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Dealing with reality: Confronting the global nursing shortageIn caring for others, take care of yourself by Darlene Sredl
Why is it that nurses take care of everyone but themselves? Busy, busy, busy, always on the go, assessing patients, delivering treatments, planning for discharge, ad infinitum. They even give themselves a guilt trip for taking a short break, but that break could save a life—yours. I know. I almost lost mine. Back then, I felt invincible. The “rules” did not apply to me. I could run on empty, so I didn’t see it coming. “It” came suddenly, like an unexpected, fast-approaching, powerful thunderstorm. I was grocery shopping when I felt mild palpitations as I wheeled my shopping cart down the greeting-card aisle. When no one was looking, I gave my chest a thump to correct what I thought was a fleeting electrical imbalance. I rambled on, leisurely filling my basket—meat aisle next, then down the paper aisle for a few holiday supplies. By the time I reached checkout, I was faint, short of breath and sweating clams. I weakly tried another chest thump, not caring who saw it; the fluttering in my chest was constant and ominous. This time, the palpitations did not stop and I felt strange stirrings inside. Scanning the nearby housekeeping supplies section, I looked for a bucket to vomit into, realizing there was no way I could handle groceries. I’m having a heart attack, I thought. Right here in this checkout line, I’m having a heart attack! My husband, Fred, had one five years earlier, and I remembered seeing his ashen face and the cool beads of perspiration oozing from the pores on his forehead. Lightheaded, I swayed, falling against the candy racks. By now the checker was busy pulling, swiping and bagging the contents of my cart. Hearing the clatter, she looked up momentarily and, when our eyes met, we both knew that I was in no shape to complete the transaction. As I made a feeble apology, she voided the order and I stumbled—empty-handed—out to my car. Once seated behind the wheel, I momentarily felt better, more able to weigh my options. The palpitations had stopped, my nausea had subsided and I could think more clearly. What happened? What should I do—go home and sleep it off or head for the emergency unit of the nearest hospital? “You’re just overtired,” I told myself. It was 8:30 a.m., and I had just come off a weekend of three 12-hour night shifts. I had carried a more-than-full, four-patient NICU assignment and, last night, had also been the delegated charge nurse for the unit. Yet, here I was, after all that, shopping for groceries. Was I crazy or what? Convinced I was just suffering from mild exhaustion, I decided in favor of going home. Sitting comfortably in my car with the heater and butt-warmer on, I began to feel that sense of security you sometimes get before the bottom falls out of your world. “You probably picked up a touch of stomach flu,” I told myself. Convinced I would be OK with a little rest, I headed for home. My eldest son, Steve, waved at me as my car pulled up, and he quickly backed his loaded truck out of our driveway. As I watched him go, a forlorn feeling of sadness came over me. I was scared. He turned the curve and was soon out of sight. Once inside the house, I departed from my usual custom of taking the phone off the hook, a habit I had developed so I could sleep undisturbed. It later proved to be one of several lucky departures from my normal routine. Too tired to eat, I popped an aspirin, slugging it down with a mouthful of water, just in case. Isn’t that what you’re supposed to do when you think you’re having a heart attack? Briefly, I thought back to last night, when I popped an ibuprofen to keep going despite my throbbing feet, instead of taking a meal break like I should have. Assigned to the recently admitted patient, I didn’t have time to eat. I sure wasn’t hungry now. Sleep, precious sleep was what I needed. I headed upstairs to sleep in Stacy’s comfortable old bed, with cordless phone in tow and my dog, Lucky, at my heels. A terrible mistake! Climbing the stairs triggered another ominous cold sweat and nausea, now coming in more frequent waves. I called my husband’s work number. “He’s not in,” said the secretary. “He went to a meeting at one of the other stores—not sure which one. Would you like me to try to find him?” “Yes!” I gasped. It was all I could say. Soon the phone rang. “Fred, I’m dying,” I choked. “My God. I’ll call the doctor!” he responded. When the phone rang again, it was Doc. “Can’t talk. Gonna throw up,” I gasped. As the phone slipped from my hand, I retched. With eyes closed, I retched again, aware I had vomited all over the bed. There was a strange, slimy taste of iron in my mouth as my head fell back into the vomitus. The warm, wet fluid seeped into my hair, but I was too weak to move. Suddenly, it was eerily quiet. I was aware of floating slowly, effortlessly, down a deep, circular well lined with red bricks. Like a feather, I thought—so peaceful, so quiet. Gradually, I became aware of a consciousness next to my body. When I turned my head to see who was there, I was amazed to realize the consciousness was me! As I continued to float down the vertical tunnel, my consciousness floated in tandem with my body, and I could not figure out how to get back in my body. I wonder if I am dying, I thought. It didn’t seem too important. In fact, it didn’t matter at all. Floating was very peaceful. I felt no fear, but rather pensiveness, an uncertainty. Am I dying? I didn’t really want to die. There was still so much left to do, so much to live for. Suddenly, a new thought commanded my attention. “Grab the cross,” it commanded. I