Jacob Sims: Finding Fulfillment in Tough Situations
The day started like any other in the Bon Secours St. Francis Emergency Department. After getting report from the night shift nurses, my preceptor and I made our morning rounds on our assigned rooms, checking on patients and making sure the rooms had all the necessary equipment. The day continued in the typical ER fashion.
Buzzing all around us were meters and monitors signaling a flurry of high-paced critical patient situations. Just before lunch, EMS brought a patient who was short of breath into room four. For reference, a normal oxygen saturation is 95% or greater, and this patient’s was teetering on 70% without supplemental oxygen. Even once we put a nasal canula on her to provide her with extra oxygen, her oxygen saturation would not come up.
I took some time to talk with the patient. She was hard to understand but I was able to recognize that she could not breathe through her nose. Normally, I would place an oxygen mask on a patient experiencing these symptoms, but we couldn’t do that in this instance because she had COPD, and too much supplemental oxygen could stop her from breathing independently. Eventually, we improvised by placing the nasal canula near her mouth, so that she could breathe in the supplemental oxygen without receiving too much.
This caused a new problem since the patient had very limited movement of her extremities. She would slide down in the bed and the canula would slip out of her mouth. I made sure to keep a close eye on the canula placement because occasionally when I walked by the room, I would see her oxygen saturation had dropped back down to 75%. Her face would contort into a horrified expression as she laid in the bed because she felt so short of breath.
At the same time as this was happening, the ER received a call from EMS stating that they were on the way with a patient who was currently undergoing CPR. My patient with COPD was moved from room four into a hallway bed to make room for the new patient.
Once EMS arrived, the code team and I immediately took over CPR, starting with compressions. We inserted an artificial airway, initiated an IV, and administered medications to help restart the woman’s heart. My primary job was to do compressions and with every manual beat of her heart I felt the artificial airway clawing at my arm. The patient was later declared dead, so we cleaned her up and prepared her body to be viewed by the family when they arrived.
A patient died in my hands. She may have been a mom with a loving family, the daughter of proud parents, and a great friend to someone so close that she was considered family. What happened must have been absolutely devastating to everyone who loved that person. I felt the weight of these thoughts immediately after this woman passed away. I felt like this horrible feeling had grabbed me by the throat so hard that I couldn’t breathe. I had choked back tears while preparing the woman’s body to be viewed by her family.
But in the moment, with no time to deal with any emotions, I went back to work checking on each of my patients. The former room-four occupant’s vitals could no longer be seen on the monitor at the nurses’ station and her condition put her in danger of not being able to breathe. I continued checking on her while she waited for EMS to transport her back to her assisted living facility.
Before she left, I noticed she was trying to say something to me. I bent down and tried to understand what she was saying. In her whispery tone she told me, “My grandchildren would be so proud of you.” It was a simple phrase that brightened a very dark day and it’s still what I think about when people ask me what convinced me that I wanted to be an emergency room nurse.
In the critical care environment, things change very quickly. One moment you have one of the worst experiences of your life and the next thing you know, you are having an experience that you can feel is the starting point of a lifelong passion for Emergency Room nursing. It is like a roller coaster with many wild ups and downs, only this ride has no safety belts keeping you in your seat.
The ups are really what makes ER nursing worth it. I love when patients come in and can walk out healthier than they were before, with the appropriate resources they need. A patient could come in with fluid on their lungs and we are able to give them medications to help them breathe easier. Someone else may come in as a cry for help because they are being abused and we can identify that to get them the help they need. This is one of the only forms of nursing where the nurse is one of the last bastions protecting our patients from the brink of death, and it is truly a gratifying feeling. So gratifying that I left feeling fulfilled even on my worst days in the ER.
As I discussed earlier, there are times when the ER can get dark. Times that make you want to break down in the moment and keep you up at night months after the fact. However, every day during my externship I went into work with the mindset that I would do anything I could to improve my patients’ health. This could be anything from placing IV’s and inserting nasogastric tubes, to simply checking on my patients frequently and getting them something to drink.
Mark Twain once said “Do the right thing. It will gratify some people and astonish the rest.” As I continued living out my commitment to my patients, this quote proved itself time and time again. There were times when I even astonished myself. Dedicating my career to caring for critically ill patients and improving their wellbeing is a truly wonderful feeling, even when it isn’t.
Jacob Sims is a nursing major, and he completed an externship at the St. Francis Bon Secours Downtown Emergency Department in Greenville, SC. He is expected to graduate in May of 2022. He plans to continue working in the St. Francis Bon Secours Downtown Emergency Department as a registered nurse after he graduates.