Courtney Phillips, Trauma in the ER, Impolitikal

Courtney Phillips on the traumas of working as an ER nurse

I met Katy* when she had just finished a 12-hour night shift at hospital. She was wired on energy drinks, something that most of the fellow nurses in her age group relied on to get through the gruelling work week.

“It takes me ages to come down off the bloody things, so I can’t actually come home and get some sleep. I end up only getting a few hours [sleep] before my next shift starts. It’s a constant, shitty cycle.”

She’s still in her cobalt blue scrubs, they must be at least two sizes too big for her, and when she throws her body onto her couch they engulf her. I always imagined nurses would wear those orthopaedic-soled comfort slip-on shoes, but Katy has street cred-worthy adidas shell toes, telling of her 26 years. They are spotless except for a spray of brown dots covering one shoe. When I bring it up she bends down casually and picks at the mess with what’s left of her bitten fingernails.

“Oh, fuck I just washed these,” she says. “It’s blood from a patient we had in the other night. She had a really bad miscarriage; she was 19 weeks pregnant, which is very late to miscarry. She was haemorrhaging really badly, and blood was literally gushing off the table. The doctor actually pulled the foetus out of the woman while she was lying there. The team leader told me to take the foetus away; seriously I’ve never seen anything like it. It was like a little doll, hands, feet, fingers and toes. It was devastating for the parents. They were my main concern. Later that night I didn’t sleep. I stayed up all night researching why she could have lost a baby at such a late stage. That’s the hardest thing with this job, the whys… sometimes we just never find out.”

Welcome to the world of the ER Nurse.

She is a pretty young woman, with slightly crooked teeth and incredibly blue eyes — when you can catch them — and she radiates warmth, the kind that makes you want to take your shoes and socks off in front of and curling up to reading your favourite book. Hailing from small town in Ireland, Katy was raised in a family with four siblings. Being the middle child she said she generally got away with being of “average shithead-ness.” Instead of going to university, Katy wanted to own a nightclub. Her mother wisely decided that she should go to university, where according to the Irish high school points system she was given three choices: nursing, social work or veterinary nursing. She chose nursing.

“I loved it, every minute, then in my second year student placement something really fucking bad happened when I was only 12 weeks into my first ER ward placement.” I watch the goosebumps rise on her arms as she recalls the event.

“The red phone rang in the ER, which means there is a massive trauma on its way. The ambo arrived; there’d been a hit and run. A woman, aged 33, massive trauma. Being a student nurse I wanted to help out — I thought I could perform CPR, but when I got in the room the doctor pulled back the sheet, took one look and pronounced her DOA [dead on arrival].” Katy stops making eye contact and picks at her cuticles. “The woman had pieces of the car in her stomach; her mobile phone started ringing in her pocket, somehow it had survived but her body had be torn to pieces. When I cut off her clothing later her body was like slush on the inside, she had been pulverised.” She told me later that it had been the woman’s husband trying to call.

Katy, along with a nurse who was making jokes in poor taste, were left to place the body in a body bag. She was given no support or guidance after the ordeal which left her, at  20 years old, with insomnia, binge drinking problems, drug addiction issues and, it was later discovered, Post Traumatic Stress Disorder (PTSD).

“I had so many questions, I wanted to ask so many medical questions, had to clear so much up. It was the first person I had seen die. A few days later the charge nurse came and told me that it was the worst trauma that she and the doctor that had been in attendance had seen in their collective 30 years working in the ER.”

Katy admitted to me that she now has a fear of dead bodies. She felt ridiculous admitting it, as she has sat with many people while in their last moments and doesn’t believe that there is anything left of the person after they have died, but she now cannot enter a room without another people if there is a dead body in it. She giggles when she tells me this, but there is a real fear in her eyes.

The charge nurse at Katy’s hospital told me, “There is not any type of counselling available to nurses to help deal with stressful situations. We do a lot of talking amongst the team and there is always a ‘post-mortem’ conversation after an event where we dissect what happened, what was good and bad, but this is at a clinical level. However there is a drinking culture among A&E staff, they tend to have lots of social gatherings to help with team building and de-stressing but sadly there is also a lot of gossip after these events as someone usually takes things to far and makes a fool of themselves.”

Research has uncovered that within the Australian hospital system approximately 24% of ER nurses test positive for symptoms of PTSD related to their work environment, compared to only 14% of general nurses (and 17% of soldiers who served in the most recent Iraq war).

“No nurse will ever show how bad it ever affects them, not to each other, never. It’s a big problem, that’s just how everyone is taught to deal with it I guess.” Katy says.

When I ask Katy what it is that sets her apart from those nurses she struggles to answer. She finds it hard to answer questions that make her speak kindly or highly of herself. She pauses for while, silent while the question settles in her mind. “It’s the little things really, the other nurses make fun of me for this, but I always warm the water before I give a patient an enema. To me that is a kind thing to do, I wouldn’t want freezing water up my arse when I am sick. I used to work on a stroke unit; I would spend 10 minutes putting on the women’s make-up in the morning and shave the men. If they arrived with their own PJs then that’s what they would wear, I wouldn’t change them into the hospital ones, even though using the hospital ones would make it easier for me to do my job. Those are the things that would make a difference to the patient.”

“As hard as it is, we [nurses] speak for the patients. I take that very seriously. You need to be compassionate and respectful in this job, and a lot of people are burnt out, or don’t care enough for the patients, that really kills me.”

She speaks of feeling a special connection to her patients, more than many other nurses have, something which her manager confirms. “Katy finds it hard to ‘let go’ at the end of each shift and she really worries if she knows that the nurse taking over her case load was not as passionate about the job and she would fear for the patients.”

Many people might say that all this might be part of the territory of being an ER nurse. That other high-pressure jobs within the medical field will face similar issues. That might be true, but I’ve only met Katy, a 26 year-old ER nurse who has dedicated her young life to caring for sick people, when clearly she is overwhelmed and sick herself — as a direct result from the job that she loves so much. We talk for a while about the mundane, and when we do she’s full of witty Irish charm. When I turn the conversation again to her work though, a serious shadow comes across her.

She’s dedicated her life so far to nursing, and with everything that has happened so far, will she stick with it in the long term?

She’s quiet for a very long time while she thinks, then finally she says, “I want to, it’s what I do, what I love, but I’m worried about getting burnt out, I don’t want to burn out, I think it’s every ER nurse’s biggest fear.”


*All names have been changed.

Courtney Phillips is a Melbourne, Australia-based freelance writer and lifelong unicorn enthusiast. Read more by Courtney on Impolitikal and at the Unseen Life. Image by Ralf Heß CC-NC-SA.