What Witnessing a Code Does to Us...

By: Sarah K. Wells, MSN, RN, CEN, CNL

What is a Code: For the context of this post, a Code is a coordinated resuscitation effort to deliver ACLS or PALS care to a patient

Who is the “us”: Members of the healthcare team that are part of the Code response or who witness the Code response

How witnessing a Code impacts us: Codes are traumatic to witness, let alone participate in. The impacts on those healthcare team members involved can cause a range of emotions with the negative severe effects potentially being as serious as conditions such as PTSD, depression, SI, etc

Why am I talking about this?: The tragic incident of #damarhamlin receiving CPR and a potential defibrillation on the field during this week’s Bills vs Bengals game exposed millions around the world to a Code. People are reacting strongly. Players at the game walked off the field. Discussion is happening about how people are feeling after witnessing such an event.

Where does that leave HCWs?: While the world gets to discuss and feel for days or more about witnessing a Code online, on TV or live at the game, HCWs are going to work and participating in Codes as just another day or night at the office. We need to start discussing better preparation options for HCWs involved in Code response work in terms of management of the stress and trauma for those involved, increased mental health support for all HCWs, and continue the meaningful conversations about the society’s disparity of expectations for the public vs those that work in healthcare.

Bottom Line: We save lives for a job, but we must protect ourselves above all else because what happens when no one is left to respond to the next Code?

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Reader: Are you a nurse or healthcare worker who has participated in a Code response? How have these experiences affected you? What helpful resources would you want other HCWs to know about?

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About the Author: Sarah K. Wells, MSN, RN, CEN, CNL is an 11+ year nurse with over 10 years of that working in the Emergency Department. Sarah has helped with countless Codes and has experienced many mental health effects due to this work.  Sarah hopes to see more work being done to support nurses and other HCWs focused specifically on providing psychological safety and increasing their mental healthcare access.

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The light in the dark of 2020

I have failed so many times this year.

I have failed to get out of bed on days where my body wouldn’t listen to me.

I have failed to be open with my family, friends, colleagues, and clients when the despair was too great to function.

I have failed to be as present as I could have been during this most unprecedented time – historical mostly due to failures in leadership, process, and procedure that have cost our country 289,000 deaths and counting as of the writing of this post.

But most of the time, I am able to do so much – get up, work, smile, speak, write, advocate, care, support, listen, live, be – and each action is a success that must be celebrated.  

These are the days that will define my life.

I was a high school student during 9/11, graduated college in 2008 during the Great Recession, and worked as an emergency and radiology nurse during disasters, epidemics, and the worst days in the lives of so many of my patients. But this pandemic, this year, these moments – these will be what I tell future generations about.

And while I will speak to them about working through PPE and supply shortages, not knowing what to do when others needed it most, shouting reassurances to patients through masks and goggles, managing the public misinformation, and drowning in cleaning supplies at work yet not being able to find basic hygiene products at home, there are other more important moments that I will share first and most frequently.

I will tell the future generations of nurses and other healthcare workers about the fear of others, fear of an unknown, and a fear of bringing an evil home that could harm or kill my loved ones. I will tell them about the loneliness – missing my family, my friends, and not knowing when it will be safe to be around them again. I will tell them about the isolation – not just the feeling of being alone but also the physical distance between people – eating lunches outside, not in the break room with my coworkers. About edging away from others because of the unease of being around people without a mask. And the feeling of fear that was not always of others, but of myself, not knowing if I was unwittingly passing on a novel evil to others.

I will tell them about the crushing weight of shame when I called out of work as an essential frontliner, not for COVID-19, but for anxiety and sadness that I could not get under control, no matter how much mindfulness, self-care, and therapy I sought out. I will tell them about the days when I couldn’t move without my husband physically hauling me out of bed and into clothes to get even the most basic things done.

I will tell them that even in the darkest, loneliest moments that I was still me.

I was still a nurse. And I was no less of a nurse because of my struggles. Every time I took a stronger dose of my SSRI - I was a nurse.  Every call to my therapist, appointment with a psychiatrist, and day I stayed in bed and streamed 12 hours of TV in an attempt at harm reduction – I was a nurse. I was nursing myself. I was nursing my mind and my brain chemistry. I was nursing chronic conditions called anxiety and depression that were exacerbated by the most unprecedented year in medical history.

