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What patients ask from an ER nurse

March 22, 2017

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What patients ask from an ER nurse

As many of you reading this know I am an ER nurse for more than ten years.  When I first started working in the ER coming from a theater background I was interested in the stories of the people and the healthcare staff, the so called ER dramas, so I started a blog.  After some time, as I became overwhelmed with the stories and the pains became too real, I gave up on writing most of them, just tried to find a cleansing ritual for myself to be able to survive to the next day.  

During the past seven years I devoted my time to study and practice of Chinese Medicine, one of the most comprehensible ancient healing systems available to us today.  Today I work both as an acupuncturist and as an ER nurse.  And I feel the need to write the stories of those I encounter again.


Today I feel people need to hear these stories, because these could be anyone's dilemma one day. We all have encountered the stress and confusion of the current medical system.  That is why we need to hear opinions of other health care practitioners, healers, holistic nurses, acupuncturists and not rely solely on one medical systems' point of view...  

Without feeling ashamed or being dismissed, more and more I find myself having a full voice in the day to day lives of the patients I encounter, both in the ER or in my private clinic.  A lot of us are experts at what we do, but when it gets to our bodies and our health we let other professionals make decision for us, sometimes matter of life and death.  I am starting this blog with the hope that these stories will inspire the readers to take charge of their health and start to think about medicine as a play they have the main role in.  




Imagine waking up one morning, making your routine coffee, getting ready for work, checking emails, and suddenly you stand up and there is a head rush, a tingling sensation going up your neck, you feel it spread to the left side of your face and you start to lose your balance.  Fear takes over, you call your spouse, they are more scared and call 911.  The next thing you are in the ER.  The doctor quickly evaluates you, makes you do things like touch your nose quickly with alternating fingers, move your legs, squeeze his fingers, then he rubs his hands to your cheeks and asks you if you feel them the same.  In your fear and head rush you tell him no.  You are starting to babble a little bit.  The next thing he mumbles something about a stroke and two people rush to your stretcher to take you to the CT scan.  


The CT scan does not show anything.  The whole time you are feeling the tingling sensation on the back of your neck, and you even express that it feels as if your hair is standing up.  They have a neurologist talk with you with the distant portal.  She appears on a screen, asks you a million question again in a rushed tone and at the end is asking you if you want to get the TPA, which is an aggressive treatment for bursting clots, and it only has a window of one hour left in your case, hence all the rushing.  


Then starts the dilemma...  


In all my years of working as a nurse I have used TPA multiple times on stroke patients.  Some instances I have seen the miracle of it.  A limp arm starts to move again, as if rising from the dead.  However calling it an aggressive treatment by the neurologist herself is a proof of all the dangerous side effects of the drug, i.e. bleeding anywhere, possibly even from the brain itself.  Therefore we don't use TPA on older patients and those with risks of internal bleeding.  In the case of my patient, he was alert and smart, still had his sense of humor and cracked jokes here and there to release some of the tension.  However, the amount of information he was being bombarded with was so overwhelming that he was just not able to make the decision.  Interestingly his wife had a history of stroke in the past and her experience magnified his situation as well.  


Meanwhile I kept moving and doing all the necessary things, moving his stretcher to the CT scan and back, putting an IV in him, drawing blood and assisting the computer neurologist in parts of the neuro exam that needed my hands.  When the moment of decision making came, he turned to me and said, what should I do?  Now this is a question that no one likes to answer in the medical field.  The liability is too high, what if he does have a stroke and it develops in the next few hours, but he is out of the window for TPA already?  What is he doesn't have a stroke and gets a bleed from the medication.  


No one is going to take the risk of making that decision for you.  You are bombarded with all the information in the span of half hour and left to make a life and death decision for yourself.  If you ask the monitor neurologist who is examining you from California she will keep repeating the same information.  The ER doctor is not going to make that decision for you either.  So you turn to the nurses... 


Usually in these moments I like to assist the person to center themselves.  There is so much fear and anxiety around had I been in his place I would feel my hair standing up also.  What is the truth and how to move on with not knowing.  I believe that deep down our body is wise and we all have the answer.  I told him there is confusion in his mind but in his heart he knows.  Then I asked him directly, you have lived in your body your whole life, are you having a stroke right now?  


Even if he did have a small stroke, did he need the aggressive clot buster that has revived so many from the dead?  At that time his walk was improving, there was no problem with his speech to begin with as he told me that is the natural way he talks and the tingling sensation was subsiding.  He closed his eyes and was left to meditate for a few moments without anyone's interruption.  He then decided to not get the TPA.  


Interestingly, in our mainstream medical system, we do want the patients to make their own choices.  We provide them with all the information necessary, or as much as we can or think is necessary.  But the agony remains.  The agony of not knowing, of searching in the dark for an answer, of something being wrong but not knowing what.  I believe that is really deep down caused by our living condition separating the mind and the heart.  I told my patient that I am an acupuncturist, and in the Chinese Medicine world, the body is mysterious.  


In the ancient healing system, not only the emotions are inseparable from the physical body, but also there is room for mystery.  For not knowing.  For emptiness.  You need space for movement to happen. The Chinese culture has an amazing understanding of how things work and the patterns governing life.


If you push and bombard something into someone, they will not have room for response, they will just react out of fear or anxiety.  For truth to emerge you need to provide stillness, even if it's hinted at in a busy ER, for a few seconds.   

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