Let me start by saying that 2020 has been crazy year thus far. Before I knew how the year would unfold, I interviewed for a flight nursing position that would be the start of an amazing adventure. I submitted my resume for this job late 2019 when my provincial government announced they were planning to lay off registered nurses. Although healthcare in my province took, what i perceive to be, a foreboding shift, it was a great catalyst for personal change. You see, I've had this air ambulance company in mind for years. I heard about them from a nurse I worked with while in nursing school. I've kept this company in mind since then, periodically checking their website once every few months, debating whether I should apply. I submitted my application to a few places with the belief that this air ambulance company would be the least likely to respond but a few weeks later I received an email from my future manager about an interview. Once I got the interview. I was confident that I would get the position not because of my resume but because I rehearse for interviews like they're American Idol auditions. Although, I talk about this process rather platonically it was the complete opposite. You would expect, that once I got this position that I would be screaming for joy but then I started to think ‘what the heck?” My feelings ranged from self-doubt, to fear and confusion. Happiness, accomplishment, and excitement took less than 10% of my emotional space. Let me break this down for you. You've got a nurse who has been on the job for about three years and has spent most of that time on a nursing floor and away from critical care areas. I knew enough about the job to know that I would be handling patients potentially on the brink of death. I continued to feel that this position was out of my league but I think we've all been there and you can choose to break yourself out of this perpetual cycle of self-doubt or not. I chose the former. I told myself ‘so what?' If I make a mistake, I get back up again and learn. Failure has such a negative connotation but it really isn't because everyone stumbles; the trick is refusing to let your failures define you. You know how this ends, I got the job and was off to training. When people ask me how training went, I say 'imagine a ballot box being stuffed to the brink with papers and then a bomb exploding in it.' Yah, that ballot box was my brain. I think you get the sense that it was difficult but I completed training with this great sense of accomplishment. I felt exponentially more prepared to deal with a plethora of medical concerns. Although, I did feel mentally prepared, this did not erase my self-doubt, fear and uncertainty. I again headed to the internet and tried to equip myself with as much knowledge as possible, watched videos on electrocardiograms, looked up different sources of medical protocols for different conditions, watched videos on all the drugs that I have not yet encountered. I moseyed along these past few months in this new position with that curious, can-do attitude and most of the patients I've had the pleasure of caring for were relatively ‘alright.' When I say ‘alright', something was undeniably, medically wrong with them but they were at little risk of dying on the plane. Things were relatively tamed, for which I was thankful for. I had some time to get my feet planted on the ground before crazy things happened. Until earlier this month, when my colleague and I dealt with a situation in which my patient was, forgive me if I'm saying this too nonchalantly, actively trying to die. They were already on a standard medication called norepinephrine which is meant to squeeze blood vessels and essentially raise blood pressure. I just had to keep increasing the dose of this medication and giving intravenous fluids because her blood pressure just kept dropping, to the point where I worried about perfusion to her brain. To top it all off, we weren't even sure if we would be able to land because the weather was terrible. The most likely outcome being that I would probably be stuck with this patient for at least another two hours without the support of a hospital. This uncertainty lasted about 15 minutes until our pilots made another attempt to land and were successful in doing so. Tensions were high but she made it to the hospital alive. For that, I gave myself a pat on the back and then thought about ten things I could have done better. Although I think my job is super cool, I'm telling this story not to show-it off but to inspire. I'm as ordinary of a nurse as they come, riddled with personal and professional self-doubts and, honestly, nothing is wrong with that. Sometimes questioning your knowledge and seeking new answers serves to make patient care even safer. Personally, when faced with life-changing decisions and imagining to life the worst possible outcomes, you need to say to yourself “so what?”

