In it For the Long Fall

The first step in my nursing career was as a Patient Care Associate, or Nursing Assistant. Patient Care Associates (PCAs) perform tasks ranging from ambulating patients, bathing, feeding and taking vitals to performing CPR during rapid responses and providing post-mortem care. Needless to say, they do the “dirty” but vital work that is a part of in-patient clinical care.

Being a PCA taught me so much and shaped how I work on my unit. I treat my aids as if they are my equal; I scratch their backs and they scratch mine. There is a sense of synergy in my unit because they know I was a PCA; they know I have been through the hell of being an aid and that it takes a team to make it through the night. Most nurses do not have the experience of being a Nursing Assistant - I feel this should be a requirement before becoming a nurse. I do not just see aids as individuals I delegate tasks to, I see them as critical members of the healthcare team. I hold myself personally responsible for the work they produce and the care they provide.

Every member of a hospital is a team and should be treated as such.

Most people who know me would agree that I go above and beyond and try my best to not half-ass anything I do. As a PCA, I followed this exact mantra and went above and beyond the call of duty with regards to the job description (as vague as many job descriptions are). I took this job with the intention of going to nursing school, and continuing on to get advanced degrees; apparently my aspirations were problematic for my coworkers. It was a shock to me that furthering my career would put a bullseye on my back and cause drama. The work environment became toxic and I began to find myself alone when I needed help. Most of my coworkers had no desire to become nurses, and they were more than okay with the line of work they chose. Rumors started to spread and I ended up having to defend myself in situations I never thought I would find myself. I was confused that there would be so much pettiness in a place where teamwork should be of utmost importance and where people depend on help to get better.

My preceptor always had my back; he was and has always been there for me, even to this day. He taught me everything I know when it comes to providing care and making light of hard situations. He was there for me at my weakest and most emotional moments, as well as moments of celebration. From day one he said, “Do not go out of your way for anyone or go above or beyond what is required of you because no one will have your back and no one will give you the help that you give them; trust no one and just do your time and get out of here to nursing school.” I should have listened to him, because he was right. The only time help was available was when you managed to get assigned to a kind nurse (who was a PCA at one point) or there was another PCA who was going to nursing school; this was seldom the situation.

This leads me to the event that has unfortunately shaped how I think about providing care, causes me to be hesitant at times, not to rely on others, and to not trust management. In July of 2019, I was about two hours into my second 12-hour shift in a row and I was making my rounds talking to patients and taking vitals. I walked into room 14 and I met two great patients who told me their life stories while I took care of them. I made my way over to the patient in bed two; to give a better picture without violating HIPAA, I will just say that this patient was about 5’10 and weighed around 285 pounds. For comparison, I am 5’9” and weigh approximately 140 pounds. This patient was visibly nervous and I asked them what was wrong. They replied with, “The nurses and doctors are telling me that I am going to die if I don’t have a bowel movement”. Now, I had this patient earlier in the week and knew that what I was experiencing during this conversion was a drastic change compared to my initial encounter. Despite being out of my scope of practice, I tried to console the patient and provide some education and reassurance regarding his current situation. After taking their vitals, I realized something was off: their heart rate was significantly elevated and their blood pressure was lower than normal. Knowing that this was not a good sign, I asked the patient if they were feeling “alright” and I could see that they clearly were not, both emotionally and physiologically. I left the room to grab their nurse and explained the situation; we proceeded to ask the patient to sit on the edge of the bed before we transferred them to the chair. Getting to the edge of the bed was a clear struggle; the color left the patient’s face, their breathing quickened, and they became diaphoretic.

We waited for the patient’s breathing to settle and for the patient’s “go ahead” regarding transferring from the bed to the chair at the bedside. This patient’s ambulation status was “an assist x1 out of bed”; we planned accordingly and I said that I would assist the patient with standing and pivoting from the bed to the chair. As soon as the patient was ready, we stood up and began to pivot to the chair. Right after we began to move, the patient dropped to the floor and took me with them. I am not a big guy and I was not expecting 285 lbs of complete dead weight to just drop to the floor.

