I am not afraid to ask for help, or to admit that I am completely ignorant about a given subject. It has never bothered me to turn to my colleagues and say, “I have no idea what I’m doing. Would you kindly assist me so that I don’t end up killing my patient?” Take blood administration, for example. I am absolutely, utterly hopeless at giving blood. No, not the patient identification part. I get that. I mean, cross-checking a bunch of numbers isn’t exactly rocket science. It’s the actual administration of it. I can never remember which clamps to open, and when to shut them. So I end up either fluid overloading my patient, or priming the line with blood. On top of this, I make a huge mess. I don’t know how I do it, but somehow I end up with drops of blood on my hands, on the floor, on my scrubs. It is so bad that I actually close the door when I’m hanging blood, just to save myself the humiliation that is sure to come when another nurse walks by and asks me why my patient’s room looks like a scene out of Sweeney Todd. So if you ever take report from me and it looks like I just clocked out of a twelve-hour shift at the Chicago stockyards, you’ll know right off the bat that one of your patients recieved blood products that day.
I used to think of my willingness to embrace and publicize my weaknesses as a strength – and I guess there is a part of me that still does – but in the ER setting it has proved otherwise. You see, in my repertoire of facial expressions, I do not have what is called a “game face.” This is an emotionless, nonchalant face that says (with a shrug of the shoulders), “I’m a bad-ass. And??” I have discovered that, at work, I have approximately three facial expressions. The first one, a look I like to call “serious/focused/pissed” is the one I use the most. I’m not entirely aware that I am making this face, but my hope is that it conveys to my co-workers and patients the mostly-false notion that I am deep in thought about my patient’s lab values and how the medications I am about to administer are going to be incorporated into the mental care plan I am currently developing for them in my brain. In short, I think my “serious/focused/pissed” face makes me look smart; in reality it probably just makes me look angrily constipated.
My second expression has been dubbed “quizzical” by a colleague of mine, who has caught me on various occasions pursing my lips and knitting my brows together. I’m not gonna lie here – what he actually saw was me in the middle of an imaginary conversation with a patient/family member/doctor who had just done something to irritate me. I am usually having these inner dialogs when I am pulling meds (because narcotics + distraction = fabulous survey results!) and I’m pretty sure they are my brain’s way of attempting to process the irrationality and illogic that are a nurse’s daily bread. The conversation goes something like this: “Well, Patient X, why in the hell did you come to the ER if you don’t want treatment? Yes, I know your primary care doctor told he was going to have you direct-admitted, but he is a liar. He didn’t want to be bothered with the paperwork, so he sent you here to the ER to rot. I’m sure he is probably at home, snuggled in his 1000-thread count sheets with his arms wrapped tightly around his trophy wife, dreaming of gold-plated caviar and his upcoming vacation in Bora-Bora. You, meanwhile, are stuck here – wearing a back-less gown and dining on yesterday’s turkey sandwich. And puh-lease don’t even try to tell me that your call light has been on for thirty minutes because I have been standing out in the hall directly across from your room talking about how irritating you are and the light just came on for the first time two minutes ago.” (This is the point in my little day dream where I dramatically walk over to the call light, yank it out of the wall, and drop it in the bio-hazard bin. Then I dust my hands off, give a bright smile, and say, “There. Ah, that’s muuuuccchh better.”
My third look – and thankfully I haven’t needed to employ this one very much – is sheer panic. This is the expression I would wear if, say, my patient coded in front of me – which is the exact situation in which a “game face” is most needed. For example, the other day a fellow nurse (whom I respect very much) hit the Code Blue button. Once we figured out what, exactly, that alarm sound meant and where it was coming from (the Code Blue button is much under-used in the ER. Staff mostly just yell out from the patient’s room) several nurses and medics made their way to her room, where she calmly turned to us and said, “He’s not breathing.” She said this in the same exact tone that you might use when you ask your spouse to pass the broccoli or to tell your child that their pants are unzipped. Totally calm, emotionless, flat – and yet she was in complete control of the situation. She was bagging the patient like she was born to do it, while the rest of us rushed in, pink-cheeked with adrenaline. She was, in short, wearing her game face. See, if this exact situation happened to me, I would either a) stick my head out and yell for help, eyes wide as saucers and shaking with terror or b) play it safe by scanning the ER for the doctor/nurse/physician’s assistant who least intimidates me and, in my best I’m-trying-to-look-calm-but-it’s-really-just-a-thin-veneer-beneath-which-is -a-quivering-mass-of-RN-flavored-pudding voice say, “Um, would you mind taking a quick peek at my patient?” Yes, option B does take up a few more life-saving seconds than exercising option A, but it saves me from the humiliation of looking panicked – and it is all about me, right?
I’m hoping that over the course of my career, I will learn how to balance these two things. That one day I will find that harmonious spot where a willingness to learn and calm confidence in crisis are not mutually exclusive. That in the near future I will have a “game face” of my own – and it won’t simply be a mask to hide my fear or ignorance. Until then, I’ll stick with “serious/focused/pissed” and “quizzical” – and hope that nobody catches on.