(Story by Jennifer Cole, OCRed and edited from online images posted, for easy reading.) I lost a patient today. He was not the first, and unfortunately, he's definitely not the last. But he was different. I've been an ER nurse my entire career, but in New York I find myself in the ICU. At this point there's not really anywhere in the hospital that isn't ICU, aII COVID-19 positive. They are desperate for nurses who can titrate critical medication drips and troubleshoot ventilators. I've taken care of this man the last three nights, a first for me. In the ERI rarely keep patients for even one 12-hour shift. His entire two-week stay had been rough for him, but last night was the worst. I spent the first six hours of my shift not really leaving his room. By the end, with so many medications infusing at their maximum, I was begging the doctor to call his family and let them know. "He's not going to make it", I said. The poor doctors are so busy running from code to code, being pulled by emergent patients every minute. All I could think of was the voice of my mom in my head, crying as I got on the plane to leave for this place: "Those people are alone, you take good care of them". I was the only person in that room for three nights in a row, fighting as hard as I could to keep this man alive. The doctor was able to reach the family, update them. It was decided that when his heart inevitably stopped, we wouldn't try to restart it. There just wasn't anything else left to do. Eventually, he gave up. It was just him and me and his intubated roommate in the next bed. The wooden door to the room is shut, containing infection and cutting us off from the rest of the world. I called the doctor to come and mark the time of death. I wished so much that I could let his family know that while they might not have been with him, I was. I shut the pumps down (so horribly many of them), disconnected the vent, took him off the monitor. We didn't extubate him, too much of a risk to staff. Respiratory took the vent as soon as I called. It's just a portable one, but it's life to someone downstairs. The CNA helped me to wash him and place him in a body bag, a luxury afforded only to those who make it out of the ER. Down there the bodies pile up on stretchers, alone, while the patients on vents wait for the golden spot my gentleman just vacated. We'll talk about the ER another time. My patient was obviously healthy in his life. I look at his picture in his chart, the kind they take from a camera over a computer when you aren't really prepared. A head shot, slightly awkward. I see someone's Grandpa, someone's Dad, someone's Husband. They aren't here with him. My heart breaks for them. A bus takes us back to the hotel the disaster staff resides in, through deserted Manhattan. We are a few blocks from Central Park. We pass radio city music hall, NBC studios, times square. There is no traffic. The sidewalks are empty. My room is on the 12th floor. At 7pm you can hear people cheering and banging on and pans for the healthcare workers at change of shift. This city is breaking and stealing my heart simultaneously. I didn't know what I was getting into coming here, but it's turning out to be quite a lot.

“How did you get that scar?” a curious child asks. She is referring to the “V” shaped scar on the right side of my stomach, just above my hips. While others have commented that the scar is “weird”, I have never found shame in it. “Are you talking about this one?” I ask, just to be sure. She nods. I'm at the pool with kids i'm babysitting, and in my bathing suit, revealing my stomach and scar. The child's question is one that I have been asked my whole life. “I had surgery,” I say. “Because I was born early.” I think about all the babies who are born early, all the anxious parents who spend sleepless months in a hospital, and the hundreds of doctors and nurses who spend countless hours working to ensure that the premature babies continue to breathe. My twin and I were one of those babies. We were born at 24 weeks. When you are just 24 weeks pregnant, your baby is about the size of an ear of corn. Doctors gave her the news that no parent would ever want to hear; “Your twins have only about a 10% chance of survival, and if they do survive, a plethora of severe health problems are likely”. My twin, Kara and I came into this world 4 months early on September 14,1998. Kara weighing 1.06lbs and Me weighing 1.04lbs. Each baby could fit in the palm of their dads hand. Their parents were only allowed to put their fingers into the incubator box to touch Kaylee and Kara. At one point i dropped down to 12oz, the weight of a can of soda. Within two days, sadly and heartbreakingly, the doctors informed my parents that Kara had level four brain bleed leaving her with almost no brain activity. Kara died and my family we able to hold her, love her and say their final goodbyes. Then she became my Guardian Angel. I gave my parents plenty of scares when I would often stop breathing, making my skin turn purplish as well as my heart rate would drop. The sound of alarms going off sent fear through my parents.Several days after my sister passed away, my parents got an early morning phone call and another big scare… Kaylee had ruptured her bowel and needed emergency surgery. The surgeon informed them that I had a 5% chance of making it and that they should prepare for the worst. Family and friends had said their final goodbyes before I went in for surgery and everyone thought that was it, I wasn't going to make it. The doctors also informed my family that if I were to make it, I would be unresponsive, in a wheelchair and have allot of problems my whole life. But, as I always did, I fought through it and survived with no complications . 100 days later, on Christmas Eve, I got released to go home after I had beat insurmountable odds. I do not remember my months in the hospital. I do not remember all the needle pricks that gave me permanent scars along my wrists, ankles, and stomach. I was a baby. Still, today I am grateful for my scars. I am so grateful that I am alive and forever grateful to all of the nurses and doctors who saved my life. My dad has always told everyone “Kaylee is a promise to our friends and family that life does go on…She is our miracle” Being a micro preemie I do still have complications because of the surgeries. I still have scars from the surgeries and IV lines. Being a preemie is the best thing that God could have given me. It gives me a spirit to fight and never stop. It gives me compassion for those going through painful situations. It gives me passion for babies that never get to see the light of day.I want to be a occupational therapist for little kids and babies or a NICU nurse. I know that I can give hope to families of premature babies with my story and working to make miracles happen for them as well. Occupational and physical therapy made me into who i am today. Physical therapy was tough for me but it helped me drastically. If it wasn't for therapy i would be in a wheelchair and unresponsive. I am thankful my parents put me through therapy.