August 6, 2006, 11:20 pm

What Would Florence Nightengale Do?

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Have you ever felt like the nurse in this photo?

No, I don’t mean have you ever felt bigger than a air bus.

I mean feeling that your patient is so fragile, so dependent that you feel their life is in your hands?

Literally?

Or have your patient tell you that you are their angel when you feel it has been an honor to be able to care for them?

I’ve had both experiences.

The one thing I have never had to do as a nurse is deal with patients in a disaster.

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While catching up with my “doctor” links today, I read this post at Dr. Hebert’s Medical Gumbo.

It’s a thought-provoking post on the situation in New Orleans, where a doctor and two nurses have been accused of active euthanasia of four patients during Hurricane Katrina.

I won’t summarize the post here, as it is worth reading in it’s entirety, including the comments.

It did, however, get me thinking.

What would I do when faced with a disaster situation?

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I live in what is essentially Earthquake Central. The land around here does its rock-and-roll thing every now and again.

In 1989 I was home during the Loma Prieta quake. It was quite a ride. It lasted a lot longer than most quakes round these parts.

I was on the phone to Round Table ordering a pizza, as the Oakland A’s-San Francisco Giants World Series was about to start. The woman on the other end screamed at me, “HOLD ON”!!!!!!!

How rude!

Then the shaking started. They say it lasted fifteen seconds. I would have put it at two minutes.

I have distinct memories of my five-year-old son looking like he was surfing in the hallway as he tried to keep his balance and my husband running frantically down the hall to save my daughter’s ceramic mouse collection.

(To this day I have no explanation of why my husband did that. We had Lladro figurines all over the house but he goes to save a collection from the Franklin Mint. Nothin’ like an earthquake to bring out your priorities.)

We had a rather “Oooo, was that an E ticket ride, or what?” sort of attitude. (Disneyland used to “grade” their rides. An E ticket was used for the best ride.)

We did not know of the devastation to the Cypress freeway or the damage in the Marina district or how many had died as we had no power. When I put batteries in a small radio, we heard the Bay Bridge was “down”.

Oh my God…..

We saw there was power in the town below us (we are on a slight hill) so we drove to my parents’ home where the scenes of the disaster blew us away.

And while it was a 7.1 and directly on the San Andreas Fault, we weren’t even the epicenter.

Thank God.

Oh, and by the way, we stopped at a supermarket within three hours of the quake. Every single bit of water, batteries, flashlights, matches and candles were gone. Not looted, it wasn’t like that. They had just sold everything out.

I chose not to go into work.

Primarily because my kids were frightened out of their wits and both were under ten years old.

Secondly, I had been out of ER nursing for two years; Loma Prieta occured during my tenure as a psych nurse. There was no way I was leaving my kids that night.

That was then.

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What were they thinking?

Every single hospital in the San Francisco Bay Area is on a faultline. In fact, if you travel down Freeway 880 from the San Jose Border until it ends at Interstate 80, you will pass a hospital about every ten minutes. On Highway 101, you pass one every five minutes.

I personally know of four medical centers that are rebuilding to meet the “new” earthquake standards, because retro-fitting the existing facilities would actually cost more.

What do you think is going to happen when “The Big One” hits either the San Andreas Fault or the Hayward Fault?

Most of my reading puts the prediction of “The Big One” hitting the Hayward fault by 2030 at 62-80%.

They call “The Big One” 6.7 or greater on the Richter scale (similar to over 5 million tons of TNT).

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Since I spend anywhere from 48 to 64 hours at my hospital, using the 64 hour number there is a 38% chance that I will be at work when “The Big One” hits.

My facility will probably be incapacitated in some way and require the evacuation at least of some of the patients. Not to mention the “walking wounded” or ambulance patients, assuming the roads are passable.

My question, after reading Dr. Hebert’s post was, could I ever leave a patient that could not be evacuated? Even in a damaged hospital, I’d have access to IV fluids, syringes medications, even if only limited to one Pyxis machine, so pain and suffering would probably be relievable.

Abandoning a patient is anathema to every nursing bone in my body.

Could I stay if my own life were in danger? With no water in 110 degree heat and no help on the horizon?

Would I stay? How could I leave?

How do you look a patient in the face and say “I’m sorry, I can’t stay?”.

