Since I posted my birthday wish, I’ve gotten so many lovely lessons from friends and acquaintances. Below is one from my friend and former coaching client, Diana Dodds. Diana served as a nurse for many decades. Here she talks about the lesson she learned to say no, even to those in authority.
Whoosh….…whoosh……whoosh went the beige bellows that rose up and down in the clear canister sitting on top of the respirator in the corner of the large surgical intensive care unit. The unit was one very large room with curtains that dangled from the ceiling as the only separation between patients. Those curtains were kept out of the way unless family entered to see a patient.
The sound of the respirator would have been mesmerizing except for the occasional alarm, which grabbed my attention above the din of all the machines, each with its own pattern of sounds. At first the loud beep accompanied by a red alarm button turning on and off was rare. Soon, the beeps were more frequent, and I saw that the bellows on the respirator were not going up as far as they had previously.
The patient lying in the bed, connected to all these devices, was resting with his eyes closed. I stepped away from the bedside long enough to find the charge nurse to help me decipher what was causing this ongoing alarm.
“Diana, you are aware that this patient was fighting the respirator, and that he really needs to rest and let the machine breath for him right now.”
“Yes, that’s part of what has me so concerned. We’re giving him doses of a muscle paralyzing agent, and if something goes wrong with his respirator or the endotracheal tube in his airway, this person would be at great risk of suffocating”
“What do you think is the problem, Diana?”
“I think that soft cushion that surrounds the endotracheal tube that keeps it in place might have a leak in it, and with that cuff deflating, it would allow more air to circulate back out as the respirator attempts to put it in. I see the tube moving up and down, and it shouldn’t be doing that.”
“Let the doctor know when he rounds. Meanwhile, add some air to the cuff.”
I took the end of the thin tubing attached to the endotracheal tube cuff, twisted a small syringe of air into it, and injected 2 cc’s. The beeping stopped, which proved to me that I had diagnosed the problem. But I was a brand-new RN, so I did not push my charge nurse any further. My care continued for the gentleman, and within fifteen minutes, the beeping returned. I continued the battle of keeping the cuff inflated, the whole time convinced that this endotracheal tube needed to be replaced for his safety.
There was a loud buzz, and Dr. P. entered the intensive care unit through the main metal and wooden door. I immediately went to speak to him. He had many patients to check in on, and I waited my turn. Eventually, I was able to get him to come over to my patient’s bedside.
“Dr. P. I have been noticing that my patient’s endotracheal tube is riding up and down in his mouth and the inflation alarm goes off because he isn’t getting all the air we have prescribed for him.”
“It’s the tape. The tape is pulling it out.”
I stopped for a moment and let that register, but it didn’t make sense. “The tape is supposed to hold the tube in place.” I replied.
“Well, it obviously isn’t doing that!”
“The alarm stops when I add air to the cuff. Do you think that there is a leak in the cuff?”
He ignored me. “Cut the tape.”
“Cut the tape.”
Who was I to tell a surgical resident physician what to do? I took my bandage scissors and cut the tape like a good nurse. Then the alarm sounded almost constantly. Imbedded in the tape was the small tubing that was connected to the cuff. Since I had cut it, all the air was lost now. Dr. P. walked away. I yelled for the charge nurse and told her what I had done.
“Get out of my way! Go get an IV catheter. We will have to use it to inflate the cuff.”
I ran with all due haste while the charge nurse calmly threaded the catheter into the the remaining tubing to the cuff and reinflated it. She took a clamp and clamped it off, and retaped the tube in place.
“Do we need to call someone to replace the endotracheal tube?” I asked anxiously.
“You just keep that cuff inflated!”
I did as I was told over the next three hours, while I held back tears. I could have killed this man, was all I could think of. The charge nurse got angrier as the shift went by. At last, she told me to go home.
“I would like to stay and help.” I said.
“I think you have done enough!” she said.
I went home, but I couldn’t sleep. What was I supposed to do?
The answer came from the unit supervisor the next day when she called all of the new RN’s onto the fire escape. She stood on the floor and we sat on the stairs. She didn’t call me out specifically in her lecture, for which I will be forever grateful.
“Last night, we had a problem with an endotracheal tube on a paralyzed patient. The end result was that the anesthesiologist had to come and remove the endotracheal tube and put another one in as quickly as he could since the patient could not breath on his own. What can you learn from all this? Well, I will tell you. Brand new RN’s should not work in surgical intensive care. This is not your fault. I’d tried to tell the nursing office this, but we are in the middle of a serious nursing shortage. You have been thrown in the deep end. I prefer my nurses to at least work 6 months on the floor before trying to work her. Why? Because you need to learn to say no. Nurses have the right to say no. You have your own license and you are responsible for it.”
I learned the hard way that it is better to say no and have faith in your own ability to reason, than do something that you know is not right. Let the doctor do it himself if he insists on it, and then it becomes his problem and not yours. I never forgot that very intense lesson about following my own instinct, and it set me in good stead for the rest of my career.
Wouldn’t it be great if we could learn important stuff through listening to one another’s stories? You know, I believe we can! That’s why I became a therapist in the first place. (What? You think I just wanted to help people? Sure I did, but I want to learn from them, too.) And being with other people’s stories is why I read, write, and coach writers, too. I LOVE stories. And I ABSOLUTELY BELIEVE they change us.
So here’s what I want this year, friends:
I want your wisdom, and I want to know how you got that wisdom. I want to know the things that you learned the hard way. Here’s the deal, you write your story and the moral of your story in the comments underneath this post. The stories and the bits of wisdom that strike me the most (the ones that inspire me, make me laugh, make me cry, or make me go, “well, sh!t, I never thought of that”), I’ll highlight. (I’m happy to add your website, your bio, and a plug for anything that you’re peddling if you want me to—or if you don’t care about peddling anything, I’ll just give you credit for being a really smart person.)
These lessons don’t have to be deep, deep, deep. They just need to be relevant to your life, something you think other people should know. They can be drop dead serious lessons about relationships or they can be how you learned not to buy cheap shoes. They can be lessons about how you learned to take care of the earth or how you learned to take care of frizzy and uncontrollable hair. I welcome lessons about running, writing, traveling, dogs, wine and whiskers on kittens—some of my favorite things. I also welcome lessons about how to get stains out of silk blouses. Or how to keep from falling in with bad characters at your favorite karaoke bar. Or how to stop smoking (even though I don’t smoke I think the lesson could be transferable to something else, don’t you?) REMEMBER, TELL THE STORY AND THE LESSON! USE AS MANY WORDS AS IT TAKES.
When the year is over, I’ll put all my favorite stories of wisdom-gotten-the-hard-way together into a book. It’ll be a great gift for your other friends as they turn 50. Or 60. Or 70. Or… 120. You don’t need to be a great writer, by the way. I’ll clean up your punctuation and grammar for you without judgment. In fact, upload a video if that’s more your style.
Tell me what you’ve got!