August 24, 2008, 4:28 am

My Charade is the Event of the Season

How could we ever forget the old commercial:

“Remove wrenched ankle..HA-HA-HA!”

I wanted to punch that kid, and I was about the same age!

I was not a good player of “Operation”, either, I always made the nose light up.

Good thing I didn’t go into surgery, folks would be running around with electric, red noses.

The price of the game today? $14.99 on

Did they increase the fee paid for removing that ankle?

I bet the “fees” haven’t changed from the original game. Guess it isn’t so far from real life as I thought.


I am a hollow shell.

How’s that for a dramatic beginning?

It’s how I feel right now, and it hasn’t changed since I last left my unit..

I expended so much mental and emotional energy during my run of night shifts. And no one was critically sick.


Let’s make things clear from the outset, so you don’t think I’m a burnt out old hag.

The vast majority of patients who present to the emergency department are patients who are anxious about something that is happening to their body. It may be serious. It may be nothing.

But they don’t know that.

My job is to validate their feelings, help relieve their symptoms, plan an approach to help them solve the problem and make sure they have the resources to follow up.

This is what I do as a nurse. I engage my patients. I am there for them and my physical and emotional energies are directed at helping them get through a stressful time, be it a life-altering event or a minor illness.

It can be exhausting, but it’s a good exhaustion. A sense of accomplishment. The feeling that maybe my presence and my nursing care made a scary time easier.


But what are you supposed to do when you are being “played”?

When the BS is so thick the unit needs twenty-five septic tanks just to handle triage.

When you might as well be a waitress at the IHOP because all you are basically doing taking the patient’s order, and the patient knows you will do it because they are, well, the “patient”.

When all you are is a legal conduit for drug administration with a clean needle.

When the story you are being told as “history of present illness” has so many holes in it swiss cheese is a block of marble in comparison.

And they know you know it.

But you have to treat them.

And they know it.


I’m not a perfect nurse by any stretch of the imagination (and I have a unit full of colleagues to confirm it!), but I put my heart and soul into my patients.

And I hate being manipulated. More specifically, I hate being part of a system that can be manipulated, at will, by anyone who knows the right buzz words.

Trust me, I see right through the act.

Do they see right through mine?


I am acting, you see.

These patients will never, ever see the anger, frustration, and fatigue (emotional and physical) that being manipulated engenders.

They will get a smile, a warm blanket tucked in, their meal delivered, detailed discharge instructions discussed with them.

Because while I may not be a perfect nurse, I am one hell of an actress.

The performances I put on during a recent run of shifts were worthy of Emmys, Tonys, Oscars and Grammys. (Okay, hold the Grammys, I don’t sing.)

The patients got everything they needed, when they needed it. They also got everything they demanded, when they demanded it.

My charade really was the event of the season.

And I walked away feeling like my soul was dead.


To paraphrase a famous Prince song: this is what it sounds like, when a nurse dies.

I don’t like that feeling.

Thank God I’ve been in the profession long enough to know it doesn’t last.

But it hurts like hell to be numb.


  • Healthcare Today

    August 24, 2008 at 4:32 am

    My Charade is the Event of the Season // Emergiblog…

    Why is being manipulated so exhausting?…

  • Strong One

    August 24, 2008 at 6:17 am

    I feel our pain my dear.
    We each have our own coping mechanisms, and blogging and leaning on a fellow shoulder works well most of the time.
    Lean away.
    Lean away.


    August 24, 2008 at 6:53 am

    The hard part is making sure that numbness does not creep its way into the rest of your life. I think one of the prices we pay in healthcare is the loss of the connection to our own feelings.

    Good for you for recognizing it.

    Now go scream into a pillow or go hit something.

  • lorenzo

    August 24, 2008 at 8:47 am

    Numb….how dead to us the soul suckers feel.
    Don’t let the numb creep into your off-hours. Keep the faith in humanity.

  • girlvet

    August 24, 2008 at 2:51 pm

    We have all been there.

