C L I N I C A L N U R S E S F O R U M

Beth L. HuFaculty MemDallas, TX.

For correspoSt, Dallas, T

J Emerg Nu

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March 201

A NIGHT IN THE EMERGENCY DEPARTMENT: ANURSING NARRATIVE

Author: Beth L. Hultquist, MSN, RN, CNE, Dallas, TX

Section Editor: Andrew D. Harding, MS, RN, CEN, NEA-BC, FACHE, FAHA, FAEN

I t was a very slow night in the emergency department—the kind of night you don’t discuss, you simply enjoy. Ihad the corner assignment, which consisted of just 3

rooms that usually held patients with challenging problems.The benefit of this assignment is that only 3 instead of 4patient rooms make up the nurse’s assigned load. Inaddition, I was working a “princess shift,” which is whatour staff calls a short, 4-hour shift to bridge the gap instaffing. As “The Princess,” I was lightening the load of myfellow nurses and thus enjoyed a great deal of good will. Itseemed nothing would rain on my parade. After all, howmuch can happen in 4 hours?

An empty room is not necessarily a good thing for anED nurse. An empty bed is just the remedy the triage nurseis looking for as the number of patients starts to grow in thewaiting room. However, this night it was the fact that I hadan empty room combined with the luck of the draw thatbrought Madeline to me and me to her. She walked inslowly, accompanied by her mother (who was not mucholder than I) and a man. Madeline was young—28 yearsyoung—with a sparkle of humor in her eyes. The 3 of themwere joking and laughing, and my cynical mind immedi-ately thought, “What could possibly be wrong to bringthem into the emergency department tonight?” Thisthought in hindsight was rather odd because, as I previouslymentioned, I wasn’t busy. What gave me the right to passjudgment on a brief encounter in the hallway on the wayinto their room?

The physician examined Madeline while I cared foranother patient, and when I checked the orders, I couldn’tbelieve my eyes. Port-a-cath access? Laboratory tests? Bloodcultures? Morphine? A straight catheter for a urine sample?

ltquist is PhD Student, Georgia Baptist College of Nursing, andber, Louise Herrington School of Nursing, Baylor University,

ndence, write: Beth L. Hultquist, MSN, RN, CNE, 3700 WorthX 75246; E-mail: Beth_hultquist@baylor.edu.

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Although it was a slow night, I didn’t welcome thisadditional work! In the shorthand of emergency chatter, thephysician simply said to me, “Stage IV ovarian cancer, andshe feels horrible.” For the second time in as many minutes,my cynicism was put in check.

This would be my first solo port-a-cath accessprocedure, and I was somewhat apprehensive, but when Ientered the room I fell in lockstep with their funny banterand sarcastic comments. I liked Madeline the moment wemet. I quickly staked my claim as her nurse and told her Iwould do everything I could to make what we were allhoping would be a short stay in the emergency departmentcomfortable and perhaps a bit fun! While carrying out hernursing care, such as accessing her port and getting the urinesample by very intimate means, I listened. Her pain isalmost unbearable for me to recall. I learned her father haddied in our emergency department just a few months before.He had a massive stroke and died in the room opposite theroom we were in that night. Her mother winced at thememory, and Madeline spoke softly. She herself had beenfighting ovarian cancer for years. Her mother said, “It was arelief for him not to watch Madeline suffer any more.” Hermother’s brother was also very ill and dying, and they hadjust lost a grandmother to old age. They had experienced somuch loss, so much sadness, and yet they would speak ofthese things and then remember a fun time or a funny story,so we were all laughing through tears. Madeline’s mom justlaughed and beamed. I could not at that moment believe shewas still upright with all the grief and pain that had beenhanded to her. I had to leave the room; I did not want themto see the actual tears run down my face.

I took a short break to get myself together and wound myway around to the vending machine, which can sometimesserve as a nurse’s therapist. Madeline’s mom arrived at the samemoment, and in the chatter of what to choose, I asked her if Icould give her a hug. I told her I was in awe of the strength ofher character and the love she had for her daughter. I have noidea who needed the hugmore, her or me. She cried quietly andthen, in the manner of mothers, wiped her tears and said weboth needed to get back to Madeline.

The time was now spent watching television and waitingfor results. I brought coffee and snacks, warm blankets, andmagazines. I looked for opportunities to go into the room, tohear more stories. I made rounds on all my patients but

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returned quickly to Madeline’s room, looking forward to thenext round of stories, when I met the doctor leaving theroom. This time when I entered, all 3 were crying. I saidfirmly, “What did he do to you?” The physician had justdelivered the horrible news that the infection was raging andshe had to stay for a few days. In all this pain, in all thislaughter, the one thing Madeline did not want to do was staythe night. She sobbed, saying it was all so unfair, and it was.Why did she have to stay? “I’ll take the antibiotics at home!”she insisted. Why did she have to have cancer? The outburstwas brief. Amazingly brief. As quickly as the anger hadarrived, it left. She apologized. Apologized! It was incredibleto me that she was apologizing for being angry. After all, I wasangry for her. I too felt angry at the cancer that was taking adaughter from her mother, angry at a stroke that took a man Ididn’t even know from his family, and angry about a youngwoman who wanted to be a mom like her own. So muchanger, and yet, then it was gone. Laughter ensued, betting onthe food delivered to patients at this late hour, betting on thetype of nurse she’ll get on the floor; “No one will be like you,”she said sincerely. I have been in awe of human strengthbefore, but never so profoundly as this small family unitbuoying each other on life’s sea.

I was at the end of my shift, and although on any othernight I would have taken Madeline up to her room myself, Icouldn’t bear saying goodbye. I knew I would find an excuse

168 JOURNAL OF EMERGENCY NURSING

to sit down with them and not leave, but my role in thisfamily was winding down. As the nursing technicianwheeled her out of her room, barely missing hitting the doorjam, we laughed and laughed about male drivers. Thegurney stopped in front of me and Madeline asked if shecould give me a hug. She lingered and thanked me. Me.Madeline said they had waited so long before coming to theemergency department because she hates hospitals andespecially our emergency department, but the visit turnedout to be “bearable” and she would fight this battle, too. Istuttered that she was an inspiration and to keep fightingand as the gurney rolled away, I know her mom saw mytears. I could do nothing else but sit at the nurse’s stationand cry.

When nurses tell their stories, the funny stories, theheartbreaking stories, the stories of their youth or the storiesof their experience, there is always a patient and a nurse.There is always caring, often laughing, and certainly crying.And in all these exchanges, we are transformed. This humanconnection is the essence of nursing, and I’m humbled eachtime it happens to me.

Submissions to this column are encouraged and may be sent toAndrewD. Harding, MS, RN, CEN, NEA-BC, FACHE, FAHA, FAENADHardingRN@gmail.com

VOLUME 40 • ISSUE 2 March 2014