears started to form in my eyes. “You know, this isn’t going to be as useful as you want it to be, officer.” His lover saw the tears forming and immediately fell to the floor in emotional agony. I almost dropped the glass tube as I handed it to the officer. For just a moment, I felt like I experienced just a miniscule fraction of her pain as if I had lost someone close to me. I kept my composure and wiped off my face until the body was on the helicopter and in the air, the family was gone, and the room was rapidly cleaned. I hid my tears very well and splashed cold water on my face right before heading back out to my desk. My fellow team knew exactly what I had just been through and suggested that I take a break to eat some dinner and to get off the unit. I told them that I would quickly help out to discharge one more patient to at least feel like less of a failure. I sometimes need to keep busy to dissociate from my emotions.
I walked into a new room on the other side of the ER with some discharge paperwork for a patient that presented, by ambulance, with a request for klonopin, a controlled substance. I calmly explained that she would have to follow up with her psychiatrist, and that we could not simply prescribe controlled substances to anyone that simply wants it without a prescription or reason. I Just wanted to get her going so I could grab a quick bite.
This woman was seeking her fix and was not thrilled with my response. She grabbed my pen and attempted to stab me in the left side of my neck with my favorite pen. I was at loss for words. Instinct took over and I wrestled and restrained this woman to the floor and called for security. Another few staff members jumped in and took over and allowed me to catch my breath.
I immediately made a jog for the staff break room, ran into the bathroom, and just began to cry. Not only did I feel like we failed this first patient that expired, but I also felt like my emotions compromised my safety out of my own personal negligence. I kept asking myself in retrospect if I was going through a panic attack, or what any human being would feel witnessing what I just had. I quickly washed myself up, ate a few bites of pizza before dumping the rest into the trash since I felt sick with knowledge that I still had six more hours left in my 12 hour shift.
After my relief came onto the unit to take the rest of my patients, I went to the local police department to report the woman that attempted to stab me over drug seeking behavior. After leaving the police station at 5:30 in the morning, I headed to my co-worker’s house to decompress with a few other nurses as we all agreed that we each had the worst shift of our lives. Shortly after, I headed home as the sun continued to rise to see my wife in bed and reading a book. I proceeded to cry in the doorway of our bedroom as I filled my wife in with what I had just experienced. I could not describe how I felt at the time. Perhaps I was just numb. She invited me over to bed and rubbed my head until I drifted off into sleep out of sheer exhaustion. I felt numb for the next few days and sleep was near impossible. In hindsight, I didn’t have much of an appetite, either. I lost a lot of weight while I was working in the ER.
It wasn’t until I got back to work the next week that I had my first sense of closure following this situation. The patient that expired was the best friend of one of the other ER nurse managers. He pulled me aside into the closet to tell me how thankful his family and he was for our collective efforts. He reassured me that there was absolutely nothing more that I could have humanely done for his friend, and that his lover was handling his passage as expected. We shared a brief pause before he told me that the heart and liver of his friend were immediately harvested and being transferred to another adolescent patient in need of them across state lines. Our efforts and teamwork ensured that the sacrifice of my coworker’s friend did not go unnoticed. Because of our efforts, this man’s heart still beats strongly in the body of another person who was certain that he would face death. One life for another. I keep telling myself this, but I still have trouble forgetting the sound of his lover’s scream when she was impacted with the horrible news that no one expects to hear. I’ll take the memory of that scream into my old age.
After a few events similar to this one, I decided to take a break from the ER for my own mental health. I learned that death is not the means to an end and that it can occur at any time; this is normal and to be expected. Obsessing about the past and what could have been done will always blind you to what lays in the present and in the distant future. It’s important to be thankful for what we have today and to enjoy the lives we lead now, since they may change in an instant. Most importantly, it’s acceptable to fail as long as you give everything 100% of your time and effort. I may go back to emergency medicine one day, but I’m grateful for the time off to reflect on my experiences.