It was a hot, dry summer’s day. Penn felt the sweat trickle down his face into his shirt. Suddenly, shots were exchanged, and Penn’s heart raced. He had never been in the middle of combat before this as he was a new medic. The injuries to which he tended were casualties of a battle with insurgents or snipers or those wounded from the explosion of an IED. Penn was nineteen years old and he had never experienced combat firsthand. He tried to be brave but he was so afraid.  The more experienced medic with him crept toward a wounded soldier but, to Penn’s horror, she was shot. Penn froze. He wanted to scream or cry out, but he couldn’t make a sound. Was he a coward? When it was safe to do so, he and an uninjured first lieutenant moved the wounded soldiers out of harm’s way and then to their nearby Combat Surgical Hospital, which was the replacements for MASH units after the war in Iraq. More medics, nurses, and doctors came to triage and treat the wounded soldiers. The chaplain came to pray for those who were dying or already dead. Penn kept seeing his dead colleague, who left behind two small children. He smelled burned flesh and the acrid remnants of gunfire. Finally he cried, broke out in a sweat, and started to scream.

“Hey, Penn,”one of the other nurses sleeping in the staff lounge called out. “You okay?”

“Yeah, I’m fine. Just a nightmare. Sorry to wake you.” He used to have frequent nightmares about his tours in Afghanistan, but they abated when he got therapy through the VA. Shortly thereafter, he met his group of friends and got much-needed social support. Occasionally something might trigger his PTSD. It might be a crowded room or a discussion of combat on a news show. The worst trigger was loud, unexpected noises like a car backfiring or unexpected fireworks. He had begged off seeing July 4 fireworks every year, saying that he had seen the real thing. He thought the worst of his PTSD was over. And now this. When he worked in the ER, he had some flashbacks to his experiences as an Army medic. Now those flashbacks threatened to drag him down, into the darkness that was PTSD. 

Penn wasn’t able to get back to sleep, so he showered, dressed, and showed up in the ER. It was 3AM, and he didn’t need to come in until 7AM, but he knew he might as well be useful. As soon as he told the nurse supervisor that he was working early, he punched in, grabbed his gear, and started triaging patients. He was finishing up with his third patient of the shift, when a call came through about a multi-victim motor vehicle accident. Penn’s COVID patient was stable so he was freed up to help with the accident victims. One of the victims was unresponsive and Penn jumped on the gurney, straddled the patient, and immediately started doing CPR. Meanwhile one of the doctors and a couple of other nurses stripped the patient, cutting through his clothes with bandage scissors, so they could draw blood, start IV lines, and place electrodes for an electrocardiogram. As per the EKG, the doctor determined that the patient needed cardioversion, so Penn got off the gurney and took the paddles and called out, “Clear!” to ensure no one was in contact with the patient and accidentally received a shock. The effort to correct the patient’s heart rhythm was unsuccessful, so Penn started chest compressions again. An unholy dance of chest compressions, checking the EKG, and cardioverting the patient continued for two more cycles. Eventually, the patient flatlined. Penn insisted on repeating the cycle just one more time, but the doctor called him into the staff lounge.

“Penn,” Dr. Bishop started, “What happened out there? You tried to control the situation but, in spite of every effort we made, our patient could not be saved.”

Penn’s cheeks reddened and he was on the verge of tears. “There is so much death in the ER with COVID-19, but I thought I might be able to save this patient’s life. I mean, I know I could have. When I was a medic in Afghanistan, we saved many more soldiers than we lost. Even the ones with traumatic amputations or bad head injuries–we saved their lives. But with COVID, it seems all that we see are patients we know will die from this disease.” He stopped to catch his breath and pray that any tears he might shed would go unnoticed. “It’s just mind-numbing to deal with one death after another.”

“That’s right. You were a medic for what—four years? And you saw a lot of trauma, from minor injuries to soldiers who would have been fortunate to die from their wounds.”

“And once. Just once, I wanted to save our patient and not send yet another person to the morgue.” Penn’s eyes were downcast and he sighed. “The worst thing of all is that my best friend’s parents died of COVID when they were in Italy. Nicest people I’ve ever known. They knew I was thousands of miles away from my family, but they treated me as if I was one of them. I think about my friend and how is heart is breaking. And I can see their faces in the men and women I take care of, especially those who die in the ER.” And with that, Penn broke down and cried.

Dr. Bishop patted Penn’s shoulders. “So you have PTSD, which has gotten worse with your ER work, you’re working way too many hours, and you think about your friend’s loss of his parents. And you didn’t get to walk for graduation and you have no time to take your licensure exam. Penn, that’s way too much for anyone to handle. I think you need a break.”

“But why should I get a break when other nurses going through the same thing?”

“You’re a good nurse. You are empathetic and skilled, and it would be a shame if you burn out so early in your career. Look, let me talk with the nurse supervisor to see what we can do. You need to take some time off. Like right now. Go home. Grab something to eat and maybe a beer. Talk to someone. Check with the VA for some resources, maybe online meetings. And talk to your best friend. Talk to another friend if talking to him is too rough right now.”

Less than 15 minutes later, Dr. Bishop and the nurse supervisor came into the room where Penn was. “Penn,” the supervisor said, “Dr. Bishop told me what happened. I also heard from some of the other nurses who shared sleeping quarters with you that you’ve been having nightmares, usually about being back in combat. You’re one hell of a nurse and we want to do what we can to help you through this. So I want you to go home now, and stay there for a couple of days. When you return, I’ll assign you to do mobile COVID testing. That should give you a bit of a break from the ER.”

Penn tried to protest but he knew the doctor and the supervisor were right. He gathered his things, punched out, and headed home. 

To be continued…