Here is the World.



I’ve been trying to find the words for this blog post for a long time, actually long before I even stopped working at the hospital. Maybe it began when my daughter was born. I’ve talked about this shift before, the irreversible schism that happened in my soul once I had a child. My emotions expanded in ways I didn’t think possible; places of my heart that I had shut off became uncorked and years of suppressed feelings came pouring out like a waterfall. I changed and I started to think that maybe being an ICU nurse forever wasn’t feasible for me anymore, or at least desirable at this point in my life.

It really was a strange phenomenon. Suddenly with the addition of a tiny person in my world, all the pain and loss and heartbreak that I saw at work everyday and had been able to subdue, rose to the surface. I could no longer stuff it down or shut it away. My patients became real in a new way, as if blinders had been removed from my heart. Not that I didn’t care about my patients before; I just cared for them in an alternate capacity, one that closed me off enough from my emotions to be able to deal with these most heartbreaking moments of their lives. In many ways it had been protective and even beneficial. But I had lost that and it was making it very difficult to do my job.

All of my emotional volatility culminated when, a few months after I had returned from maternity leave, I was asked to take a fourteen year old boy who was most likely going to die from brain damage. By the end of my shift, we were coding him and I was staring at his mother’s face knowing that this was the end, for him physically and for her emotionally. It sounds very bizarre but I saw his life flash before my eyes in those last moments and all I could think about was how his mother had nursed him as an infant, chased him as a toddler, hugged him after his baseball games, and now held his hand as he slipped away. In that moment her pain became my own, tearing my insides in two, and I couldn’t imagine losing my precious daughter in the same way that she was losing her son. It was unfathomable. It was a tragedy. It was life and death. And I knew I couldn’t do it anymore.

Now, a year and a half removed from my ICU days, my life looks very different. I wipe a runny nose and fix lunches that my daughter may or may not eat, make a fool of myself chasing her around the playground and take the dishes out of the dishwasher day after day, the same actions on repeat. It is full of monotony and I can honestly say that’s been the best thing for me. I needed days where no one died. I needed to forget that terrible things happen to normal people everyday. I needed my most frustrating moments to be about getting Evy’s shoes on in the morning rather than running back and forth between two crumping ICU patients. I needed the monotony and it is healing me, helping to give me my perspective back.

I read this quote the other day and it quite literally blew my mind. I’m not sure why, it’s not complicated or verbose or even that eye-opening. But to me, it was profound and I’ll tell you why.

“Here is the world. Beautiful and terrible things will happen. Don’t be afraid.” – Frederick Buechner.

These few words stopped me in my tracks. Gosh, I wish you could feel what I felt when I read this quote. This man, Frederick Buechner, deserves my thanks because this was the truth I had been trying to say in many more words and had yet to capture.  I realized why my soul had needed rest and monotony, how emptying the dishwasher day after day was the best kind of catharsis. Because I needed to remember that the world was full of both terrible and beautiful things. I had actually forgotten that.

As I transition to becoming a different kind of nurse, a nurse practitioner headed for primary care, I have started to grieve the loss of critical care. I realize that I probably won’t ever again work with patients on ventilators or draw an ABG or help run a hospital code. There are many things I will miss and many things I won’t. I think it’s that way with any job. But now I’m moving on to a less severe, although not less important world, wanting to try my hand at the flu and immunizations and much less life-threatening problems. It sounds boring in comparison maybe but I don’t think so. I think it’s exactly what I need.

There are a million different kinds of people in the world and, accordingly, a million different types of nurses. Some can work in the ICU forever, some stay in primary care their whole career. Some transition from one area to the next, taking advantage of the endless opportunities in this field. So where do I fall? Maybe I could’ve stayed in the ICU longer. Maybe not. But I chose to go a different direction, not because I got “burned out,” but because I knew what my soul needed at that time. I needed to be home with my daughter and heal from the very real tragedies that I had had the privilege of being part of for the past six years. After working in the ICU for almost seven years I thought I could handle anything, when in reality, seven years in the ICU is what I could no longer handle.

There is beauty in watching my daughter dig in the sand. There is beauty in being a part of someone’s last moments on earth. The important thing is that I remember that the world is full of both. Beautiful, terrible moments. And everything in between.


The Double-Edged Sword

This is a re-post of a blog post I did years ago when I was working at the bedside in the ICU and I’ve had several requests to post it again on this site. Still rings true!

Natalie-17Sometimes I wonder how to maintain a balance.

Just the other day I watched a man in his early forties, who had come to the hospital after an accident, bleed to death. With his leg wrenched off, a mess of shreds of flesh and coagulated blood, he had reached the end. The doctors took his wife to the bedside and calmly but firmly explained that there was nothing else they could do. The damage was too severe, the injury too great. The dripping blood collected in a pool underneath him like a morbid summary of the sad tale.

