Do nurses ever truly clock out?

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Ahhhh… Vacation.  Gotta love it.  Nurses tend to joke around about never truly being on vacation.  We make t-shirts about it, send each other funny memes, laugh about it at work.  But really, we do tend to try to avert anything that looks like it might turn into an emergency, because hey, everyone needs a mental break sometimes.  Even nurses. That being said, we also jump in and help without hesitating if the need arises.  Even on vacation.

Last weekend I met up with a girlfriend of mine for a weekend away from home.  We met in St. Louis, which makes the most sense for us while trying to meet halfway.  (I live in Oklahoma, she lives in Ohio.)  We had an awesome weekend just catching up, trying some new restaurants, seeing some great sites and places.  We even managed to get in on opening night of Miss Saigon.  I did not manage to get away from being a nurse for the weekend, however.

We were hiking up the concrete steps of the Gateway Arch when it happened.   I was blazing a trail to the bathroom (which seemed a good half mile off in the distance) when I hear my friend call my name.  I turn around and see her.  One of the sweet little elderly ladies we had just talked to is lying on the ground, clutching her head, groaning softly, a grimace on her face.  My friend later told me “her head sounded like a melon cracking open” when she hit the ground.  She has fallen down the concrete steps onto the equally hard concrete pavement below and taken a direct hit to the back of her head.  My friend motions me over, saying “You gotta help”, and I’m doing a split minute decision on whether my bladder will hold out for this emergency, or if it will become the main emergency itself.  I can’t NOT help her though, so I rush back to her side.  I gently address the elderly group surrounding her– “I’m a nurse, may I help you?”  The look of relief is evident on their faces.  I quickly assess her while someone goes for help.  She hasn’t passed out, and she is talking to me without difficulty, so I know she is okay for the moment.  Soon a physical therapist stops and offers help, and bystanders are quick to help with whatever they can–keeping her shaded from the bright sun shining in her eyes, something to put under her head to pillow it from the concrete ground,  etc.    Her friends are praying out loud, panicky, scared something terrible has happened.  My training kicks in–regardless of what has happened, calm the patient and those around her.  I quickly point out to her and her friends that she is stable for the moment, and that emergency services will be here shortly for further assessment and to take her to the hospital.  I talk directly with the patient then, discussing her condition and telling her what needs further testing and why.  She insists she doesn’t want to slow down her group of friends, which has not yet gone up in the Arch.  I gently remind her that she might have suffered a brain bleed from the fall, which wouldn’t necessarily be obvious in the few minutes that have passed.  At the very least, she might very well have a concussion.  I convince her to keep from moving until Emergency Services get there to take over.  Once they arrive, I step back and let them do their thing.  We leave after they have taken over and have things well in hand.  I still really need to use the restroom, and it’s almost time for our tour to go up the Arch.  For all I know, that elderly group of visitors may have been slated to go up on the same tour as us.  We’ll never know; neither will we ever know how things turned out for her.  We did ask a park ranger after the tour if they had any updates.  Apparently, she was still refusing further medical care and was not taken to the hospital.  I laid awake that night, worried for her.  Was she okay? Did she eventually get worse as time went on? Was she near help if she did worsen?  As I lay there, I thought of all the things I could have done differently to help her.  Did I miss something? Was there anything else I could have done before EMS arrived? And other thoughts I had…Why are the steps and walkway designed like they are at the Arch? How many people fall on them each year?  How much worse are they when it’s actually wet?  How do they respond to emergencies inside the Arch? Or at the top? How far is it to the nearest hospital?  Where DID those emergency workers come from so quick? Why aren’t there better signs posted around the Arch, directing traffic?  Sometimes I have a hard time shutting down the “what if” questions. 

Nurses are trained to look at scenarios to find out what’s wrong and to try to fix it.  I guess that’s something you don’t just turn off when you clock out and walk out the door.  I had a great weekend in St. Louis, but I came away with a few golden nuggets of wisdom.  1) Allow plenty of time to reach your destination, in case something unexpected happens.  2) Never turn down a bathroom break when it’s presented to you, as you may really, really wish you would’ve taken it a little while later.  3) Always be prepared to lend a helping hand to those around you…you’ll be so glad you did.  

To the sweet little lady who fell, I hope you are okay.  I hope you and your friends were able to go see the Arch.  I hope your vacation was all you dreamed of.  And… here’s to many, many more adventures for the both of us. 

                   Nurse Ames, RN

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