August 12, 2007, 10:30 pm

Suddenly I See


We survived!

Two weddings in six weeks and we are all still sane.

This is a photo of my son Kendall and new daughter-in-law, Kristin.

The wedding went off yesterday without a hitch.

Well, okay, there were two hitches.

One, the priest called my son “Kelly”.


You could pass it off as a slip of the tongue, except the priest is Kendall’s uncle!

Then, (it was a Catholic wedding mass) after “Christ has died, Christ is risen, Christ will come again”, my little four-year-old nephew loudly proclaimed…


Already debating theology at the age of four…


This summer encompassed three family weddings, a funeral and a milestone birthday.

It was a summer of multiple sudden changes.


In wracking my brain for a topic to cover this week’s Grand Rounds theme of “sudden change”, I realized that I deal with it every single day.

What does the child who suddenly spikes a fever have in common with the thirty-four year old who blows a cerebral aneurysm while standing in the mall? How is the sixty-year-old who develops chest pain on the golf course related to the twenty-four year old who lacerates their left index finger slicing a tomato?

They are all experiencing a health-related crisis.

Emergent or non-urgent, all are precipitated by a sudden onset or event.

A sudden change.


The majority of patients who present to the emergency department do so for one of two reasons:

  • They are experiencing a sudden onset of “not feeling well. Even if their symptoms have been going on for days, something changed that made them decide to seek care.
  • They have a chronic illness but experience a sudden exacerbation of symptoms. Diabetes. Chronic pain. COPD. Ulcerative colitis. The patients handle their symptoms on a day-to-day basis, but sometimes the intensity of the symptoms will suddenly overwhelm their ability to cope (or become critical) and they, too will utilize the ER.

Something has suddenly changed.


Emergency nursing is based on helping these patients cope with these sudden symptoms through assessing both their physical and emotional status and identifying patient needs. We collaborate with the emergency physicians to meet those needs by facilitating the medical plan of care, executing appropriate nursing interventions and evaluating the patient’s responses to the those interventions.

We can take it one step farther and say that emergency nurses are responsible not only for helping patients deal with the sudden change that brought them to the emergency department, but need to be astute observers to head off those sudden changes in patients’ conditions that occur while they are in the department.


Suddenly I see that emergency nursing is based on helping/supporting people through those sudden changes – through the unexpected events that bring them to our front door.

Not all of our interventions bring sudden resolution.

When patients are better able to cope – when their coping mechanisms are strengthened and supported or when they find new ways of coping with pre-exisiting conditions, we know they will do better in the long run.

And we know that we have made a difference.


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  • therapydoc

    August 13, 2007 at 4:24 am

    Mazal tov.

  • Caroline

    August 13, 2007 at 8:17 am

    Great way to link the stories in. The bride and groom look very happy by the way. Can’t wait to read COS this week. Nurses must be VERY used to change…in fact one of the reasons I left corporate america is because of the incredible stagnancy (is that a word?) I specifically chose nursing because of the fact that it’s an ever-change atmosphere, even outside of the ER. I’m just a student and I can already see that. Even nursing school is different than other programs–we don’t just have “x” number of classes during a semester; there are clinicals, schedule changes, I have classes on Saturdays, etc. They are preparing us for a world of change that we will find in nursing. 🙂

  • Liana

    August 13, 2007 at 12:42 pm

    Congrats on the weddings!!! I just got recently engaged… the story is on my blog. Any advice?

    I’ve noticed an increasing number of people who come into the emerg room not because they’ve noticed a sudden change, but because they don’t have a family doctor. For example, “I’ve been having back pain for the past 2 and a half years. Nope, nothing’s changed or gotten worse.” Sigh.

  • Candy

    August 13, 2007 at 3:27 pm

    Two beautiful couples in as many months — congratuations, mom-in-law!

    I’ve experienced the “sudden change” twice in the past 5 weeks w/darling daughter (at 25, a magnet for weird health problems), once at home and once in Madison, WI, at the UW hospital ER. Surprisingly, I’ll take home any time. At UW, while we were triaged and in the room within 15 minutes for what I was sure was a corneal abrasion, it took a doc 2 hours (TWO HOURS) to see her — and the place was very, very quiet. The nurse who first saw her first put propacaine in the affected eye, but didn’t have her take out her contacts first, so the pain never got any better. We had the unfortunate planning to come in during the docs shift change. The nurses stood (or sat) around the opulent nursing station (think gorgeous dark wood and tile floors) chatting about nothing in particular (including patients) while we waited. I went out every 20 minutes and asked for help; finally, at the 2 hour mark, I got a little huffy as daughter cried in the exam room. When the doc came in, he was snippy because she still had her contacts in (“I can’t examine you if you won’t take them out!”), then got even testier when he found the propacaine bottle had been taken out of the room. He finally checked out her eye, found 2 corneal abrasions, wrote out a scrip for pain meds and ointment, and left. I had to ask for a vicodin for the road, which they gave her grudingly. All the while, she was telling anyone who was in ear shot that she was at 10 out of 10 on the pain scale…not a ringing endorsement.

  • beastarzmom

    August 13, 2007 at 8:28 pm

    Congratulations! You’re way ahead of me. 4 kids, 2 of marrying age, nothing on the horizon except an obsessed stalker-type ex for the daughter. (not a good situation)
    I’m happy for you.

    …and thankful you guys are around to handle our abrupt changes!

  • Harry

    August 14, 2007 at 5:58 am

    Congrats! Woah three weddings in one summer?? I’ve never even been to one!

    Also just wanted to say a quick thanks for adding me to your blogroll, much appreciated!

  • may

    August 14, 2007 at 6:42 am

    wow. they look so sweet. are you ready for grandkids? they might come all at the same time too 🙂

  • Stephen G
    Stephen G

    August 14, 2007 at 7:59 am

    Great blog!

    I’ve spent a good portion of my life in bay area ER’s , both professionally, and as a patient. I wonder if you’ve ever taken care of me?

  • Vand

    August 14, 2007 at 10:40 am

    You have one beautiful daughter. I nearly snorted my coffee up my nose at what your nephew said giggggle.

    Ok,I’m not a medical person I really enjoy your blog. It’s on my feeds as a must read.

    Sigh, we have the NHS Call Direct 24/7, and also have a doctor on call 24/7. I know our Er’s still have to cope with folk using it as a family doctor.

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  • Becky

    August 15, 2007 at 8:30 am

    Thanks for a beautifully written philosophy of ER nursing. I am a new ER nurse and I continually feel overwhelmed with the details of my new job and responsibilities (paperwork, charting, policies and procedures, learning the nuances to look for in really sick patients vs. mildly sick patients, etc). After reading your blog, I now have “the big picture” that I have been missing in the details. We are there to help patients cope with the sudden change!! Brilliant! BTW, congrats on your new role as mom-in-law.

  • Liana

    August 16, 2007 at 2:56 pm

    Thanks for the congrats and advice, Kim. So you’re saying a wedding in rural Mexico with a mechanical bull at the reception might not be a good idea?

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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