Anything that’s human is mentionable,
and anything that is mentionable can be more manageable
-Fred Rogers-
“Code Blue ER,” the familiar announcement rang out. Somehow, my reflexes have only slightly dulled to these words after almost 25 years of doing ER and trauma work. “Take a breath and feel your feet on the ground,” I said to myself on the way to responding.
Currently, I am working close to my hometown, doing contract work at a 25 bed critical access hospital. Which means, I was walking down to the same ER and likely to the same room, where a close relative left this world much too soon, but somehow also exactly in the timing of providence six years ago.
I walked into the unexpected. In less than a second, the similarities in the story in front of me and the story that played out six years ago, caused my brain to tell me: “This is the same thing and this loss is happening all over again today for you. Remember how horrible it was for you and your extended family? That is what is happening for this family right now.”
In the next second I grabbed myself out of that story and into the story that was in front of me. I offered my clinical expertise in helping to ensure we could all know we did everything we could and that the ending just wasn’t ours to rewrite this time.
The first case of the day and the OR team were all waiting for me upstairs. Somehow, I needed to regroup in the time it takes to go up one flight of stairs. I said to myself before swinging the heavy metal door to the stairway open, “That was not my person (because I couldn't stop thinking about their people), and that was not ______ (the name of my relative I lost previously). Then, I went into the locker room, sat down and took a deep breath, and held space for the experience I just had and offered myself kind support.
Boundaries, self kindness, asking for help and support, sharing my experience. These are things that I never knew were there to support me when I first started working as an ER nurse at age 19. But I know them now and leaned into them heavily with this experience.
Boundaries: this is permission to take a deep breath and remind your brain and the feelings surging through your body that this patient isn’t your person. You are free to have “detached concern,” when your brain says: “Hey! This person’s age/situation/appearance is super similar to someone you love deeply so let’s live all the feelings like it is them!” Sometimes, practicing a ritual can help with setting emotional boundaries with yourself. For instance, when I change my OR scrubs after a super difficult case I’ll say to myself “I’m leaving this here,” as I throw my scrubs in the laundry bin.
Self Kindness: Darling, “You alone did not cause this and you alone cannot fix it.” I have to remind myself of this often in hard clinical situations.
Asking for help and support: I would have NEVER done this when I started in the ER. There was so much shame associated with letting others see you sweat, and the threat of losing all sense of belonging in the ER tribe was great if you let them see you cry. Now, asking for support is one of the first things I do. There was one other CRNA working with me this day and I told them, “This hit me particularly hard and this is why.”
Telling your story: What we can’t speak of, we can’t heal from. What we can’t speak of, we hold in our sacred vessels as shame. Before I started my first case after this event, I texted multiple people I love and trust and told them I had just had a difficult experience and was needing their support—-I told my story. I stay with my parents when I’m on call because our family homestead is close by, and when I got home I told my dad I had had a super hard day and cried and said out loud all the terrible sad things that were flooding me.
“Integration,” that’s the term that describes what I was up to with all of the above. And, it is the term that those who study the secondary effects of trauma on trauma workers use to describe making sense of the terrible awful in front of us and finding a hopeful way forward in the midst of it.
I want to honor the courage and determination it takes for me and for you to do this process over and over again. We stare the terrible awful in the face, do the work to heal (or not and die a little inside each time) and then we choose to do it again and again for years. We are a brave bunch. We are also a wounded tired bunch who carry unconscious scars that, sometimes, we can’t even tie to a conscious story anymore. Somehow, the beautiful and painful truth of being the brave and the wounded lives in all of us. Thank you for being here. Thank you for reminding me over and over again that I am not alone in my good days, I am not alone in my hard days, and I am not alone in this profession.