And I never did it alone. I had my husband, my amazing partner in all things, who cared for me every day. I had my family and friends, IRL and online, who helped support me during my best and worst moments. I had my incredible nurse community – because we are a community that can withstand all things – who checked in, sent me packages, emails, texts, DMs, messages, and the most hilariously inappropriate memes to make me smile on days when I thought the world was ending. I will tell them that my nursing and healthcare people came together to support me because that’s what we do when the shit hits the fan – we roll up our sleeves and figure out how to fix it.

I want to tell everyone going into healthcare in the future that you are never alone.

You have generations of us - nurses, doctors, nursing assistants, techs, phlebotomists, imaging technologists, respiratory therapists, social workers, therapists of all varieties, and all the other medical roles that make up our incredible healthcare team – who have had those dark days, been in those paralyzing moments, and gotten through to the other side. We are here for you to lean on, get guidance, and receive all the wealth of our collective experiences. We are also here to represent those who have not made it. We know how impossible the work is, yet we continue to do it. Through the hardest moments, we are there to care for others, keeping them alive and comforted, making them better. 

But know that you will have dark, challenging moments too. And often those moments will be in your car, on the way home, or at 0400 when you are unsuccessfully trying to sleep. You will be replaying things in your mind, wondering what you could have done differently, or thinking about how all of it doesn’t matter anyways. You may despair. You may want to give up. And it’s OK. I want you to know that I have despaired. I have wanted to give up.

But I haven’t, and you shouldn’t either.

I have seen the dark, and yet I eventually got up out of bed again. I showered, grabbed coffee, and put my scrubs back on. I got my PPE. I grabbed food and my nurse bag and went to work. I put on my mask and goggles. I cared for others because that’s what I do because I am a nurse.

 When I tell others about 2020, I want to make sure they know all the parts.

And I want to make sure that no matter what year it is, the dark moments have happened and will happen again, but despite the darkness, there is so much light to be had. I show up every shift for the light. I am here to help you see it too.

Sarah @ New Thing Nurse

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About the Author - Sarah K. Wells, MSN, RN, CEN, CNL is an educator, speaker, blogger and owner of New Thing Nurse, a professional and academic coaching company for the nursing world. New Thing Nurse is organized to provide support and guidance to aspiring nurses, newly graduated nurses, and veteran RNs looking to make a change in their life. 

Whether it’s a new school, new job or new idea,

New Thing Nurse wants to help with your new thing!

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COVID-19 & My Nurse Mental Health - I feel like shit that has been trampled by elephants.

I literally can’t get out of bed some days. 

Everything makes me cry. 

Going through the day feels like walking through waist-deep mud.

I am tired of talking to people who are not my nurse or healthcare friends. No one else understands.

This is what COVID-19 has done to me. I have not caught it. I am physically well but mentally, I feel like shit that has been trampled by elephants over and over again.

If you are in the healthcare field, you may know what I’m talking about. There is a constant dread during every waking moment. It is a heaviness that for me, is often on my chest, making it hard to breathe. I have heard others describe a giant pit in their stomach that will not go away. 

And your dread is valid. This effing novel corona virus is a REAL bitch, and it’s killing healthcare workers around the world. 

Plus, we are often being expected to work without the equipment we need to stay safe and keep our patients safe. It’s a time when we are being called “heroes” but are being treated like trash. 

Yet there are people out there who care. I see social media posts, public displays of appreciation, and huge philanthropic efforts to support us. Everyone I know texts, calls, or emails. They all want to know the same thing - “How are you?” 

I don’t know how to answer.

I want to say - “I am awful. I am afraid. I am worried about every one of my friends and loved ones getting sick or dying. I can’t see my family or best friends. I’m terrified that I am going to bring this wretched virus home to my husband. I am so lonely that I can’t move. Every shift gives me a panic attack before and after and sometimes during… but otherwise, I’m good. Have you watched Tiger King yet?”

I don’t think that’s what people are hoping for…

Thankfully, I have amazing friends.

