The Resus buzzer goes off.
Two minutes from arrival is a patient who is unconscious. We know the drill. The team assembles, roles are assigned, and we talk briefly about potential causes, issues, and our approach. The ambulance arrives and we off-load a female patient, all the while assisting her breathing. We receive handover from the paramedics and then set to work assessing and managing airway, breathing, circulation and disability. We have done this countless times before – resuscitation is the core of our core business.
About five minutes in, the administrative staff have completed transferring the patient’s details from her wallet into the paperwork. A senior nurse in the resus room looks at the patient ID sticker, looks up at the patient and says to me, “This is one of our nurses”.
Something shifts imperceptibly.
But we have a job to do, and we know how to do it well. We collectively talk through possible causes for unconsciousness. We look for anomalies and address them as we find them. We stabilise her blood pressure, intubate her and place her on a ventilator. Once she is safe, we transfer her to the CT scanner. Soon after, we discover that she has sustained a catastrophic injury, one she is unlikely to survive.
The scan raises as many questions as it answers. Yet we have a job to do. We liaise with our neurosurgical and ICU teams. Collaboratively we formulate a management plan, and enact it.
Meanwhile, the ED continues to rumble as usual, relentless, and oblivious to what is happening – what is happening to us. We are looking after one of our own: the prognosis is grim; the circumstances are uncertain. We don’t even know exactly what it is we are feeling.
Still, we have a job to do. The patients in our ED who were already sick and deteriorating need ongoing care. The steady stream of new patients, who may be stable or may also be very sick (we won’t know until we have assessed them), continues unabated. We have a job to do, and we continue to do it well.
Looking after our colleague consumes, on many levels, those of us who are directly involved. We are still thinking technically and ensuring that we are addressing ongoing and new issues in her care. Meanwhile, we are also dealing with our emotional response to this unique situation. This response is as yet undefined, but what we do know is that we are distressed.
The ED family now has a job to do, and it does it well.
The Nurse Navigator continues to coordinate patient movements and flow. She is a veritable switchboard, conducting numerous conversations with various wards to effect the expedient transfer of patients.
The Social Worker has been involved from the outset, and although she already had a heavy patient load, from my vantage point, it is as if our Resus patient is our only one – she is concertedly trying to make contact with family, and liaising with other community services that need to be involved.
The Nurse in charge of the department reflects that the scenario is very close to a deeply personal one she faced less than a year ago. Yet she comes into the resuscitation pod and takes over the role of the Team Leader so that the latter can focus on the patient and on her own response.
Senior nurses from the after-hours team come to ED and take over roles in the Resus room and also assist with other patients in the department.
Our ICU team, whom we have flogged all evening with the other sick patients, move mountains to transfer our colleague out of our ED and into their unit before our night shift arrives. At handover, they assure us that our friend “will be treated like royalty”. I know that she already has been. And I also know that we have treated her no different to any other patient who is anonymous to us – because we deliver world-class care to everyone.
Late that night, the ED nursing and medical directors are contacted. The intention is simply “We thought you should know before you next come to work”. Their response is shock and concern, followed swiftly by both attending the department in person.An informal hot debrief is conducted for the evening shift staff. We talk about what we know and what we don’t know. We talk about how this feels and that it is “totally messed up”. We talk about everyone’s immediate plans and what they will do tomorrow. Almost all are due back on shift. They are given permission to take time off if needed. Phone numbers are distributed on paper towels with earnest statements of “I want you to phone me if you need to talk”.
I accompany the nursing and medical director to ICU. With permission, we enter our colleague’s room. They stand to her left, and both forage under the top sheet to find her hand and hold it. I feel compelled to put my arms around each of them, except that I’m much shorter than them, so that for those moments as I grip their outer shoulders, I feel somewhat suspended. I realise that my own emotional response is also suspended for now.
I return to the ED, in which the only trace of what has just happened is in the staff that were on the evening shift, but are staying back “to help out a bit”. Their faces are drawn with exhaustion and their shoulders are drooped.
The next day, senior staff come in on days off to support the ED family. Huddles are held in the handover room, updates are given, formal support is offered. A former patient who is a Reiki master volunteers her time to conduct brief sessions with interested staff – she sets up in the tearoom courtyard and a steady stream of people avail of her service. A senior nurse declares that she is not a Reiki master, but is here simply to give out hugs. A bouquet from our ICU team, and a hand-written letter of support from our Chief Operations Officer are on the table.
With ravaged and tearful faces, our team members hold hands, give each other hugs, and sit close. We share stories about our colleague – that she is a wonderful nurse; that she is funny and quirky; that she is resilient; that she has been so happy in recent times. We share stories about our ED family – how, somehow, we always manage to pull through, logistically and emotionally; how we exercise kindness that has no limits; how no one should have to see Greenie (Director of ED) in his board shorts at 9.30 at night. (We love you, Greenie).
Staff say to each other, “I’m so glad it was you that was here last night”, all the while knowing with utmost confidence that we would have felt the same way, no matter which of our colleagues had been in the ED or in the Resus Room with us.
We innately know that we have a phenomenal team – it is mostly just the vibe and the culture – we are almost stubborn in this self-fulfilling belief. But on the occasion, where we truly have to pull together and deal with a harrowing situation, where the critically unwell person in the Resus Room is someone we personally know and love, our innate knowledge manifests into reality.
And that reality is what defines us as family.
