Guest post by Kellen Squire, Democratic candidate for House of Delegates in the 58th district (Albemarle, Greene, Fluvanna, Rockingham).
There’s a few reasons I decided to step up and run for office this year. This story covers just one of ‘em- and for your convenience, I’ve written it in a “cliff notes” version, and a “regular” version.
The “cliff notes” version? Because I’m a nurse- and nurses don’t quit.
The regular version? Well.
I’m an emergency department nurse, so I occupy a very big part of our community’s safety net, alongside my brothers and sisters in Fire, EMS, and Police. We’re where everyone comes when things go wrong. When they have nowhere else to go, or don’t know what to do? They come to us.
You kinda recognize that before you join the emergency services field, but I always tell folks, it’s like when you’re having a baby. You know it’ll be huge, and that there’s nothing that’ll prepare you for it, but you never recognize the height of that particular cliff until you’ve already jumped off it.
And anyone who works with emergency services knows, too, that there are a lot of days where you spend almost as much time being a counselor, a psychiatrist, and a social worker than you do as a healthcare worker. Comes along with the territory. Usually, too, by the time people roll through the doors of my ER, all of their problems- medical and otherwise- have been piling up for so long, that they all come out at once.
We occupy a role that’s both humbling and stressful at the same time. Things that people haven’t been able to tell anyone else, problems that’ve been bothering them, things that’ve gone wrong in their lives… finally, there’s someone who’ll listen to them. Who cares. And that- that right there. We don’t get into these jobs for the fat, fat paychecks. We don’t work long hours because we don’t have anything better to do. We don’t go a whole shift without eating because we’re not hungry. We do it because we care about people.
And because of that, we take our patients’ problems, and we put them onto our already overburdened shoulders. We just do. Nobody tells us to- nobody has to. We pick people up and help them shoulder their loads, ignoring our own stress, our own needs. And we do it no matter what.
The unofficial motto of nurses is “Nurses don’t quit- they just burn out.” Very dark, but a hundred percent true. We don’t- ever. We work hard, we take on everyone else’s problems, and let our own pile-up until we’re burnt out. Suicide, stress, and PTSD rates among emergency services providers is at critical levels. Because all that weight that sits on our shoulders, that we take so other folks don’t have to? It doesn’t go away.
I can attest to that personally. For example, I hold every single pediatric code I’ve ever worked on my heart. No exceptions. I remember every single one of them vividly. In your hands, you can feel their ribs cracking under the pressure of your chest compressions. The feel, the crunch that the IO makes when it goes through their bone marrow. The bright pink foam coming from their lips, spraying into the air, droplets landing on their ashen grey skin. Mom shrieking and crying in terror in the background.
Sometimes, in the middle of the night, I’ll sit awake and try and think through what I did wrong; or what I could have done differently. And there’s the thing, too. I was only one of an entire team of people in those codes, but we all take it on as a personal burden.
One kid- when I worked in Pediatric Acute and Intensive Care at the UVA Children’s Hospital, we had a HemeOnc patient (see- leukemia) who I absolutely loved. He was amazing. Sharp as a whip. He’d give me crap for being a UVA fan, he was a Hokie, and so everytime the Hokies beat UVA, he’d rub on me mercilessly. Anytime UVA won, he’d shrug and go, “It was a fluke!” Heh.
God, I loved that kid.
He was great, too- he’d demand I be assigned to him as the tech for his nurse, and then I’d get to play video games with him in his room. Heh. Only time I’ve ever been able to get away with playing video games on the job. And he’d kick my butt in them, too- I told him that I was just letting him win, but he knew. And he gave me relentless crap for that, too.
One weekend, I worked a 7am-7pm shift, and had hung out with him. He was fine; wasn’t feeling a hundred percent towards the end of the day, but anyone who works with our oncology kiddos knows that. Nothing out of the ordinary. But I left without giving him a hug because we had another patient who required a multiple-person intervention, and I needed to go shower afterwards. I’ll skip the details, but any nurses in here read my five by five on that one, I’m sure.
I got to work the next morning and kiddo wasn’t doing so hot. They rushed him by me as I was just coming out from punching in, headed to the PICU. I hadn’t gotten my assignment yet, but I followed the crowd of nurses, doctors, his family, over to the ICU room that had been cleared for him.
He died an hour later.
I didn’t work that code- I sat in the background on that one. Kids, you gotta understand… adults, they’ll go down a slope when they’re getting worse. Their bodies are more robust, have more reserve capacity. They decline. Gives us at least some time to intervene- or, at least, to prepare, both medically and psychologically. Kids, though… they drop. Fast. Off a cliff.
There was so many people in that room- anyone who’s worked a code knows what that’s like- I just hung back and was stunned. I had just been playing video games with him. He’d been fine. I hadn’t said goodbye to him the day before. I hadn’t given him a hug.
When it became rapidly clear he wasn’t coming back, I stepped out of the room. His parents didn’t understand. They knew it was bad, but most folks who haven’t worked codes, particularly pediatric codes, don’t get it. And, I mean, damn- they were his parents. They had to have hope. So I stood with them- but… then dad. Dad, big, burly dad. Tough guy, at least four inches on me, biceps the size of my thighs. He looks me in the eye, and asks me, “Is he going to make it?”