My concern at this point was taking care of my patient, disregarding the audible pop I felt in my back.

The nurse responsible for this patient jumped in to help lift the patient off of me. At this point, the patient was barely responding to us, passed gas and some stool on me and the floor, and was visibly in respiratory distress with their head on the seat of the chair. Both the nurse and I, with all our strength, tried to get this patient up and onto the chair with no success. I checked that the nurse had the patient braced up against the chair before I left the room to ask for one of the stronger nurses on the unit. Both the other nurse and I came back into the room and as soon as we both tried to lift the patient onto the chair once again, things took a turn for the worse. The patient went unresponsive, became incredibly diaphoretic and cold, turned purple, and passed more gas and stool. The nurse who was assisting me with this patient told me to run to get the sliding board and yell “cardiac arrest” in hopes that someone would call the rapid response team.

Coming back into the room, the nurse and I put the board on the ground and threw the patient onto the board. We began to take turns providing chest compressions while more help arrived. It was complete chaos and I was visibly shaking and in pain from the patient taking me down, but I knew I needed to help save this patient’s life. More members of the rapid response team arrived and four of us lifted the patient off the floor and threw them onto the bed. We hooked them up to the Zoll device, medications were continuously drawn up and administered, the patient was intubated, and I continued to switch off giving CPR. After I helped to attach the pads to the patient’s chest, the Zoll announced that, “there is no shockable rhythm, continue performing quality compressions”. I had received the bare minimum training in Advanced Life Care Support (ACLS), but I knew that this was not a good sign. This same announcement was repeated every two minutes. I was the only PCA in the room helping with the patient. Meanwhile, one of the hospitalists took over and continued to shout orders, all while the other nurses were carrying out the steps of ACLS and walking me through steps as I continued pressing into the chest that was now caved in. A nurse from the Emergency Room brought up a LUCAS machine; we maneuvered the patient so that we could attach the machine to the patient so effective continuous CPR could be provided. At this point in my experience being a PCA, I had only seen emergency situations when watching Grey’s Anatomy so I had some sort of idea of how they were carried out and how issues were resolved. After about twenty or so minutes of performing CPR, drawing and pushing medications, and walking through the Hs and Ts of ACLS, I heard the Hospitalist said that the patient is too far gone and that there is nothing else we can do. They instructed us to turn the LUCAS machine off and to stop providing rescue breathing with the ambu bag.

At that point, I heard a phrase I had only heard on Grey’s Anatomy, “Time of death…”. It was at that point I broke down and began to cry; I was covered in blood, sweat, tears, and stool.

All the chaos was over, the room looked as if a tornado ripped through the hospital. Guess whose job it was to clean up the mess, bag the patient’s belongings, and provide post mortem care? Yup, it was mine and the nurse in charge of this patient. I am not going to take you through the whole process of post-mortem care; but I want to leave you with the image that has forever been burned into my brain. Upon walking back into the room to provide care, I looked at the patient: they still had the intubation tube sticking out of their mouth, they were completely covered in cold sweat, blood was leaking out of the IV site, and the worst part...their eyes were open and staring at me. I was talking with this patient not just 20 or so minutes ago, I was reassuring them that they just needed to take small steps and stop refusing to take laxatives in order to have a bowel movement and that everything would be okay. Now they are dead, eyes open, and looking at me. That scene is forever stuck in my head and I continue, to this day, to have PTSD; writing this post is giving me anxiety and causing me to get emotional, but I want to share this moment in my life with all of you.

What’s the next step after experiencing trauma? Did you guess therapy? Well you’re wrong, it’s actually paperwork!

