I used to work with a surly charge nurse who loved to put his hands on his hips and joke, “Are you crying? There’s no crying in nursing!,” in imitation of Tom Hanks’s character in the film A League of Their Own, some of which was filmed in Evansville, Indiana, where I was living and working as a trauma nurse in 2005.
I’d been a nurse for five years and a nurse aide for two years before that, and much of my tenure had been spent traveling, working on contract—the nursing equivalent of a scab. Temp agencies dropped me as if by parachute into hostile, perpetually understaffed, and virtually lawless emergency rooms. Administrators overpaid me in the short term so they could, in the long term, underpay, underinsure, and understaff their nursing departments.
All of this is to say that on early Sunday morning, November 6—the day an F3 tornado tore the toe off southwestern Indiana, decimating a mobile-home park, killing 25 people, and injuring more than 200 others—I wasn’t as seasoned and cynical as my charge nurse, but I wasn’t green, either, and I knew better than to cry.
“Nurses eat their young,” we’re taught on day one, surrounded by classmates, close to 90 percent of whom are female, even now. Nursing is historically, inherently female, and simultaneously historically, inherently misogynistic.
Yes, women transformed this often icky work into a noble profession, but we labor under the direction and supervision of physicians and hospital administrators, most of whom are male (74 percent of hospital CEOs and 65 percent of physicians, according to reports by the American College of Healthcare Executives and the U.S. Department of Health and Human Services), and who often fail to see value in the soft-science side of what we do.
In order to be taken seriously, nurses will often downplay the traditionally “feminine” aspects of their duties. Bedside manner, compassion, nurturing, and intuition are not prioritized in the clinical setting. Hospitals might advertise their services with such terms, but a line is clearly drawn between the professionally distant levelheadedness of doctoring and the warm fuzziness of nursing.
That said, the best nurses—and the best doctors—know better. They know that patients who trust you tell you more about themselves. They take their medicine without a fight. They let you draw their blood. They hold still for an X-ray. All of which lead to more thorough clinical assessments, fewer errors, and timely lab and radiology results.
Still, the belief persists that nurses should strive for stoicism, even when their patients feel the world crumbling around them, because they don’t need their plan of care muddled by emotions, and they certainly don’t need confirmation of their own personal apocalypses by weak, hysterical, blubbering nurses.
The 12-hour shift stretching from Saturday night into early Sunday morning had been a busy one, a frenetic parade of applying neck immobilizers and pumping stomachs—too hectic for a dinner break, but brief trips to the bathroom were still manageable. The weather was erratic, unseasonably warm—typical for Tornado Alley—and the medics had propped open the sliding glass doors of the ambulance bay so we could smell the rain-clean air and witness the steam rising from the hot pavement of the parking lot.
Through the night, rain came in deafening waves, as if the Indiana sky was a bucket that kept filling up and spilling over, splashing water up and over the curb. Bad weather is an ER nurse’s guilty pleasure—it keeps patients with twisted ankles, ear infections, and abscessed teeth at bay.
Moving from a heart attack to a hangover can be jarring, and we don’t always handle such transitions graciously. Those rare work shifts where all of our patients are circling the proverbial drain are often validating, even restful; since there’s no need to move in and out of fight-or-flight, we can simply stay there.
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The weather alerts had remained constant through the first part of the shift. Several small funnel clouds had already touched down in northwestern Kentucky. Here, a barn gone. There, a flash flood. Then, during the normal lull in the wee hours of the morning, a dispatcher requested that “all emergency medical personnel in the tri-state” report to a nearby mobile-home park containing more than 300 trailers.
We didn’t know it yet, but a severe tornado had traveled more than 40 miles, obliterating a small farm and tossing a pickup truck into a field, then crossing the Ohio River three times, widening and picking up speed with each leg. It flipped a 10,000-pound truck and killed several horses at the local racetrack. It scoured spiral scars deep into the silt. And it tore through the trailer park, kicking through homes like they were empty shoeboxes, snapping spines and tossing bodies more than 200 yards in the process. The hopeful survivors were on their way to us.