What. the. ****. Do you say to that? How the hell do you even answer that? But he saw it in my eyes. He knew. And he grabbed me, and wrapped me up in a hug, and sobbed into my shoulder, sobbed the tears of a parent who sees the life of their child flash in front of their eyes- toddling steps, looking up at you, smiling. The feel of them against your shoulder, fast asleep. Singing “You are my sunshine” to soothe them as they cry in their car seat, knowing it’s just a few more minutes to home. Them waving goodbye to you as they walk into school for the first time. All that, by in an instant… he and knows it’s all gone, all that time, all those moments, are at an end. Forever.
I held it together; I really don’t know how. But I did. And somehow, I got through my shift. And I got home. Walked into the front door, grabbed a beer, and slumped down on the floor. And cried. Sobbed.
I still see that code, too; more often than I’d like to admit. Maybe if I’d have been doing chest compressions, instead? The PICU nurse that did ’em, maybe she wasn’t compressing hard or fast enough. Or maybe she was doing it too hard and too fast. It should’ve been me. I could’ve done better. If it had been me, I could’ve saved him. Total bullshit, of course, that nurse was doing her job just fine, but even knowing that logically, again… in the middle of the night, I think- it should’ve been me. I should have jumped in there and just done it. He’d still be here. He’d be at home. Playing with his friends. His parents.
That’s just one of a dozen or two things just like that I carry around with me, everywhere I go.
Ask any of us; ask any of my friends in Fire, and EMS, and law enforcement. They’ve got a bunch of stories, all the same. And every time a new story like that comes along, we just add it to the next one.
And the next one.
And the next one.
We don’t quit- we just burn out.
So as I see, on the news, people talking cavalierly about repealing the Affordable Care Act- our congressman had just a fan-friggin-TASTIC sneer to the effect of, “hurr, hurr, hurr, the UNaffordable Care Act, amirite, ya’ll?” in his first speech to Congress. Oh, what a comedian! When I read about the folks who chortled about making sure that Medicaid expansion in Virginia got killed- including a state legislator who’ll remain nameless in this diary- even when every major hospital in the state got together, offered to pay the state’s share of that burden forever, begged them to, just, please- let them have the money to help their patients, to hire more staff, et cetera. No, no. Can’t do that.
Why not? Oh, oh, well! It was just our principled fiscal conservatism, you see. Yes! Fiscal conservatism. Now, ignore the unfunded mandates we love to pass so we can go back to our districts and brag about not having raised taxes, while the local folks get slammed, politically and monetarily, for having to make up the difference. Ignore that we could’ve come up with our own plan, since the ACA included provisions that if they had a better idea, they could’ve done it instead. Ignore the government pork and lovely socialisms we absolutely love when they’re part of OUR pet projects. Even easier to ignore the folks who’re gonna take in the shorts, especially when you’re a career politician who has gerrymandered themselves into a district where they don’t even have to try to listen to folks any longer.
And that’s what broke me. I was, like many of you, devastated by the thought of the people who’d lose care, who’d be dropped unceremoniously for the safety net to catch, just hoping that net didn’t have too many holes. Or their sudden opposition to the “individual mandate”, or, as we call it in the ER, the “no free rider law”. I’m usually a small-l libertarian about a lot of stuff; I’m big on personal liberties, and making sure folks have the maximum amount of personal freedom possible, which leads me to oppose everything from laws restricting abortion to eminent domain. That, however, has been one place I’ve broken from that hard. Everyone ought to have at least SOME skin in that game.
But what threw me over the edge was thinking of my friends in emergency services. Because let’s be honest here- whatever fallout there is from the hole the folks in Washington are gonna blow in the ACA, or however it devolves for Richmond to figure out, it’s going to come down directly on us.
And like I said- we’re not going to quit. No matter how hard it gets. No matter what we have to endure, we’re just going to keep working harder, and harder, and harder, until we can’t work anymore.
I saw that anvil, hanging overhead. Hanging over the heads of my brothers and sisters in emergency services. And I thought- there is absolutely no damn way I’m just going to sit here and let that weight drop onto us. Or, if it is, then I’m going to fight it with every single fiber of my being. The politicians who love to use us as props and then ignore our needs? Well. If they’re gonna ignore our needs, I’m going to DAMN well make sure it’s not because someone wasn’t speaking up for us- wasn’t FIGHTING for us. And if the worst thing that happens is I go home in November, and my brothers and sisters in emergency medicine get the attention they deserve- that the folks we SERVE every day get the attention they deserve? I can sleep like a baby at night.
And, like I said, that’s why I’m doing what I’m doing. That’s why I’m in it for the long haul. That’s why I’m running for the Virginia House of Delegates here in the 58th District- and why I’m going to keep going, no matter what. Because I carry the torch lit by the generations of nurses that came before me. That we all carry, regardless of the odds or circumstances. When people need help- we get to work.
We don’t quit.
Please consider donating to, or supporting, the Code Green campaign, Badge of Life, or the Firefighter Behavioral Health Alliance. Unfortunately, there’s no similar dedicated organization for nurses. Guess we’re too damn stubborn to even do that.