The Shift Quotes

“I rarely fall asleep easily after a shift, especially if I’m working the next one, but now quiescence comes, pushing at the edges of my mind. My breath deepens and I feel the calm of oblivion begin to cover me. I will do this all again tomorrow and then there will be another shift and another and another. To be in the eternal present of illness and unease, never knowing the future. It’s where my patients live so I, ever hopeful, live there with them.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“In all the hurly-burly, I’d forgotten, but now I remember: The most important thing of all is that everyone’s alive at the end of the day.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“A shift lasts twelve hours. Twelve hours of holding a few lives in my hands, trying to make order out of the chaos of bodies and disease, working within a health care system that sometimes forgets it exists to serve human beings rather than bureaucrats or businessmen. Amid the many uncertainties of the shift there is one thing I know for sure. Am I ready and up to the job? Yes. Today, and every day, for the sake of my patients I have no other option; the answer has to be, and always is, Yes.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“Hospitals are filled with caring staff, but resilience and determination are prized as highly as empathy. In the vernacular, it comes down to whether someone’s “got the balls” to make x, y, or z happen. The contrast between the empathy we’re supposed to have and constant talk of “growing a set” or “who’s got the cojones to . . .” can be jarring, but a big rock, no kidding, needs a nurse with the stones to move it.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“Like many nurses, the thing I’m always worried about is doing either too much or too little. If I sound an alarm and the patient is OK, then I over-reacted and have untrustworthy clinical judgment. If I don’t call in the cavalry when it’s needed, then I’m negligent and unsafe for patients. You don’t always know because what goes on inside human bodies can be hidden and subtle. This job would be easier if there weren’t such a narrow divide between being the canary in the coal mine and Chicken Little.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“ICU is a hard place for me since it’s often the last stop for our sickest patients.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“do this all day long: run through a mental checklist that changes unpredictably. Of course I have things written down, but nurses spend the shift recalibrating the tasks we have and their urgency.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“There’s nothing easy about helping someone start the journey from life to death. “They also serve who only stand and wait,” the poet Milton said. It’s a line I often hear in my head at work, where standing and waiting can be the best service we offer.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“It’s not rational that some of us who work in health care expect ourselves to be omniscient. “If”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“Sepsis stimulates a catastrophic response from the immune system called SIRS for Systemic Inflammatory Response Syndrome. The acronym sounds polite but the reality of SIRS is not. At the late stages of sepsis, fluid from the blood stream moves into the body’s tissues, leaving a reduced volume of blood in the arteries and veins. Due to this decrease in volume, the patient’s blood pressure drops, and can keep dropping until there isn’t enough pressure to send blood to every part of the body. When that happens, organs begin to shut down and die. To”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“Designers of electronic charting systems don’t seem to understand that checklists themselves are not the innovation, because checklists are not substitutes for care. The real innovation is having staff use lists to consistently create the safest and highest-quality clinical environment possible.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“At the nurses’ station the night-shift RNs cluster on chairs, looking like birds wanting to shove their tired heads under a free wing. Their lined faces and heavy-lidded eyes show how hard it is to stay awake and alert for an entire night. I don’t work a lot of nights, but when I do I feel it. I hit a wall at 2:00 a.m., then again at 4:00. The hospital’s strong tea, bad coffee, Diet Coke from the vending machine—they all help, but nothing non-pharmaceutical will really make me feel awake for the entire night, and I’m not going down the pharmacologic road. The day after, even if I sleep all morning and afternoon, it feels as though I’m seeing the world through gauze.