And if you are 400 pounds and paralyzed, and alert and oriented, isn’t it even more important for someone to stay? Large and immobile doesn’t mean unhuman.

I am so anti-euthanasia that I want to believe I could never, ever kill someone, even if they begged me to do so. I would never want anyone to feel that hopeless or that much in agony and I’d do anything to allieviate their suffering…

….but I won’t do that.

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As much as I hate the televised circus that some trials become, I would want to see this one on Court TV.

And so I will save my opinions and judgements until all the facts are brought out in a court-of-law.

But can we ever, really, know what we would do in a horrific, disaster situation?

Or judge someone else who was actually there?

8 Comments

  • Bardiac
    Bardiac

    August 7, 2006 at 8:22 am

    GREAT post.

    It’s important to think about the conditions those folks were working under, and to think about what we’d do if we had to make tough decisions. Do we go to our families and take care of that responsibility, or go take care of someone else? (That’s assuming we aren’t the ones needing the care.) (Sartre wrote about making that kind of difficult choice, though he set the problem in WWII France and the resistance.)

    Earthquakes, for me, are scary for the 15-20 seconds they usually last. But if you were in a hospital with structural damage, you’d also have to worry about your own safety in aftershocks. I think that conflict would be a real challenge.


  • Sid Schwab
    Sid Schwab

    August 7, 2006 at 8:36 am

    To be in a situation where every single thing is overwhelmed — our senses, our co-workers, the phyical plant, the surroundings — and where all the evidence is that it’s only getting worse with no reasonable hope of improvement in a foreseeable amount of time; such conditions are exactly what was going on in New Orleans, and I’d guess (and hope) that virtually none of us has ever faced it. It’s impossible even to imagine how I’d react.

    Meanwhile: I was at the first of the trans-bay World Series games, in Oakland, Had to leave town before the second. Was watching it on TV, and thinking I’d been on the Nimitz only a few hours earlier, and crossed the Bay Bridge.


  • kenju
    kenju

    August 7, 2006 at 5:19 pm

    I think it is helpful for you to think through how you might handle yourself in all the possible scenarios you might find yourself in with any type disaster. I cannot, however, imagine an earthquake like that. I was in a very small one in Costa Rica 3-4 years ago, and that was enough for me.


  • Jen
    Jen

    August 8, 2006 at 1:02 am

    I’ve often wondered, what would happen to my son? As I would most likely be in the ER if ever a disaster strikes. It scares me. I love my job, but I love my son more, and as much of a trauma/Er junkie that I am, I would still want to be with my son during a disaster.

    Here is a link to one nurses blog. She was stranded in her hospital during Katrina, and at times used her cell phone to post to her blog. http://www.livejournal.com/users/auryn24/297647.html
    (you have probably read it before.)

    My very first time in California as a traveler at UCSD, I can remember looking at the hospital and noting huge “X” bars on the windows as I walked in. During orientation, they told us that the hospital had been revamped per earthquake codes many times, and still does not meet the current standards………………..
    scarey.


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  • Jodi
    Jodi

    August 10, 2006 at 12:43 am

    Wow…got me thinking.
    I’ve never experienced an Earthquake…and don’t want to. The very idea scares me to no end.
    I just have to stay alert for anymore evacuees from Louisiana who may come my way again.


  • Lisa, burn RN
    Lisa, burn RN

    August 13, 2006 at 1:54 pm

    The very thought of a disaster striking anywhere scares the living daylights out of me. Although I have ICU, ER and Burn experience, I would still be in a state of shock if a disaster were to hit Los Angeles. And the likelyhood of that happening is not if but when! I just hope that our community would have enought character to hold together and not “panic” and make the situation worse. As for me leaving work…I don’t have family in the area, or kids to worry about, so I will be the one at work making that decision to save others or self. That is one decision I NEVER want to make! I guess I better start thinking about it….L.A. is on the hit list of many terrorist parties and on many fault lines!


  • Candice, student nurse
    Candice, student nurse

    February 23, 2008 at 9:51 pm

    i was wondering if i could use this photo in a project of mine. I am asked to get permission from the site it is found and am hoping it is ok. If you could email me back giving me permission or not that would be wonderful
    Thank you


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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