What You Don’t See

As I sit in the room and chat with you and your family; I get the chance to learn about who you are, where you live, and what you do.  I hear the stories about how you’ve been living with this illness, what brought you into the hospital, and how you feel now. What you don’t see during our conversation is that I’m doing my neurological assessment.  Watching and listening to you talk, seeing your eyes open and close, watching you gesture with your arms, listening to your speech, your voice, and the clarity with which you speak.  I’m able to tell your level of orientation and the possibility for confusion and delirium since the breathing tube had been removed and we had taken you off the ventilator earlier today.

You hear the monitor beeping and know that I’m going to come in and ask you to cough and deep breath again because your oxygen saturation has dropped below 90%.  I come in and look at your monitor, we practice the coughing and deep breathing exercises together, and work with the incentive spirometer.  What you don’t see is my concern.  After having just removed the breathing tube a few hours ago your oxygenation is still tenuous.  Closely monitoring oxygenation levels is an important part of the care and treatment in the ICU.  While I’ve told you the hard work that is needed to keep your lungs from becoming atelectatic and your body to keep getting enough oxygen;  It’s hard to understand the marathon length of time and energy that is needed for lungs to recover and heal until you fight through it.

While I’m listening to your heart and lungs, I place my stethoscope on your chest and move it around systematically.  Your blood pressure is being taken automatically every 30 minutes. IV fluid is infusing into the central line that was placed in your neck.  The assessments that we do every four hours are obvious.  What you don’t see is our level of expertise and knowledge.  It is important to monitor signs and symptoms of tissue perfusion and oxygenation after being hospitalized and treated for sepsis related to pneumonia.

You see me sitting at the nurse’s station on the computer.  What you don’t see is that I’m reviewing the mountains of physician consult notes.   I’m reviewing lab data, imaging data, culture data, and assessing and measuring the conduction of electricity through your heart on your bedside ECG strip.

You mention that you haven’t seen a physician today, but what you don’t see is the phone calls I have made and the text pages I have sent updating them on how well you are doing and the possible changes we need to make to medication you are on.

While on the surface it looks like I’m just giving you a bath.  What you don’t see is the complete assessment of your skin that a bath allows me to make.  I look at your incisions, look for new areas of redness, and examine areas that are healing.  We know that one of the first signs of reaction to a new medication will show on the skin in the form of a rash.

While we don’t tell you everything we are thinking; we tell you the important things that make healing possible.  The work of professionals is what makes nursing care an art and our professional practice seemingly smooth and invisible.


2 comments on “What You Don’t See”
  1. This is beautiful, true, and inspiring.

    Love every word of this piece and is a fantastic representation of how nurses are complex beings who deserve value as much for what they know as what they do.

  2. Sophie says:

    Fabulous narrative of what we do! I’m going to share this with students I precept in the ICU, if that’s ok. It’s hard to explain to them, & the lay-people we encounter, what it is we DO all day long.
    Just read through some of your past posts, and I’m looking forward to reading more of what you have to say!

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