Keeping Calm in the Chaos

Oct 12, 2017

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Learn the basics well so that you can deal with ... unexpected events. If you do not build a strong nursing foundation, when there is chaos you won’t know where to even begin.

Emely Garcia

On Dec. 3, 2015, a husband and wife opened fire at Inland Regional Center in San Bernardino, Ca., killing 14 and wounding 21 others. Trauma nurse Emely Garcia was one of those providing care at Loma Linda Hospital.

“Since I was little, I was always thrilled with being the ‘first responder,’ of our home,” Garcia said. “For any cut or scrape I liked helping and I was there. I chose to become a nurse when I started my undergraduate schooling. I knew I wanted to do something to help people.”

Garcia knew early on in her nursing education that trauma held a special place for her.

Choosing Trauma

“My favorite unit was 8100 (Trauma/ Surgical and Neuro ICU) as a student. Trauma patients can be some of the most difficult patients to care for because of the acuity and emotional involvement that sometimes these cases require. It is the unexpected, the worst accident of their life, and you meet them in that moment. First responders have done their part to get them to you and you have to keep doing everything to get them stable so that they can have another opportunity to live.”

As one might expect, there is not a lot that Garcia doesn’t remember well from that day.

The Day of the Shooting

“I'll never forget the day of the San Bernardino shooting. I was working night shift at that time, and I had worked the night before so I was asleep. I had been sleeping since 8 a.m. so I just remember waking up that afternoon, about 2-3 p.m. and my phone having like 100 messages and missed calls.

“I immediately knew something was wrong. And sure enough, between texts and reading posts and clips of the news I was updated on the fact that there was a shooting and that it was super close to my hospital, where I would be working in just a couple of hours.

“It was very unsettling. I am no hero. The thought of calling off and staying as far as I could from there did cross my mind, but at the same time I instantly thought of rushing over there because I knew our unit could be very busy, and texted all my friends and coworkers that were on that night as well. Nobody called off.”

So she went to work. But there were still an unanswered question or two.

“As I drove to the hospital, the only thing that was still unsetting was that they had not really caught the shooters, and now there were rumors that maybe there was another bomb. “I just prayed. I prayed a lot on my way to work, and thankfully I had peace. I knew we would be okay. I also had this feeling that I was going to take care of one of the victims.”

She was right.

“Sure enough, when I got to our unit and into our break room, we were given our assignments. Our charge nurse passed around the clipboard, and next to my last name was the last name of my patient. It was a DOE name. A DOE name is for when we admit patients who are victims of crime or violence. And in case I had some doubt, they let me know I would be taking care of one of the ladies who’d come from the shooting.

“We deal with shooting victims all of the time, but I definitely felt different. I knew that this was only one victim of many that were injured that day. Only one of the few who made it out alive, and I felt a sense of privilege and responsibility.

“My adrenaline definitely started pumping the second I woke up that day with all of those text. But knowing that I would care for one of the shooting victims gave me a whole new level of adrenaline.”

Being Prepared

Garcia has no doubt that she was as prepared intellectually and functionally as one could ever be for such a case.

“I think that without any doubt, working here on 8100 with such amazing people helped me not only be prepared for such a day, but helps me every day get through the difficult cases at work. We are a close family who are there for each other and help each other in ways that most people do not understand.

“I could never do this work alone. Knowing that I have such a great team just a cry away helps me stay calm as well. I know that I am not alone. Ever. And that is beyond helpful as well, so that I can focus and do what I have to do.”

The first thing Garcia remembers was trying to process the enormity of the situation.

“I just remember having such a feeling of unbelief of how this happened and I was one of those to take care of them. We see things on TV and we never think it will be us, but this was home. What also made it so surreal was walking into the hospital and the hospital being surrounded by news vans and sirens of police and law enforcement. It definitely wasn't just like any other day.”

When it was over – or at least when her 12-hour shift was over – Garcia, too, had received a sort of validation.

The Aftermath

“It was a busy shift. But more than just the busy skills and busy work, I was emotionally drained. There was a lot of emotion that night, as my patient was woken up from sedation to what would be her new reality after that horrible tragedy. She was intubated and sedated, and we had no information of her or how to contact her family. I still remember the panic in her eyes as she tried to make sense of everything. But I was reminded that night once again what a privilege we have to be there, next to individuals who are complete strangers but be able to grow a trust and relationship with them through some of their most difficult and scary times of their lives. “

Having gone through this tragedy, there is one thing that Garcia can give to newer nurses to help them prepare the best they can for such experiences.

“You can’t really be ready for something like this. There is one simple lesson, but it goes a long way. Learn the basics well so that you can deal with the stress and emotions of the unexpected events. If you do not build a strong nursing foundation, whether it is organization, skills, presence and practice, when there is chaos you won’t know where to even begin, and the chaos around you will find its way into your thoughts and will prevent you from doing your job.”

Transitioning to Critical Care

“I worked for a year in our stepdown trauma and surgical unit. That was my first job coming out of nursing school. I knew I wanted to go into critical care nursing, but I decided to take the job on the stepdown unit as they were sister units and the director told me nurses transferred to the ICU regularly. It was a great year of experience, looking back. I don't think I would change it even if I could. It has helped me respect nurses in other units so much more.

“I know a lot of times when people go into critical care so quickly, they don’t always stay. I think one of the most difficult challenges is the pressure we put on ourselves. Going home and feeling like I was inadequate at the beginning, or feeling like I'll never get to that "standard" of being an amazing nurse. We put a lot of stress on ourselves and it can weigh heavy. When that stress keeps going home with you, it's not easy to sometimes want to go back the next day.

“Critical care is hard. It's a stressful unit that taxes not only your mental energy but physical and emotional energy as well. I have the upmost respect for some of our nurses who have been in the field for 20-30 years.”

That does not deter her, though, from being right where she wants to be.

“I love critical care. You get to focus on one or two patients and really understand their treatment plan and you really do have a voice in their care. You are at bedside for 12 hours at a time and you get to know them, sometimes more than even the doctors. I think those are some of the things that have helped me to keep enjoying what I do. Stay involved;’ don't just stay in your room checking off the hours and task list.

“Ask questions about treatments and plan; learn to help those around you. I feel the days that are most rewarding are days that I can help my fellow nurses as well. Our patient population is a difficult one and can be exhausting but when you have a helping, friendly environment it makes the job a whole lot more enjoyable. “

Having a Healthy Balance

Having a healthy work/life balance is very important for nurses, and she knows it. Fortunately, Garcia seems to have that part all figured out.

“I love to travel. Getting away helps you take a break emotionally and mentally so you can come back and give it your best. I also am very involved in my local church and in my faith. I enjoy disconnecting once a week from work and the business, and I enjoy fellowship with my church family and leading the church in worship.

“Being religious isn't always a bad thing. It is a way you can practice your faith with those around you and it feeds your soul. I really believe that just as being physically healthy is important, mental health and spiritual health is needed to. It keeps you grounded on what's most important in life. The hospital, disease and the death of patients remind me every day that we are so fragile. Faith gives you a framework on how to perceive things and how to understand what goes on not only in the hospital but in your personal life.”