Perception's Reality; Depends On Where You're Standing

You've Arrived;  The ER has opened it's double coded doors to you and you are here; Whether by choice or circumstance is really no longer important because you have arrived. (Remember I would not say welcome) - Your experience is going to follow an order not of your choosing.  This order does not normally change in dynamic.  The ONLY thing that can change your impending circumstance is who you are going to be blessed with as your ER Doctor, Nurse or Tech.  In a perfect world, one might be able to cancel out the actions of the other but we all know, that's not reality.  And this is where perception divides;  Your perception and the perception of the ER staff.   Guess whose perception is most important?   YOURS.  

You are triaged;  This used to mean; We are going to talk with you and try to figure out a little bit about what is happening to you before we take you back into a room in the ER.  It used to mean we would take your vitals,(blood pressure, pulse, temperature & oxygen saturation) listen to your story and either put you in a waiting room because your symptoms were less acute than perhaps someone else and we had limited bed space or take you directly to the back.  We would have taken our time, made you feel at ease (again this is all dependent upon the RN you happen to be blessed or cursed with) - we all know what that means.  If not let me make it a little more vivid.   You could have the RN who made eye contact. An RN who took the time to touch your hand and tell you "it's going to be okay", one who smiled at you with what I call the "comfort not condescending" smile. Or you could be cursed with the Trige RN that makes it apparent before you even open your mouth, that "they" are very "busy", that "you" are impeding on "their" time (remember we nurses do get paid, so it's never really our time to begin with) they are as cold as a steel stretcher and have obviously forgotten why they wanted to be  a nurse in the first place. The differences between these two types of nurses will be obvious within seconds of your arrival.

  Triage is a place that starts the ER experience for every single patient whether you walk in through the front doors or you enter on a backboard with an EMS unit.  All ER experiences begin with triage.  HOW you are treated during the triage process begins YOUR perception of your ER reality and it's impact is BIG.  Really big.

As you are brought into the big ER house you will notice immediately a bunch of people running in what will appear to be unorganized circles.  Believe it or not, we know exactly where we're going and why we're going there but we are all moving at different paces, treating different diagnosis's, people and circumstances.  You may see a couple of nurses sitting, and you think "they couldn't be too busy, could THEY?" but remember patient.........we are in the age of computers and all of our charting is now done on a computer.  Our ability to stand before you and with you with a clip board as we paper charted, which allowed us to be present "with you", has been removed and replaced with computers. Sitting does not equate to "not busy." Remember, perception.  Your reality.  Our reality. 

An " unknown person" walks into your room, and says something along the lines "here's a gown, please get undressed from the waist up."   Dear patient, you have a right to ask why.   "Unknown person" places a band on your arm;    Dear patient, you have a right to ask what the band is for and to check to make sure it's YOUR name on the band".  "Unknown person's"  are human beings, errors are made, help us not make one with you.    You are then tucked or not tucked into a cold hard stretcher and the curtain is pulled by the "Unknown person"  who still remains nameless because they have not introduced themselves.   Dear patient, any staff that has contact with you, not only should but are required to tell you who they are so that you know the role they will play in your life.    Yes, Dear patient;  the ROLE they will play in YOUR LIFE, Pretty powerful stuff.  And then your Casper "Unknown person" (Do they even really WORK there?)  Disappears.    How's the experience working for you so far?  

Tomorrow;  Was your perception reality?   Is your reality what you deserved?    Perception ALWAYS has reality's back.

Everything Is Not What It Seems

Probably every single one of us have been to an Emergency room at some point of our lives; Some city, some state, either for ourselves, our spouse, our children, our parent's, sibling or a with a friend.   Each experience unique, each find us with a rapidly beating pulse because in one instant we have lost control of a situation....called life..   And in that instant, people you never met in your entire life, now control your time, your medications, your diagnosis, your treatment time, your outcome and your trust.  Most hospital circumstances start in the Emergency Department and many end there as you are handed discharge instructions. Many end there, period.  Many bring you not only Beyond The ER Doors but into the larger doors of the unknown called the "hospital experience."   I won't put out the welcome sign.  It's not a welcome experience.  As a Registered Nurse in the Emergency Department, which has been a part of my life for many many years - I will start you out with a poem I wrote for my nursing graduation class.  It's my philosophy on nursing - read up.    Every hospital has a philosophy.  Do they hold true to them?   You decide.   I can assure you, that I hold to mine.   Put the side rails of your stretcher up and keep your arms inside;, tomorrow you go through the double doors.