I watched for a few seconds like an unattached observer, noticing the inconsolable wife and other family members with a haze of self-protection between us. With only a ting of grief, I watched as the wife laid her body over her husband, begging and pleading into the air for him to live. Her desperate requests fell upon a silent room as she screamed and wept. Her tears wet his face but he didn’t move, already drifting in the middle place between alive and dead. Finally he passed away slowly and quietly and the family was left with some privacy to grieve. After such a commotion, the silence was deafening.

Functioning as the charge nurse that day, I was aware of the situation but because of the hectic pace of the unit at that time, I didn’t have the mental energy to soak it in fully. I cognitively understood but I held back my emotions for the sake of the job, for the sake of keeping the unit functioning at the highest level. Patients needed to be admitted from the  ER or OR, nurses required help with bedside procedures, and some of our other patients were declining at a rapid pace, requiring all hands on deck as we hung blood pressure medications and put in chest tubes. If you’ve ever been the charge nurse, you understand the feeling of the weight of the hospital world on your shoulders, the responsibility of life and death weighed around your neck. When you’re the charge for the trauma ICU, with everyone in the hospital calling you to fix a problem or make room for a patient, in many ways those are accurate assumptions.

There’s a fine line between entering into the emotions of the situation and preserving yourself for the sake of the job. A conundrum common to any area within the hospital realm. Nursing can be a diabolical and equivocal profession for this very reason: the maddening crux of self-protection and compassion. It’s a double-edged sword that boasts both danger and power.

On one hand, I consider myself to be an extremely sensitive person who relates to my patients and families on an emotional level. In my job working with families, I sit and listen as they vent about frustrations or griefs. I cry with them as we turn off the machines and let their family member drift into breathless silence. My heart aches inside of me as families have to make impossible decisions about the future of a loved one’s care. Few choices are straightforward and easy, and most require all they have left emotionally, mentally, and physically. Sleep, proper nutrition and self-care become obsolete as families focus whole-heartedly on the task at hand, the healing or demise of their loved one. I’ve gone home and cried helplessly because of a devastating patient situation, the grief and loss too much to bear. Seth has listened as I relate some of the horribly unfair circumstances that are inherent in a broken, fallen world. I function in deep compassion for my patients and families, empathizing with them over their heartbreaking situations.

Regardless of the specific area, nurses are not strangers to the unlucky, unfair circumstances that plague humanity. From oncology to NICU to outpatient clinics, we all encounter the unexpected test result, the unbelievable diagnosis, the unexpected and tragic turn of events. We experience on the ground level variations of pain and loss that many people can’t comprehend. We are exposed to some of the most triumphant and desperate situations, watching people defy the odds or succumb to the inevitable. Nursing is a highly emotional profession with the pendulum swinging between hope and loss, pain and victory, life and death.

On the other hand, I felt completely unattached to the man dying that day, knowing that if I let myself indulge, a deluge of tears would follow. I went to a party after work that night and as my  mother asked me, “how was your day?” I related the incidences in a matter-of-fact tone that seemed to shock her. I realized abruptly that it wasn’t normal for someone to say they watched a patient bleed to death while sipping iced tea at a wedding shower. In my callousness and self-preservation, I hadn’t even stopped to wonder at my own disillusionment with the situation.

But as nurses, we can’t always allow ourselves full depth of emotion at a certain time. It’s one of the disadvantages and hard boundaries that come with the job. If I imagined Seth lying in the bed as the patient and me, the desperate wife, weeping over him, I surely wouldn’t have been able to continue with the day. I would’ve been overwhelmed with inconsolable grief at simply the thought. I would’ve sat down dejectedly at the bedside and ignored the other duties required of me.

Nurses get very extensive training in assessment skills, safe medications practices, and the scope of our license. But treading the fine line between emotional indulgence and self-protection is something you have to learn on your own, in your own way, so that you can go back to work the next day and be satisfied with your profession. Everyone comes to that place, the place of peace with difficult circumstances, at their own pace and in their own fashion. And it changes as you move through various stages of life. You constantly have to reevaluate yourself, your calling, and your emotional reserve to adapt to the situations before you.

Sometimes I’m amazed at my ability to push my emotions aside and continue in the job of saving lives. Sometimes I’m surprised as I can’t seem to stop ruminating over a seemingly routine but difficult situation. I shock myself with how I react to some predicaments and not others, or the degree to which I react.

It’s an impossible double-edged sword, the blade of self-protection and compassion. It gleams at you, waiting for you as you walk into work everyday. You wield it as best you can, trying to make the wisest choices, but sometimes it cuts you when you least expect it. Then you remember it’s both your weapon and your downfall, and you grow in respect for it.

We pick it up before a shift and lay it down afterwards, but we all know it’s never far from us.