A brilliant nurse friend and colleague of mine posted the most eloquent response to this question, which I have now borrowed with her permission and will use as the response for me, and I think, most nurses right now: 

“People keep asking how I'm doing. I wanted to be very honest, so here it is. Strap in - this is long.

We are struggling.

The burden of this pandemic weighs so heavily on us. We are bearing the weight of the world on our shoulders and we aren’t sure that we are strong enough.

We carry a rock in our stomachs and a lump in our throats which have taken up permanent residence and from which we cannot be released.

We put on a brave face, but we are taking enough antacids to medicate an elephant. If we are already on antidepressants, we’ve increased them. If we aren’t on them, we are considering starting them.

We’ve stopped worrying that we’ll bring this home to our families anymore. We’ve taken that as a given. We worry that our family members could be the vectors who unknowingly spread the virus to somebody else. We need to protect the world from US.

For that reason, we take social distancing extremely seriously. Guess what? That social distancing, though? It’s killing us. We are empaths. It is both our nature and our job and now we can’t give our love to anyone. Do you know how much we could all use a hug right now? We can’t have one. Our children miss their relatives and are begging for real in-person hugs and we can’t let them. Our hearts ache.

We worry.

We worry about all of the same things that you do. We worry about our families, but we don’t get to dwell on that because we’re worried about your families, too. We worry that you will be the patient we have to tell, “I’m so sorry, but due to the isolation precautions we will all be trying our best not to enter your room after I leave. Here is your call bell. Let us know if you need anything!” We worry that you will feel alone. We worry that it will be the last words you hear from another human before you are gasping for air and we have to intubate you with no family present and nobody to hold your hand.

We worry that our kids will internalize our grief, anxiety and depression due to what we face each day.

We worry that you call us heroes. We don’t feel like heroes at all. We are just as frightened as you are.

We feel guilty to be gainfully employed when so many are not. However, we worry what the ultimate price will be for continuing to do the job we love so much.

We feel sorrow for the lives lost and for the many more that we are bound to lose due to poor planning and preparation.

We feel disposable. Under a president who refuses to acknowledge the severity of this pandemic, the CDC making subpar recommendations for PPE, a national administration that has been unable to equip its frontline staff appropriately to protect themselves so that we can SAVE FUCKING LIVES – WE FEEL DISPOSABLE.

Despite all of this, we will still SHOW UP. Because when you are a nurse, it is more than a job. It’s a calling. It’s what we do. We SHOW UP.

To all of our colleagues – from EVS to RT to MD and everyone in between – THANK YOU for showing up.

To all other essential employees of the world – THANK YOU – for feeding us, delivering our mail, picking up our trash, keeping the streets safe. THANK YOU.

And to those who are forced and/or able to stay home, THANK YOU for doing your part to flatten the curve. We know that it is not without great sacrifices for many.

To those who are donating, volunteering, sewing masks and caps, lifting us up in prayer, helping your neighbors, and spreading kindness and love – THANK YOU.

This is a battle that we are all fighting together and everyone plays their respective part, so THANK YOU.”

 - Ginelle Rasch, Emergency Department Nurse

I know. Ginelle is THE BEST.

Things are so hard. If things seem impossible for you too, know that you are not alone. I feel the same. Ginelle feels that same. But somehow, together, we are going to get through this. 

And if you need a little extra help to push through, that’s totally ok too. In the past few weeks, I have switched my SSRIs, increased my talk therapy appointments (via telephone), and have had to be very open with friends and colleagues about my mental health needs. 

Your mental health is important, just as important as your physical health. Take time to care for yourself. And know that you are definitely not alone. 

- Sarah @ New Thing Nurse

Here are a few resources that I am using to help me get through the days. Maybe they will help you too:

Crisis Text Line - Mental Health Support via Text

National Alliance on Mental Illness (NAMI) COVID-19 Resources & Information Guide

Podcast: Kate Bowler - Everything Happens, “The Emergency Button”.

Podcast: The Hilarious World of Depression - Call a Friend, Find Out How They’re Doing.

I tried yoga once so far. It was nice. This yoga is free! - Down Dog

Connecting with friends:

Art of Emergency Nursing Podcast Episode with Me, Kristen Cline, & Kevin McFarlane

FB Live Fill Your Cup Virtual Meetup with Anna Rodriguez of The Burnout Book

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