I ran to the bathroom, knowing I wouldn’t have another chance for the rest of the shift, which would now be hours longer. I splashed water on my face and tried to get my head on straight, running through paradigms and priorities. Most of the patients would need CT scans before they could be treated for whatever internal damage, broken bones, or punctured or ruptured organs they’d sustained, but we had two CT machines, and one of them was ancient and slow, and the other was brand-new but being repaired. People would have to wait indefinitely for their scans. They would be crying in pain.
The glass doors opened, and the first 10 patients were managed smoothly—sorted, scanned, stitched, and bandaged or sent to surgery. Likewise with the next 10. But then the tone morphed into something more surreal. Patients on stretchers filled the hallway, calling out in a chorus for help. The charge nurse had assigned me to float where needed, so I moved in and out of rooms, offering whatever care I could.
I started IVs, poured sodas into Styrofoam cups, and tucked patients beneath blankets pulled from the warmer. We nurses wove between one another seamlessly, like spiders busy at work on the same web. We communicated needs with nothing more than a nod or gesture.
In the hallway, I passed a child pointing at a boo-boo on his finger; he had so many splinters in his scalp that he looked like a deranged hedgehog. One door down, a patient screamed in fear. He had been blinded by the shrapnel of tornado debris. His nurse discreetly pulled the door shut to muffle the sound of his grief.
I transported patients to CT. I passed out morphine. I helped distribute color-coded vests that the hospital had purchased for just such a disaster, though none of us could remember what any of the colors meant. I took over for coworkers so they could use the bathroom.
The charge nurse met me in the hall to say management was planning personal time for the staff, and there would be several opportunities for debriefing. Debriefing for what? I thought. The aftermath of the tornado was busy and strange, but I’d seen worse—we’d all seen worse.
Many nurses are drawn to the ER because they themselves are survivors of trauma and feel most at home when the stakes are high. And, of course, the job itself is traumatic. I had small kids of my own at home, and seeing evidence of neglect or abuse was always hard, but every nurse has a list of horrors, and mine is typical. It starts with a skydiver, a young woman who landed in a tree and then fell from it; her crushed pelvis looked as if it were erupting from her shoulder and left me feeling stoned. A date rape victim, her perpetrator two doors down. The tiny feet of stillbirths. The gangrenous foot of a homeless veteran that came off in my hands. I doubted I would see anything from this tornado that would break me.
My next patient was a woman, also waiting for a CT scan. She wore the familiar face of shock, blank and serene. I asked her the obligatory questions: What was her pain on a scale of 1 to 10? Did she have any family coming? She didn’t respond. Her chart indicated that she had crushing injuries to her right side, but she was still immobilized, so I couldn’t really examine her. I asked her if she knew what object had fallen on her. She shook her head no, then changed her mind, saying, “More than one.” Then I asked if anyone had been with her in her home, and that was when she began to talk.
Her two kids had been home. She remembered that was how she got hurt, and suddenly she was animated, recalling what had happened in real time, visibly relieved. She had grabbed her children from their beds and wrapped her body around them, impenetrable as a geode. And they were fine, because she didn’t let go, even when the couch slammed against her, even when she felt she was falling through the air when the room lifted from the ground like a carnival ride. She was smiling. She’d kept her children safe.
I realized my eyes were full of tears and turned away for a moment, assuming I would stop crying if I collected myself. But it didn’t help; the tears kept coming. I wasn’t sobbing, and my face didn’t feel hot and red. I just couldn’t stem the tears streaming down my cheeks. At the nurses’ station, my charge nurse pulled me aside, a little worried. I told him I was fine, and I was. I grabbed more pain medicine and made a pushy call to CT, advocating for a jump ahead in the line. I did all of this in tears. I didn’t know what else to do.
“Can I get you something to drink?” I asked. “We have juice and soda.” She nodded and asked for cranberry, and I was relieved to have an errand to run. I thought a cool splash of water on my face might help, but it didn’t make any difference. The tears continued to run down my cheeks like rain. I wiped them away in a pointless gesture of professionalism, and helped her drink the juice through a bendable straw.
I felt embarrassed, not just for me but for her. I was thinking it must be terribly awkward to have a nurse who can’t hold it together. “Thank you,” she said. “It’s just juice,” I said. “No,” she said, shaking her head, “thank you for crying for me.”
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