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“For patients who are rarely hospitalized, who have little understanding of how the human body works, who lack money, or simply don’t read or speak English very well, our high expectations of them as outpatients may make any outcome but failure unlikely. All of us who work in health care put our shoulder to that huge rock every day trying to get the system to work. But sometimes shift after shift it feels like the same damn rock. I’m”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“Abraham Verghese, the physician and writer, speaks eloquently about the value of touch in health care. During a lecture here in Pittsburgh he explained that when doctors examine patients by physically touching them the patients feel more thoroughly cared for than if they had only been asked questions and observed. That reaction makes sense since when we’re ill it’s usually our bodies that are sick and hold the details of our affliction; a doctor intuitive enough to diagnose from touch is not just appealing, but reassuring. Nurses touch patients all the time, typically not to make diagnoses, since that’s not what we officially do, but to gather information and to help—with going to the bathroom, bathing, walking, eating, managing pain, figuring out if someone’s taking a turn for the worse. Touch connects the essential humanness of nurse and patient, reminding me that we are two people with a shared mission: healing, if we can. The image of a mother placing the back of her hand on a child’s feverish forehead is indelible because it communicates, “I can feel how you feel when you are ill.” I”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“You can only know what you know, a wise friend told me, but so much is on the line here in the hospital I sometimes want to know more than I can.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“Patient care—looking after Sheila, Dorothy, Richard Hampton, and Candace—is heart and soul, but these days, charting pulls nurses away from the bedside more and more.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“I hold infinity in the palm of my hand, and eternity in the next few crucial hours.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“When people ask why I left teaching English to become a nurse, it must be moments like this that puzzle them.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“To picture what happens during the late stages of sepsis, imagine a garden hose with small holes placed throughout to turn it into a sprinkler. When a normal amount of water goes through the hose, the sprinkling effect is constant. If the flow decreases, the sprinkler effect becomes more erratic, and if the volume of water in the hose lessens even further, the sprinkler will turn into a leaky mess that waters only the strip of garden it rests on. The”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“Work is love made visible. And what is it to work with love?” the poet Khalil Gibran wrote. In the hospital, working with love sometimes requires putting people in danger.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“Hospital administrators with their eyes on the bottom line seem to think that nurses can stretch infinitely, like rubber bands. The fewer the number of nurses the lower the labor costs for the hospital. But if I give care a numerical value, represented by TLC, while P stands for number of patients and RN for each individual nurse, then: RN/p = TLC The”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“Well, probably not with that drooling!” She returns to the computer, intent on the paperwork—charting—she has to complete. The paperwork demands have steadily increased over time and the busier a nurse is with a very sick patient the more charting is required, even though she has less time to do it in. Computers should make the process faster, easier, but instead of efficiency, they enforce thoroughness. We’re expected to chart almost everything, preferably in real time. Real time charting is impossible, though, if a patient needs a lot of immediate care.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“There will come a time when each of us will need a clean, well-lighted place that stays open all day and night, offering shelter from life’s storms. This is a hospital.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“Irving’s story is the simplest. Whether by nature or as the result of his many troubles, Irving asked little of life and in that he was adequately answered. The group home kept him safe. The rocking chairs on the front porch were comfortable and the voices in his head weren’t too intrusive or demanding. From him I learned that sometimes when we strive less we end up with more of what we actually need.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“I look at her. This is the moment when she will leave my care for good. Mine may be the last familiar hospital face she sees before she goes under and I want her to remember it as calm and present.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“A mother’s death is a deep, some would say irreparable, loss.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“Amid the many uncertainties of the shift there is one thing I know for sure. Am I ready and up to the job? Yes. Today, and every day, for the sake of my patients I have no other option; the answer has to be, and always is, Yes.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“Am I ready and up to the job? Yes. Today, and every day, for the sake of my patients I have no other option; the answer has to be, and always is, Yes.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“That was the first time I really saw that our attempts at healing can do harm.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives

“So strange to me as a new nurse, these now come easily. TLHC is a triple lumen Hickman catheter, a permanent IV line that protrudes from the upper chest. A PICC—peripherally inserted central catheter—is a different type of permanent IV line that gets inserted in the patient’s upper arm. Temporary IVs I notate as “per,” because they go into a peripheral vein: the kind you can see when you look at your own arm or hand.”
― Theresa Brown, The Shift: One Nurse, Twelve Hours, Four Patients' Lives