Emma Jetty: A Real Nurse

I’ve been in nursing school long enough to be familiar with the concept of that patient. This is the patient where you feel your practice as a nurse shift. The two of you experienced a connection that transcends the role of nurse and patient. This patient has taught you lessons and helped you grow as a professional whether they know it or not. They are the patient you reflect on frequently, remember fondly, and rarely forget. It doesn’t matter how long you’ve been a nurse, where you work, or what was going on at that time—everyone has that patient. If you’re lucky, they’re that patient because they lived. But if you’re me, it’s because they didn’t.

I remember my first day on the critical care unit. I was an 8-week-old Nursing Extern who had only recently mastered the ability to do a full bedside assessment in one try. I was brand new and knew nothing. But, here I was, in a critical care unit with some of the most elite caregivers of the whole hospital. I was all but starstruck, but it was clear I was out of my league.

Everything was different here—the equipment, the routine, and even the combinations to get into the supply closet. But more importantly, the standard I was expected to meet was higher. It goes without saying, but with less stable patients, the opportunity for severe complications is greater. Determined to meet these greater expectations, I clocked in at the start of my first shift on this unit with an eagerness to learn.

However, I was quickly humbled. By 10:00 am I had seen two deaths and a terminal extubation that would later in the day bring the total to three.  Previously, I was on a different unit where I went eight full weeks and never saw anything so serious as a hangnail. And, here I was now, three hours into my shift with just as many deaths. I couldn’t believe the day I had been having. I was so excited to learn in a critical care unit, and this is how my excitement was rewarded?

The shock I was feeling must have been pretty apparent to the seasoned staff I was working with because by the time lunch had rolled around, I kept getting told, “Don’t worry, it’s not like this all the time!” I quickly shot back to my preceptor, “I sure hope not because there is no way I could do this all the time. I thought I wanted to work in critical care, but if it’s just nothing but pulling tubes and body bags, I’m not sure I want to stay here.” I had entered nursing school to help people, not watch them die. I thought of a million excuses to never come back to critical care. I knew just in that day that I didn’t have what it takes to be a critical nurse if this was what I had to do to become one.

***

Six weeks later—still suffering in this critical care unit—I cared for that patient. She had been in the hospital for a couple of weeks now at this point, so I was familiar with her story.  Life sustaining measures, such as ventilators and medicines, were only stalling death.  Now, this type of situation is incredibly common in the critical care setting, and we often provide life sustaining measures such as ventilators and medicines. Normally, these patients are so sick and sedated, they no longer have the mental capacity to understand what is happening. However, that was not the case with this patient. This patient was dying like all the other ones, but she was awake, alert, and painfully aware of what was going on. It is one thing to care for a patient who is sedated and dying. It makes things easier as the empathy I feel is not fueled by the patient’s grief. However, the care for a patient who is dying and knows it calls for a much greater form of care.

The day I cared for her was a busy one. With two Registered Nurses, one Nurse Extern, and eight critical patients, to say we were unstaffed would have been an understatement. The charge nurse called me around the corner of the nurse’s station and asked me, “Can you handle her on your own?” I shook my head yes and she shoved me into her room and pulled the curtain behind me.  Raising her voice just enough for me to hear her down the hallway, she said, “Holler if you need help.” And, I was on my own.

I couldn’t believe it. For 4-5 hours I managed her complete care. I toggled with the monitors, performed assessments, and documented care interventions while she tracked me across the room with her eyes only stopping to roll them when I try to crack jokes. In this moment, I was being a real nurse. I began to feel energized by the work I was doing rather than dreading being surrounded by the death.

I reached a comfortable stopping place where I could grab some water and refresh for a few minutes. As I prepared to leave the room, I asked, “You need anything before I step out for a second?” To my surprise, she raised her arm and pointed to the white board on her bedside table. This was her way of communicating she wanted to tell me something beyond the answers her head shakes could give me. I grabbed the white board, uncapped the expo marker from my pocket, and braced my hands to give her support to write. While she was weak from being on bed rest for days on end, her handwriting was crisp. She wrote, “Golden Nails ask for Julien.”

I had no idea what this meant. I looked at her with a visibly confused face. She responded by holding up her perfectly manicured hands that looked as if she’d gotten them done yesterday and not been in the hospital for weeks. Then she motioned to my hands, rolled her eyes, and made a face of disapproval. I looked at my hands. Looking at my skin cracked and dry from handwashing and nails damaged from years of anxious biting, it became clear what she was trying to say. My hands were a rough comparison to her perfectly polished ones. I smirked and asked, “You’re telling me I have to go see Julien so he can fix these things?” She met my smirk with one of her own and shook her head. She grabbed the marker again and we chatted back and forth about her suggestions for my appearance. She had not spoken a word to me because of the breathing tube in her throat, yet her personality and sharp mind had shown through our conversation clearly.

A week later, after many whiteboard conversations with her lawyer to get her affairs in order, she chose to withdrawal life sustaining care and died. Once again, death showed up just like it did on my first day on this unit. However, this time it felt different. This time, it felt like a release rather than a tragedy. Her death was one that happened by choice, peacefully, and after being educated of all her options and possible outcomes. I realized that this death was different because this is what it means to have a death with dignity.

Her death opened my eyes to the beauty in end-of-life nursing care that critical care nurses have the privilege of being a part of. She proved to me that feeling like a real nurse isn’t all about hanging fluids and documenting interventions, but about the whiteboard conversations about manicures and about providing comfort to a patient who knows they’re dying. This patient showed me the privileged role I would serve in people’s lives if I chose to stick with critical care as my nursing specialty. For these reasons, she is that patient.

Emma Jetty is a Senior Nursing Major from Effort, Pennsylvania. She completed a year long nursing externship at Self Regional Healthcare in Greenwood in 2019-20, and she will be returning to Self as an Intensive Care nurse after graduation.