DO YOU KNOW ME??
I lay in crisis. Alienated from my body, unable to control or demand that which sustains my life.

Images dance in my mind of white walls, white sheets, white sounds and white smells. The hall of loneliness. The hall of my reality that has yet to be painted with the colors of my life, of my individualism. I am cold and shivering as I huddle beneath this blanket of white.

I lay so still and quiet that I can hear the beating of my own heart. I deny what my mind focuses into images of sickness and pain.  My sickness, my pain.

I lay in a bed that I did not make, on sheets that I did not purchase, in clothes that don't resemble what I tuck safely into my bed wearing. I yearn for the smells, the sights, the sounds of a life I had until the moment I came to this place, to this second in my life.

I realize that I am paralyzed by my fear.  I don't want to die. I dont' want to be here. I cannot put into words the rage, anger, pain, frustration and cloud of doom I feel in every cell of my body.  God, I'm afraid.

My family look at me with the same fear in their eyes that I know I must have in mine. We are mirror images of each other, connected by memories and love, locked into this fear together.  Guilt at what I've brought o their world. Remorse at what has been brought to mine.

My body has been invaded by things I never knew existed. Tubes in my arms that carry precious fluid into my body. Tubes that carry the same fluid out of my body into full view as the world is now privy to my public humiliation. Medication being given to help my body heal that I don't even know the names of.  A thousand nurses, doctors and tech's coming and going into my world without so much as an introduction, a glance, smile or touch. As they go about their "normal" day,  I can assure them, it is not a normal day, at least not in my world, in my reality.

Do these strangers to my world understand that when they look up at the machine that carries my heartbeat across a screen, that they are seeing the day I was born, the day I learned to walk, the day I learned to ride a bike, the day I was promoted, got my first car, shared my first kiss.  Do they understand that when they feel my arm as they attempt to feel my heartbeat that they are feeling the rushing of the blood which contains my past and my future?  Do they understand that when they listen to the rising and falling of my chest that they are in witness to the air on which I depend to sustain my world, my memories, my hope? 

They are hearing a heart that smiled the day I was married, a thousand rings of laughter and a few hundred tears that were cried in happiness and in defeat. A heart that carried me from one sunrise to the next, that allowed me to touch the precious faces of my daughter, grand-daughter's, son-in-law, hug my parent's, brother, husband and friends, that allowed me to swim in the ocean, that allowed me to live.  Among all these machines are they seeing the shadows of my life? Can you see me?  Have you looked into my eyes?  Have you taken my hand?  Do you know me?

I am without direction.  I am consumed in my white world of confusion, pain and fear.  My internal compass taken from me the moment I entered this generic world.

I glance at my name band and almost smile at the irony.  I now come with a name and a number.   I am a prisoner. I am a prisoner of my illness.  My mind commands and my body does not respond I express wishes that may or may not be heeded.   I want to be alone as I experience this intense crisis and yet I must share this place with strangers.  Tears fall at a reality I cannot change.

Strangers work to save my life.  But do they see my life?  Do you know me?  Beyond the machines, medications and beyond the routine, do you see me?  You are impacting my life with each word, each step and each touch.  I do not have a choice but to share this journey with you but you made a choice to share this journey with me, the moment you clocked into work.  Long after you have forgotten this day, this time with me, I will forever be reflecting on it.  I spent a lifetime arriving at this moment. These may be my last moments, ARE YOU SHARING THEM WITH ME?         Do you know me?   I AM YOUR PATIENT !

Cynthia Balkwill RN BSN