Ruthmary Estabrook

Submitted 2023-12-12

Charging… That is the sound any Emergency room nurse can use to recall how they feel when recalling a code blue that they have participated in, that simple word. This word can conjure memories; for most Emergency room nurses, that will hold a spot in your memory for a lifetime. When you first become a nurse, you have lofty goals about how you want to help people and make the world a better place. Nurses do make the world a better place. We hold the hand of a dying patient so that they do not die alone in the middle of the night when there is no family, or they cannot be reached. We are the people who bring a face cloth to the sick when no other treatment is ordered, and they are burning with fever. We provide a smile to the new mother as she holds her baby for the first time. These are some of the fantastic moments we experience as nurses. Working in healthcare means learning to become accountable for the care you give to others. It means planning to prepare for the day when something does not go as planned.

A beep on a monitor change or that vital recheck yields numbers that do not look right, only to be confirmed by the affect of the patient changing moment to moment. These are the moments we prepare for in the emergency department when the biannual American Heart training kicks in when the pre-emptive department mock codes become a reality, a siren that rings in your head.

Charging …. and that sound whirring from a low pitch to that signal beep, letting the room know the next step. A loud room-silencing shout, “Clear!” as everyone steps away from the stretcher. “Pulse check, one…, two…, three…, four… five…, No pulse Resume CPR”! is the phrase you stand hoping not to hear repeatedly. Minutes seem like an eternity, steam fogging the safety glasses on your face as one person begins compressions, their fingers laced tightly as they press on another human’s chest, each beat displayed on the monitor like a sinew of ups and downs.

There is a slight bead of perspiration on each person in the room, each with a silent prayer of hope repeating in their heads. The person at the head of the bed counts each compression given: one, two, three, four, five, “Breath” as they squeeze the flimsy silicone bag, breathing air into your patient.

“Pulse Check, Continue CPR” …

This is the reality of being in emergency medicine. Being prepared means practicing until these movements are second nature. It means working through each process step, anticipating each medication, and knowing each puzzle piece. It means knowing what each beat of the EKG means. Understanding each step of the ABCs in resuscitation. It is the difference between a successful code, saving a life, or participating in the chaos that ensues when the team is unprepared.

Preparing also means being mentally and physically prepared. It means making sound decisions about your own health and mental health. As a healthcare provider, you must have solutions to reduce personal stress as it occurs. It means wrestling your own personal demons until they yield to your professional demands so they do not rise, meddling with your patient’s care. Preparing mentally means understanding your unconscious biases and coming to terms with them so that you provide care to the patient that is just and equitable. It means growing each day as a professional and understanding what it means to provide healthcare. It means modeling a healthy lifestyle for yourself, your colleagues, and your patients. It means understanding the importance of your mental stresses to manage the stress of each workday, preventing burnout.

Being prepared means learning how to control the room and thoughtfully explaining each piece to the frightened family member standing in the corner so they know you are all doing the most for their loved one. It means allowing yourself to be human, crying when you are sad, and rejoicing when you are happy. It means it is okay to reach out for help when you, the provider, need it and provide it when your colleague needs it.

Being prepared means knowing how to speak to your team to review afterward about the excellent job and where they can improve next time so that all members, including yourself, grow from each experience. It means leading when you need to lead but also learning how to follow. Learning to walk the talk each day. This is the preparation that leads to the next memory… “Charging… when was the last epi given…Wait, pulse check….” Can anyone confirm it? “

“I feel a pulse team. We have ROSC…”