always wore my special cross around my neck. A few years earlier, I had commissioned a jeweler to make it with precious stones collected from our travels around the world. I wanted to give the best I had to God. Now, something was urging me to touch it. Surprised to find I still had control over my motor functions, I groped for the cross. In my religion, two promises are associated with daily prayer: the grace of a happy family life and the grace of a happy death. I wondered which grace was coming my way right now. The moment my hand touched the cross, everything changed! Instantly, I was back in my body. I don’t know how I got there. A short time earlier, I couldn’t figure out how to crawl back in. The well I had been floating down was nowhere to be found. Instead, I was again aware of lying in the now cold, stinky pool of vomit. Voices—men’s voices, urgent and gruff—came from downstairs. They were debating if they should break down the front door. I heard sirens in the distance and somehow knew they were coming for me. As EMTs bounded up the stairs, Lucky sprang into action to protect me from the intruders. On the bed next to me, his fur bristled and he looked like a lion. Shaking with fear, he guarded me, baring his teeth and growling. The fire folk stopped in their tracks. “We have to Mace him, ma’am.” “NO, NO! Don’t hurt him,” I pleaded, gasping for air. Lucky lunged forward, nipping at them, unwilling to let them near me. A fireman threw a blanket over the dog, temporarily disorienting him while two others twisted the blanket ends and carried him hammock-fashion into the shower. Lucky’s display of raw courage under stress endeared him to me forever. Transferred to a transport cot, I glimpsed back at the bed. It looked like an axe murderer had practiced his craft. Bright red blood and large polka-dot clots were everywhere! In the ambulance, I vomited again, redecorating the interior with more red polka dots. Patiently, the paramedics worked with me, starting an IV and administering oxygen. At the hospital, I was quickly transported from ER to the GI lab. They told me they were putting some medication in my IV. Then, mercifully, black nothingness. I awoke in intensive care with horrible pain in my nose and throat. Someone had pushed what seemed like a hard plastic garden hose through my nose, tethering me to a suction machine. Abjectly, I watched as dark brown stomach contents slithered periodically along the tube, dumping into the collection canister at regular sucking intervals. The doctor said the scope revealed a small, pinpoint ulcer, and theorized that ibuprofen taken on an empty stomach had perforated both the stomach lining and an artery. They sclerosed the opening with epinephrine and said I was fixed, but I was skeptical. I wanted desperately to believe the worst was over and I would get better from that point on but, to me, the simple sclerosing solution seemed like gluing together a fence of toothpicks to hold back the Nile. Little did I realize how right I was. The worst was yet to come. All night I wafted in and out of twilight sleep, only partially aware of the transfusions drip-drip-dripping into my veins. Every so often, someone would call for a transfusion count. It kept going up—4, 5, 6, then 7, 8, 9 ... 14! Why was I continuing to need so much blood? Why was nobody worried about how much blood I was losing? It was so difficult to think. I awoke once about 2:30 a.m. to see two of my sons standing beside my bed, smiling down on me. They had flown quite a distance to get there. Later, my daughter came and then my daughter-in-law and both grandchildren. My daughter-in-law held up baby Mikey—the grandson I had helped deliver only a few months before—for me to see. Then, mercifully, I slept. “Fluids wide open!” yelled the doctor. “They are wide open!” the nurse yelled back. “Start another line!” The gut-wrenching slime poured from my mouth and I, too powerless to move, heard it splat on the floor. “Get her to GI lab!” ordered the doctor. With all the strength I could muster, I grabbed his arm. “Please!” I spit out a mouthful of blood. “Please take me to surgery. There is nothing more (gasp) ... you can do for me in GI lab. ... It didn’t work the first time. ... I’ll bleed out. ... No more resources left ... can’t waste time. Please ... PLEASE ... take me to surgery!” Someone thrust a consent form in front of me. I scribbled my signature, then blissfully passed out. When I awoke in intensive care the second time, it was after a gastric resection. They demanded I cough. Foolish people! I now had two intense sites of pain: the familiar pain in my nose and throat from the pressure of the tube, and now the piercing suture pain. Again, I slept. I am so very lucky! I have much to be thankful for. At so many places along the way, any delay could have meant my death. As I lay in the hospital, healing after surgery—my family all together now, petty jealousies and grievances gone—I knew which promise of prayer I was meant to have: the grace of a happy family. What I learned is this. Use medication wisely—sparingly, if possible—and always eat something to coat your stomach, even if only a few crackers, before you take medicine. This advice could save your life. Without the wonderful work of all the health care, police and fire professionals, I know I would not be here today. I also know, with equal conviction, I was meant to tell this story to help other nurses who, in the midst of their busy lives, may not think twice about taking a seemingly innocuous little white pill called ibuprofen. Ibuprofen is not an innocent pill. On an empty stomach, it can kill. I know. It almost killed me! RNL
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