I have Post Traumatic Stress Disorder. I don’t really understand how I got to this point, but sometime last summer my doctor prescribed a drug called Trazodone for me, available in selectable increments, so that I could go to sleep, and stay asleep. This is because every time I succumb to the old torpidity, my dreams eventually cycle back to some scenario where I am at work, and my adrenal glands kick out adrenaline- thusly shooting me straight out of my slumber. So, it’s not real PTSD, like I keep thinking I’m in Kabul getting mortared by the Taliban or something. I’m not waking up in the middle of the night stabbing people. But I do keep seeing things in my sleep. And I cannot stop hearing the constant alarms that ring all day at work.
Three and a half years ago our family moved to Virginia, and I took a job as a nurse in the Surgical Trauma Burn Intensive Care Unit. I had a few motivational factors, the first being that my wife wanted to move closer to her family who live near here, the second being that ICU experience is required to go to Nurse Anesthetist school (something I was holding as a distant possibility in the future), and third- because I kind of wanted to be a badass.
You see, in Denver I somehow kept being promoted, and within two years of graduating from nursing school, I was suddenly the supervisor of about twenty, old-lady-type nurses in a small nursing home. Imagine Nurse Ratched from One Flew Over The Cuckoo’s Nest, but desiccated with age and minus the beating heart. Every time I attempted to do some managing, it was met with squinted eyes, a deep sneer, and some sort of threat involving the removal of my windpipe. It was brutal. Eventually, I made a deal with myself: the next job I would take, would be that of a regular nurse- in the gnarliest ICU I could ever possibly find. I wanted to have some war stories, just in case this ever happened to me again. Mission accomplished.
The Surgical Trauma Burn ICU at the University of Virginia is also known as the STBICU (stuh-bih-cyoo)- only because no one could pronounce it if they added the words vascular, transplant, ortho-spine, and land-mine fuck-trap into the acronym. Because it is a teaching hospital in the middle of nowhere, it pulls most of its funding from the University of Virginia School of Medicine. And because of that, it has to acquire patients from rural areas spanning from Pennsylvania to North Carolina, and as far west as Ohio. To remain a viable Level 1 Trauma Center for the Medical School, it needs to have a lot of small ICUs. To save money, somebody decided that it would be a great idea to combine them. Most hospitals combine two or three ICUs. It is not uncommon to have a Thoracic-Cardio Unit, or a Medical-Surgical ICU. My employer was trying to break some sort of world record by combining seven.
I can remember one of my first nights on orientation, I was asked to help hold an eighteen-year-old boy’s body still as an Orthopedic surgeon attempted to jam his left shoulder back into the socket. There was no need for anesthesia. This kid’s skull was broken open just above his right eye, and as I held him, his brains where falling out in pieces onto my arm. Orthopedic surgeons, I am convinced, are selected not on their intellectual prowess, but on their ability to smash things with hammers. This one was no stranger to such barbarism, and so, long story short, I started having trouble sleeping.
It never got better. I have smelled patients, over the period of months, slowly eat themselves from the inside. They slowly digested their own bowels in pancreatic juices, while we fought with every last shred of our own strength to keep these tortured souls on this earth. And the burns are worse. I was told in nursing school that the most horrible thing in the world was the smell of a fresh burn patient, because it almost smells good- like barbecue. It doesn’t. It usually smells like whatever burned them- house, couch, nightgown, kerosene, gunpowder, boyfriend. And while I thought there could be nothing more repugnant than scrubbing someone’s burnt hands as they literally peeled from the bones, I was incorrect. That horror still cannot compare to the smell of a burn patient who has been lying in a plastic bed and growing bacteria for months. It pales in comparison to watching some lipless, charred, freak die from sepsis, while their families methodically stop coming to see them, leaving you culpable for what is left of their slowly disintegrating bodies.
It’s the smells that kill you. Not just cleaning up the countless bowel movements, or the emptying of colostomy bags, or the constant cleaning of urine and vomit- but the rotting stench of someone actually being consumed by bacteria. It is anywhere and everywhere, and somehow all your body wants to do is escape from it. Every instinct you have ever had tells you to flee, and to never come back. But you persevere, because you have sworn an oath to “do no harm”. Even when what you are doing to keep someone’s soul on this earth, may be the most malefic thing anyone has ever done to them.
It’s not that we are failing at keeping people alive; it is the opposite. We are terribly good at keeping people alive- horribly adept. We are calculatingly mathematical and precise at sustaining life. Almost every body can be saved, no matter what the price to the families, taxpayers, or the medical staff.
Just so you know, hospitals work like this: 1. Doctor sees patient for 5 to 10 minutes and makes some orders. 2. Nurse spends all day fulfilling those orders, and sometimes battling them for the sake of the patient and their families to get new and/or better orders. 3. Nurse will never be a normal person again for all of the physical, mental and emotional stress they go through to save patients and help their families. 4. Doctors get the credit. Yeah, I know. Sometimes Doctors examine patients. Sometimes they even operate on them*. But what you see on television is insulting. It would be like someone making a show about World War II with just Generals Eisenhower and Patton throwing grenades at the Nazis. It’s not the doctors doing chest compressions on someone all night. It’s the guy writing this, whose back and left shoulder will never again be normal. It’s the nurses who have spent half their shifts holding in their pee or not eating until they go home. It’s the nurses who leave with un-namable diseases covering their scrubs, stripping to their underwear on their front porches so they can put on brave faces and hug their daughters and sons for whatever fading hours of daylight may still be grasped. It’s the the nurses who spend their nights wondering what they forgot to chart, what they forgot to do, if they failed somehow to save someone’s life. It’s the nurses who hear the constant beeping of alarms, who never really sleep, who never truly relax. It’s the nurses who are breaking down at their lockers and sobbing until they can pull together some false pretense of composure, to battle again for the ceaseless multitudes of sick and wounded that never stop being admitted. It’s the nurses. It’s the nurses that end up as ill-tempered old ladies passing pills in the nursing homes. Those same ones that made me leave my other job for the STBICU. The grouchy old ladies.
I took a new job last week. Assistant Director of Nursing, at, of all things, another nursing home. Honestly, my heart is breaking for my comrades in the STBICU. I will miss them immensely. I have never done anything in my life that I am more proud of. But I also get it now. There’s nothing like some PTSD to make you appreciate those prickly old nurses. Nothing.
Do no harm, my friends. I shall not forget you.
* To be fair to my many MD friends and colleagues, the problem isn’t the doctors- it’s the system. How much can one do, having to see 50 patients before even starting their operations or procedures? They are constantly overworked, and usually carrying crippling student loan debt. It is a system designed to generate profit, and it chokes the life out of almost anyone with an ounce of compassion.