Emergency, Urgency and Not

When I first started working in the Emergency Department, I never thought it would change who I was as a person. I was so wrong. I was a 22-year-old kid, prone to incisiveness and overthinking. I'm sure these are two of the worst traits an ER nurse could ever have and I'm still curious why anyone gave me that job in the first place! But I am so incredibly grateful for the manager who gave me that opportunity, choosing to invest in my development and not just write me off. It has been a defining path in my life! While I have certainly not mastered my overthinking, the ER has taught me a new framework to deal with stress and anxiety.

I remember my first few months were incredibly overwhelming. I had worked as a nurse on a cardiac unit, but this was different. Everything had to be done right away. If I was going to start an IV, I better be fast and get it the first time. Patients would come in struggling to breathe, and I had to learn to give nebulized treatments, assembling plastic devices and oxygen in a matter of seconds. Car accident victims needed CT scans to look for internal bleeding. Chest pain patients needed EKGs to rule out heart attacks. Many of those first shifts I felt like I spent the whole day wide-eyed trying to consume all the information and memorize it while simultaneously failing every patient by not moving fast enough. And just a few short weeks later, my preceptor cut me loose and I certainly felt the panic set in. Every patient felt like an opportunity to let a life slip through my fingers. I willed my body to run faster. I didn't have time to walk. But then was frustrated when moving too fast made me clumsy and I dropped things I needed or couldn't make a medicine drawer function at my speed. I skipped food. I had no time for it. Bathroom breaks? If you don't drink anything, you won't know you need to go! If I didn't have all the answers fast enough, someone was going to die. And it would be all my fault. Feeling the weight of everyone's lives in my hands, my palms would sweat, and my heart would pound. And so, the perpetual cycle began. Fret, work faster, fail, fret, work faster again.

Until one day, one of the older nurses decided to take me to task. We will call this nurse Jan. Now there's really no telling how old Jan was. She could have been 40, she could have been 60. I never could figure it out. She was a heavy set woman whose skin was permanently tanned to a dark copper from hours spent in her garden. Her black hair was always drawn back into a French twist clip with just a few curly bangs lined perfectly over her furrowed brows. She wore "readers" and was quick to shoot a glance at the "young" nurses through the gap between her glasses and her bangs with a slight scowl. She often complained that she was going to have to "fix" some "youngin's incompetent" attempt at some skill and that would be faster if she just "did it right the first time". If she hadn't been a nurse, I think she would have made an impeccable sheriff in a wild west film. She was order in our lawlessness and unwaivable justice. She had one speed. She couldn't be rushed, and she certainly wasn't slow. She just moved with a methodical timeliness. But between her grunts of disapproval, you could often catch a little smirk or a small wink when she knew you had finally figured out how to start an IV without letting the blood leak onto the sheets or you caught that little change on a heart monitor that had previously gone unnoticed. If you have ever worked in healthcare, I am sure you have already pictured who your seasoned unit nurse is, that one who "hmmmmphed" at the baby nurses.

Whether it was out of sheer love or total exasperation for my chaos, I will never know what prompted her. But that day, Jan caught me mid-spiral and said, "Baby girl. Not everything is an emergency. Stop acting like the house is on fire when it's just smoke in the kitchen, or you won't have any water left when it's actually burning down." I was confused. Was this not an emergency department? Didn't the literal neon red letters plastered on the wall in all caps say so?

But she was right.

In the ED, we use a system called Triage to determine the possible severity of illness and allocate resources. If someone's tooth hurts or they have a small cut on their toe, they would be a level 5. This is an issue that if beds are scarce, can wait. Whereas a true heart attack or a gunshot wound to the chest, is a level 1 and there can be no waiting. Part of being a successful ER nurse for me, would mean learning how to prioritize appropriately. I needed to treat levels 1s like the house was burning down. But I also, needed to treat level 5's like the roof was still intact, even if the patient was frustrated or angry with me. I was only one person. I can only fight one fire. And when I stretched myself thin incorrectly, I failed the real emergency.

