On the Other Side of the Rails
Leaving a Lasting Impression
Terry M. Foster
“I know your name is Terry and I know you’re an ER nurse. Last year, you took care of my father-in-law when he died.”
She’d caught me completely off guard with this statement.
We were at a social event and I’d spotted this woman earlier, and vaguely recognized her as someone I’d met before. I could not recall the details. We were at a local charity benefit event for a fellow nurse and there were hundreds of people there, but somehow this woman singled me out, anyways. As emergency nurses, we can be leery of interacting with a stranger who may have been a patient or family member when we are in public. All night, I kept asking myself, ‘Did I care for her in the emergency department? Was it a good experience? Was it a bad one? Did they have drug seeking behavior? Were they angry at the hospital, the doctor, or me?’ I’ve learned over the years to trust my intuition, either regarding a patient or someone in a social setting. Somehow, by the way she’d looked at me throughout the evening, it was not a feeling of anger or regret (thankfully), but I still wasn’t sure. In my culture of origin, there are social barriers and nuances that make it difficult for an older male to approach a younger female to ask if they had met in the past.
At the end of the event, the large crowd started to disperse. Around this time, I saw her waiting in the lobby near the exit. She was looking right at me as I was heading in her direction. She was waiting to speak to me, but I was very hesitant. This was a great night. I hoped it wasn’t ending in a confrontation or on a bad note. As I walked into the lobby she asked, “Could I talk to you?”
“Yes,” I replied, hoping someone was nearby to rescue me if this went badly. There wasn’t anyone around. I was on my own. That was when she shared that I had cared for her family member as an emergency nurse.
I still had no idea exactly who she was but could tell by her approach and tone of voice that my previous hesitations were now unwarranted. She continued to relay the events of the time we’d met before, “He had a cardiac arrest as my mother-in-law and he were leaving the doctor’s office. The [ambulance] squad brought him to your hospital. You came out to the ER lobby and told us it was bad, and asked us if we wanted to be in there while they were working on him? We didn’t know we could do that, but we said yes, right away, and you took us back to him.”
She continued, “As soon as we walked into the room, you announced that his family was here. You introduced us to the doctor and explained everything the team was doing. You went through what his heart rhythm was doing, all the drugs that were given to restart his heart and what the many tubes were—but that none of it worked. It had been a long time since his heart stopped and the doctor asked us if we wanted to stop. You put your arm around my mother-in-law and she started to cry and said ‘stop, please’ and they did. You gave us the worst news in the world, yet you were so nice and helpful about it.”
When she finished speaking, I was left absolutely speechless and stunned to say the least. As she began her story, I thought, ‘I don’t remember you all at all.’ Then after the first couple of sentences of her story and the more she talked, the more I acutely remembered everything. Even though I couldn’t recall the patient’s name, I remembered clearly what happened. He was a male in his 60’s who had just seen his family physician for a routine check-up. There were no immediate, major health concerns identified in the routine exam. As he walked to his car in the parking lot, he collapsed in full cardiac arrest right in front of his wife. The local EMS was dispatched, and the family physician came out and started CPR. The family physician even continued CPR all the way to the hospital, rotating with EMS.
Upon arrival, the patient had been in asystole throughout the entire resuscitation, was completely cyanotic, and his pupils were fixed and dilated. The family physician required emotional support, facing the unanticipated sudden cardiac arrest immediately after there was no evidence of immediate health concerns on the routine primary care physical exam. As an emergency nurse for many years, I have learned that not all life-threatening emergencies can be detected, or often evade detection, on routine preventative exams.
At the benefit, the daughter-in-law continued, “I sent a text to my mother-in-law and told her you were here.” She said, “I told her that guy from the ER was here. She wanted to come up here to see you.” We talked a lot that night and she asked me a couple of questions, wanting to connect to my review of that awful day.
And it truly was an awful day for both this family and for our emergency department. As a Clinical Nurse Specialist, I usually don’t have a patient assignment, but I was assisting the staff on that busy morning. More than one patient died that day with little or no warning before their life-threatening emergency. We cared for families who witnessed a sudden, unexpected death. Just as we were finishing up with the care of one sudden cardiac arrest, we received an EMS call that another one was en route.
The routines for expert emergency nurses include ensuring the privacy and separation for the family that just experienced the death of the loved one, and mentally compartmentalizing each case to prepare to deliver the best care to the incoming patient. That day, I had to repeat the “it doesn’t look good” talk with multiple families, offer them to come back into the room to be with their loved one, and explain the code procedures.
The lesson to me was that we never know the long-lasting impact that we make on a patient or their family. As emergency nurses, we are pleasantly reminded that patients and their families often never forget their ED experience, be it positive or negative. For this particular day in the emergency department, I didn’t do anything different than other emergency nurses all over the country were doing as well. But that one somewhat routine experience--for me and the rest of our staff--turned into a forever moment for one heartbroken family. We must remember no matter how many times we care for families grieving a sudden and unexpected death, that our actions are never insignificant to a patient or their family.
When I think about that night, it was apparent that I left a lasting impression on her. But also, by what she told me, she left a lasting impression on me. Emergency nurses often maintain a protective emotional layer when meeting people in the public. I learned in this encounter to occasionally let my guard down a little in order to witness the long-term, positive impact inherent in the practice of nursing.
Terry M. Foster, MSN, RN, CCRN, TCRN, CPEN, CEN, FAEN, is a Critical-Care Clinical Nurse Specialist for the five Emergency Departments of St. Elizabeth Healthcare in northern Kentucky. He also has a dual role as an Ambassador for the St. Elizabeth Foundation. An emergency nurse for 42 years, Foster serves on the Board of Directors for the national ENA and is a member of the greater Cincinnati chapter.
How to contribute
We encourage submissions from any reader who has been touched by the healthcare system. Some contributors may be involved directly in patient care and might want to share the impact a patient, family, or colleague had on them. Others may want to write about life “on the other side of the rails” …those moments when the caregiver becomes the patient…or maybe sees healthcare from the vantage point of a family member. Inquiries can be sent to [email protected]