What I learned from my nursing colleague one weekend at work.
A while ago, I worked over a weekend at the smaller of our two hospital campuses. It houses a fully functional Emergency Department (ED) but has fewer tertiary referral services than our main hospital campus. At approximately 5000 patient presentations a month, it is far from a poor cousin, but certainly there are those who would argue that it lacks the glamour and prestige of our University Hospital.
Things were going smoothly. We had a full complement of medical and nursing staff, despite the winter viral assault and the havoc this had been wreaking by way of staff sick calls.
Our emergency department is frequently challenged by bed block – where our emergency beds are occupied by patients whose work-up and initial treatment we have completed, but for whom no ward beds are available – but on this day things were flowing smoothly…
Around mid-morning, a lady arrived having suffered a few days of a flu-like illness. It soon became apparent that she was desperately ill, likely with a severe bacterial infection. She deteriorated quickly and we treated her with fluids, antibiotics and even inotropes to keep her from crossing the fine line towards cardiac arrest. Early investigations revealed that every organ was failing fast.
My colleague, who was leading her resuscitation, advised the Nurse in Charge, Brett (named with permission), that we were going to need more pairs of hands. Swiftly, there were four nurses in attendance all finding a useful contribution to make: one set up the airway trolley, another prepared the biPAP machine, a third set up for invasive catheters.
In the middle of all of this, the poor patient became faecally incontinent. Again, like a well-oiled machine, the nurses and orderlies changed sheets and beds, all while attempting to disrupt the patient and her attached life-lines as little as possible.
I had scrubbed to insert an arterial line. As I was waiting outside the curtains with my gloved hands crossed, I caught a glimpse of the scene within. The Nurse in Charge, Brett, was completing the hygiene care of the patient. Wet wipes in hand, he gently and respectfully explained to the patient what he was doing, and that she’d be clean again in a moment.
It was a truly humbling moment – to witness such servitude in leadership.
Later, after the patient had been safely dispatched to ICU, I mentioned to Brett: “You know, I know you could pretty much run a Resus, and there you were wiping a patient. It was probably the most impactful moment of that whole episode of care for me”.
His response was simply: “That’s just what we do. And I need the team to know that I won’t ask them to do anything that I wouldn’t do myself”.
I also commented that, despite having a lesser critical care load than our larger ED, I was impressed by the skill and confidence of the nursing team in this setting. His opinion was that this campus benefits from a stable cohort of experienced staff and, as such, they benefit from a cohesive team spirit; and their approach to the sick patient is thorough and competent.
It is gratifying to run the big cases and to enjoy the high-profile successful treatments. But often, it is the smaller cases, and what we sometimes regard as the trivial acts of care that can be the most impactful. Brett told me another story:
For a long time, we had been seeing a man who would present intoxicated with alcohol. James (not his real name) was a man in his 40s, who had previously worked in the emergency services, but his life had become derailed – he was dependant on alcohol, he’d gradually eroded his relationships and become estranged from his family, and he was intermittently homeless. He would often be brought into our ED by ambulance or police car, having caused a nuisance in the community. He would act belligerently to our staff and require security to contain him.
Then James stopped coming.
It was about four months after he’d last been to our ED, that Brett was at work and was called by a colleague to the triage desk, who stated that someone was here and asking to see him. Brett attended the desk and was approached by a man who was clean-shaven and neatly dressed. Brett was silently disgruntled, thinking the Nurse Director had arranged for him to meet an equipment salesperson. But it was James.
“Hi Brett”, he said, “I’ve been sitting in my car for 20 minutes wondering whether I should come in or not. But I just wanted to see you and say thank you. You helped me turn my life back around”.
They spoke and James described the episode that helped get him back on track.
One afternoon, James had presented intoxicated and was sitting in our waiting room, as all our beds were full. Unfortunately, he lost control of his bowels. Brett was out front and noticed what had happened. Immediately and without fuss, he guided James to the showers, got him towels and a fresh set of clothes and got him cleaned up.
At the end of his shift, Brett drove home, picked up a couple of bags of clothes he had earmarked for a local charity after decluttering his wardrobe, and brought them back to ED for James.
Brett encouraged James to escalate his efforts to detox. He followed this advice, and his attempt was successful. James completed his rehabilitation treatment, reconciled with his family, and was now training to work in drug and alcohol counselling.
I don’t know if that day in the waiting room, Brett thought that he was doing something significant for James, or that it might be a turning point towards James’s recovery. He was simply providing care and humanity in the manner that he himself would like to receive it.
I’d like to think that the unspoken message understood by James that afternoon was: “You’re one of us. You matter. You are worthy of dignity.” And that he was able to be fueled by this affirmation, and to set his life course straight once again.