After a rapid response or an emergent situation occurs, there is an aftermath report that recollects everything that happened. Guess who was not invited to give their report? I was told to go back to work since we were short staffed. I was fairly new to the job, didn’t know my rights, and wasn’t able to provide my perspective on the aftermath report At this point in time, I knew something happened to my back, but I was not in pain so it did not occur to me to seek legal advice or medical attention. A couple weeks go by and my back pain is increasing in severity to the point where I need to start taking medication to alleviate the pain while at work. The pain accelerates where I need to go to the Emergency Room to be evaluated; all my coworkers knew that I hurt myself during that emergency situation, and continued to watch me work in pain for the rest of the summer without reporting it to management. Upon the ER evaluation, the hospitalist informed me that they didn’t even need a scan to know I had a severe herniation. At this point, I made an appointment with my Primary Care Provider; they prescribed some steroids, no pain medication, and made me some appointments for physical therapy. The steroids had no effect, pain was not alleviated, work was unbearably painful, and physical therapy was a waste of time.

-Third spinal steroid injection

On top of all of this, nursing school was starting and I was still in a tremendous amount of pain. I had to hide this as best as I could from the faculty, because I knew I would be asked to leave the program due to being “unfit” for clinical. Three months after my initial injury, my work manager texts me asking for me to come in for my yearly evaluation. I advise them as to why I have been unable to pick up shifts due to the injury which occurred at work. My manager then proceeds to call me and inquire as to what occurred, why I did not report the injury, and why I did not go to Employee Health. Placing the responsibility solely on me, I was blamed for my own injury; my manager knew of the rapid response, my injury, and the unfortunate death of this patient and did not advise me to take these actions. Being a new employee, I was completely unaware of the process and what my rights were. My manager advised me that I was not even listed in the aftermath report of the emergency situation which occurred in July. They asked me to provide a detailed account of the entire situation, all those who were included, and that they would submit an incident/injury report on my behalf since I was unable to come into work. I found out that this never happened and that the Manager was actually asked to resign without any notification to me or other staff.

I went to Employee Health in visibly excruciating pain; they evaluated me and scrutinized me for not reporting this earlier; they did not believe that this occurred at work. After finally convincing the Provider that this did in fact occur at work, they had me fill out an incident report and apply for workers compensation. I applied for workers comp and was denied; they said I had zero evidence that this injury occurred in the workplace and that I must have hurt myself while off the clock. I hired a Workers Compensation Attorney and have been fighting with my previous employer’s lawyers for over a year and half now. I even provided a list of four or five witnesses (nurses who took part in the rapid response, and people I went out of my way to help throughout my time as a PCA); they all claimed that they did not recollect me injuring myself at work. Ironically, all these individuals were up for the Unit Manager Position.

Who would testify against their own employer and the people who have a direct impact on employment and promotion?

Nurses experience traumatic events every shift, it is unrealistic to think they would remember every death of a patient. At this point, I cannot prove that the injury occurred at the workplace and I cannot prove that it did not occur outside of work; I possess the burden of proof and cannot save myself with having no one who will testify on my behalf.

I am constantly reminded of this event every time I move awkwardly, or stand, or sleep. I have nightmares of the very rapid response and refused to enter room 14 after that day. This injury has caused a marathon runner to hang up his shoes as I am unable to run for the foreseeable future (according to my neurosurgeon). Now that I am working as a nurse, I finally have insurance; workers comp isn’t paying for anything and I knew I could not take the pain anymore. Both my legs started to go numb and the pain began to increase in severity over a year after the injury. I received an MRI and realized that surgery was necessary to get me back to some sort of normalcy. 628 days after my injury, I received a laminectomy and a decompression surgery on the L5 S1 area of my spine; I could potentially have permanent nerve damage at this point. I was also advised that I will need a disc fusion surgery at some point in the near future because of the severe decompression of the disc. Something to look forward to, right?

- 30 minutes prior to surgery

Currently I am trying to rehab and increase my ambulation so I can get back to taking care of critically ill patients in a place that, at times, represents hell on earth itself. I embrace the chaos of my current place of work, but I know that I am truly alone and I am the only one who has my back. Though I now work in a different hospital with supportive management and colleagues, I still struggle to trust anyone. I may not be allowed to run for the foreseeable future, so for now, Nursing is my Cardio.