Like Jan, I had to find my constant, deliberate pace. I learned to live by that old military adage – "Slow is smooth; smooth is fast". Just because the emergency department walls buzzed with perceivable angst, I did not have to. It's like the moment you're on a rollercoaster, and the pit of your stomach rages against your spine because you know you're about to drop 80 feet towards the ground at reckless speeds. Everything in your body is telling you that you are going to die, but you scream only in mock fear because you know the danger is not real. You know this is not real danger, because your mind has concluded that the harness holding you is perfectly capable of restraint against the powers of gravity. Anxiety was merely the overwhelming feeling that everything was an emergency, everything was immediate danger, forgetting the facts of what the true triaged problem was. The ED was my rollercoaster. Some of these drops were not as scary as the environment around me would lead me to believe. And some, I was conceding too much power, letting them grow into larger percieved dangers than reality. I would have to choose if I would believe the palpable fear or the conclusions my mind deciphered from facts.

I remember some of the first encounters I had with patients and low blood pressure. I would rush to a doctor, demanding this patient was in danger. And when the situation was truly grave, it would illicit action. But sometimes, the doctor would just nod, considering possible outcomes and ask me if the patient was awake. They would then say, "Ok. Go recheck it. Let me know if it's still low in a few minutes." In nursing, we call this monitoring. And at first, it felt really strange. I sat in the room hovering over the patients waiting for any change. Are they breathing faster? Is their skin paler? Did they just close their eyes because they are unconscious or are they just trying to avoid the awkward stare contest I have inevitably started by standing at the foot of their bed for an undesirable amount of time? But monitoring became a part of my nursing process. Over intervening also had consequences. Every medicine I gave had a possible side effect or harmful interaction. Giving a medicine to correct something minimally undesirable was worse than allowing the body the time to recalibrate itself. If it was unclear someone was having a heart attack, we would simply repeat the labs in 3 hours to compare them. Sometimes before opting for brain surgery, a neurosurgeon would say let's just repeat the head CT in 6 hours and see if this is really necessary. What initially felt like a neglect of action, over time became a slowing to appropriate action. I found the beauty in wait, watch, and see. Doing nothing isn't always apathy. Monitoring is an active choice to wait and learn.

As I began to tweak my "emergency response system" at work, I began to wonder how many things in my personal life was I over triaging. It turns out, very few things in my life really were really as emergent as my "what ifs" tended to make them. A cryptic text would pop up on my phone and I was catapulted into a state of anxiety. Someone talking poorly of me and suddenly I'm wondering what horrendous impact would this have on the rest of my life? What damage would this have on my relationships with people or future opportunities? I needed a response now. This needed to be fixed now. A new job opened up. I needed to decide immediately if I should take it. If I didn't, I could miss out. A roommate was leaving, I needed to find someone tomorrow to fill the spot. If I didn't, what certainty did I have for stable housing?

Instead of letting the things outside of my control drive me into a state of emergency, I would control the only thing I could: my mind, my heart, and my actions and I would leave the rest to God. In the ER, this meant letting other people experience their emergency. I empathized without internalizing. It was not my emergency. I would do what I could do to solve just one problem in front of me at a time. I learned to move objectively. Recognize the problem. Seek out the solution. And if it did not need immediate attention, do not be afraid to say, let's just monitor this.

Personally, I had to let go of the fear of people – the largest drive of my personal anxiety. My desire to be liked and accepted had left me whipped around at the mercy of other's opinions or devastated by unkind things people said about me. But their power over my life was only as deep as the Lord allowed it and I consented to it. I had to let them say whatever they felt so inclined to say. But I would walk in correspondence with my conscious and pray that as people "monitored" my walk, they would glean enough information to see me for who I am. I had to let go of the idea that they had more impact on my life than I did. We both existed in a world upheld by the hand of God, so why fear what they could do to me?

It was not an easy transition, nor have I perfected it, but through the years I have certainly improved. Even this week I have had moments where I had to stop and ask myself, does this text need an answer right this second? Is this emergent.... urgent... or truly not? If I gave myself a minute to recalibrate instead of act, would it feel less like my world was going to implode? Would my response to this situation be different?

So dear friend, if you're journey right now feels more like chaos, emergencies, hurricanes, or rollercoasters with no seatbelts, I feel for you. I really do. I know that feeling. The pace of this world is often pulling, demanding your attention, telling you that every decision is imminent and your failure to action is permanent. But this is simply not true. Do not believe the lies of the angst that buzzes around you, wanting to force you to its pace of emergency or urgency. Do not let what looms in front of you to illicit that inevitable creeping anxiety if the danger is not real. Walk instead in your determined pace, resting in the confidence that what is not in your control is certainly in the control of the God who holds the universe in suspension and is actively willing to hold you too if you so choose.