  • whitecap nurse

    August 24, 2008 at 6:33 pm

    I work with a nurse like you. She is sweet, organized, totally competent and nothing but polite to every patient and co-worker. She confessed to me once that she has an interior monologue going the whole time about what she’d REALLY like to be saying (profanity included). Make sure you allow yourself to have that interior monologue and keep on smiling. You don’t have to let yourself be totally manipulated either. You can talk that doc into 600mg of ibuprofen only – I know you can. Good luck – some days are harder than others. But as my old medic partner used to say – “cheer up it’ll get worse.”

  • Candy

    August 24, 2008 at 7:04 pm

    Here’s a hug and a promise that for every patient who tries to steal your passion, you’ll hvae a dozen who will re-energize it. You are not a nurse because you have a degree saying so, you are a nurse because that’s whats in your heart. So put the JSS CD up as high as it will play in your car and drive out into the country, away from people and scream and cry, then come home and remember how many people are grateful you give your whole heart to them when they need you (me included :))

  • Mike

    August 25, 2008 at 7:55 am

    I have often told others I am nothing more than a high priced bar tender. A sad commentary for sure. It is hard on a good day – as you know. I wish I had an answer to make it better, I don’t. I keep playing the lottery each week -$2.00 – and maybe, just maybe.

    If only I had stayed at Domino’s Pizza, I could be an assistant manager by now!

  • NPs Save Lives

    August 25, 2008 at 8:28 am

    Kim, I can feel your pain. Thank God I don’t work in an ER setting where you get most of the drug seekers. I see too many of them in the office and it can be very draining on the psyche. Hang in there!

  • AlisonH

    August 25, 2008 at 11:41 am

    Can you look them in the eye and tell them straight out, “I know what you’re doing, I think you’re destroying yourself and it hurts me but it’s your problem not mine” and then walk out of the room and let them stew, or would one’s boss have one’s head for it? Because it would so clearly be doing them (not to mention you) a favor, even though it’s so much not what they want to hear right then. But do the rules allow them to be done that favor? You can tell I’m not a nurse, I don’t know. It sounds like not. Which is a screaming shame. (Yeah, I know, they’ll be the ones screaming. At you. But they might finally think, later.)

  • Candy

    August 25, 2008 at 2:02 pm

    Having been very intimately associated with both a substance abuser and a zillion nurses, I can answer Alison’s question — the abuser will NEVER “finally think about it” and the nurse will get into trouble for speaking out of turn. The only time you can volunteer anything is when the patient asks for help. If they’re in getting a fix, they don’t want help, or the only help they want is to get through the next half hour.

    You have to remember someone addicted to drugs or alcohol doesn’t usually WANT to be addicted — getting clean is a lot harder than it looks. As for those looking for a little fun of the drug variety in the ER, nurses might be able to “assist” the doc in offering a nice NSAID instead of something a little more recreational…

  • Jen

    August 26, 2008 at 7:03 am

    Can you look them in the eye and tell them straight out, “I know what you’re doing, I think you’re destroying yourself and it hurts me but it’s your problem not mine” and then walk out of the room and let them stew, … Because it would so clearly be doing them (not to mention you) a favor, even though it’s so much not what they want to hear right then”

    You would stew about it Alison because you are a person with healthy relationships & active in our society. People with addictions are more likely to have a history of unhealthy relationships and be excluded from the everyday processes of society. A stern word and good think coming from some one you respect (in this case an awesome nurse like Kim) would work on you and me because a) we have respect for her/others b) we have respect for ourselves and c) we aren’t singularily focusing every moment on getting our next fix. It’s important to note too that not all people with addictions are like this. The ones that show up in the ER to manipulate others for drugs usually are though.

  • Jen

    August 26, 2008 at 7:04 am

    Oops, I meant to indicate the quote in the above post with “Alison said:…”

  • jelkel

    August 26, 2008 at 11:44 am

    You are right about the enormous amount of energy it takes professionals to be nonjudgmental which can lead to feeling “numb”.

    Our inpatient works hard to have a lot of laughs on the job so we don’t get too fried and lose compassion. You are also right that the most stressful people to deal with (not just patients) are the entitled who think the world owes them everything.

    Hang in there! Get yourself a fart machine- it sounds goofy, but it can really break the tension sometimes!

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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