We’re working ourselves to death.

by Kellen Squire

When I graduated from nursing school, I went into my first job ready to take on the world- as many newly-minted RNs are prone to. I look back now wistfully at the doe-eyed baby nurse that I was then. Why, back then, I’d run gleefully through fields of daffodils, gently playing the lyre, and reciting beautiful poems. Getting me to smile was almost as easy as getting me to volunteer.

Reality sets in quickly, especially when you choose a field like emergency medicine. Nursing burnout is at crisis levels, but particularly so in high acuity settings. One of the biggest differences between success and failure for these new nurses are mentors. They need to be teamed with an experienced nurse who can guide them through their tentative first steps. Be there to catch them when they fall, be someone they can lean on when times get tough- and times will get tough. So even when we do end up bitter, cynical, disaffected, and perpetually undercaffeinated, we do it with a purpose. With our humanity intact, able to keep going forward, helping people.

One of my mentors was like that; who’d been there, done that, and helped me learn how to keep it together in the face of unimaginable odds. Unimaginable odds are something she was familiar with; she actually lived near Blacksburg, Virginia, 2-3 hours from where we work in Charlottesville, but she spent 5-6 days a week (or more) in Charlottesville. She worked at both our ER, and as a case manager at the Level-One trauma center a couple miles from us. Her husband did the same thing; he was a nurse as well, also working six days a week at two different emergency departments.

It wasn’t easy; she had kids and grandbabies back home, whom she loved dearly. When I decided to run for House of Delegates, though her politics were a marked departure from my own, she encouraged me unequivocally, and said she’d have voted for me if she lived in my district. Turns out she’d seriously considered running for school board once upon a time, as she had a special needs child who the schools had failed pretty comprehensively. But she never ended up running because, as any working class person can relate to, real life got in the way.

One of the problems that caused them to work as much as they did stemmed from an all-too familiar story. A medical bankruptcy. See, my mentor’s husband had been driving home from an overnight shift in the ER, at the tail end of too many days working in a row, and fell asleep at the wheel of his car.

He survived- but only just. If you saw pictures of the crash, you’d be singularly amazed at how it was “only just.” And only to the tune of hundreds of thousands (if not millions) of dollars in medical bills and an accompanying medical bankruptcy. So, like the hard-nosed native of coal country she was, my mentor- and her husband, once he recovered- buckled down and worked as much as they could. They never talked about it, never complained about it. They were doing what society demanded they do; sacrifice all else to pay off their debts.

A normal day for her went like this: wake up in her car, at about 5am. Go into the big, level-one trauma center; shower, eat breakfast, and punch in by 6. Work until 5pm, when she’d get off, grab something to eat, and drive to our ER. Punch in, work until almost midnight, then drive back to the parking garage at the big hospital- where she’d curl up in her car and go to sleep until it was time to wake up for work the next morning. Day after day, week after week, this was her schedule.

And that’s how she worked herself to death.

One night this spring, she got off work at our ER, and drove to the parking garage at the bigger hospital down the road. This was during the last cold snap we had before the weather turned, so she left her car running when she went to sleep. But she’d chosen to park in an out-of-the-way corner of the garage where the concrete came together with no ventilation.

She never woke up.

The last shift I worked with her, she’d told me she was finally going to take some extended time off, because one of her adult children had been having trouble (stemming from a familiar problem in Southwest Virginia and West Virginia), and consequently, it sounded like she was going to have to raise her granddaughter. She was so animated, talking about how she was going to take her horseback riding, how she was going to teach her granddaughter to work the farm they owned in rural Giles County. You know, the sort-of schmaltzy thing you see in a bad movie.

Except it’s not a bad movie. It’s real life.

It hit me a lot harder than I’ve liked to admit. It’s why it’s taken me almost half a year to write about it, I think. It came on the heels, too, of one of our EMTs, a parent of two teenagers, going home after a particularly hard day at work and killing themselves. That sort-of double whammy, back to back, was a lot to process. And I suppose, like the good emergency services professional I am, I just shove those uncomfortable feelings deep down inside, into a place where they can be ignored, and you can pretend like it never happened.

Stupid, because I don’t care how tough you are, they’re not ignored. They’re not forgotten. They come back, in the middle of the night. Or when you go on to chart on a patient and see the last person who reviewed the allergies was that nurse, and when you click the button to say you reviewed them, her name will disappear forever- like she never existed. Or when you see a twenty-something year old from one of the rural counties outlying Charlottesville come in, in respiratory arrest, from an opiate overdose. Or as it’s now me mentoring the new nurses, wide-eyed and hopeful, with no idea about the weight of the world that’s about to settle on their chest.

But that’s what we do in nursing; in emergency services. Because there’s so many people out there who are hurting; who need us. We’re the ones holding the safety net together that keeps our community safe and sound. If we falter, everyone else suffers. We don’t have time for ourselves, for our problems.

This story, though, could be anyone. Car accidents, heart attacks, and cancer diagnoses don’t discriminate. Medical bankruptcies are the most common kind of debt in our country today; about 75 million people had at least some medical debt in 2012 alone, and nearly one in five have “crippling” levels of medical debt. Emergency services folks aren’t the only ones who work themselves into oblivion, or suffer from crisis levels of suicide and PTSD. It’s a epidemic in our country that, despite the news blaring about the low unemployment rate, isn’t being addressed in any comprehensive way; merely crocodile tears from a lot of politicians who’ve never had to work a hard day in their lives.

In the meantime, my mentor is gone. Her family doesn’t get to see her again. She doesn’t get to ride horses with her granddaughter. She doesn’t get to help her children through the ups and downs of their lives. The tens of thousands of lives she touched during her career all but invisible, except to those of us who had the pleasure of knowing her as a colleague and a mentor. A wife and a mother.

As a nurse.

Let me state this now, unequivocally:

Our generation will be the one that finally right these heinous wrongs, so stories like this one never have to be told again.

Yes. We WILL. But not without a lot of blood, sweat, tears, and toil; not without tireless work from activists and political candidates, and from everyday normal Americans. The road will be fraught with dangers and pitfalls and setbacks along the way; the slings and arrows flung by those who benefit from the way the system is now, who prosper when we fight one another and ignore them entirely.

But we will prevail.