March 2, 2025 • 32 mins
03/02/25
The Healthy Matters Podcast
S04_E10 - Controlled Chaos: A Day in the Life of an Emergency Nurse
There are a lot of important people in healthcare, but the medical system itself simply would not exist without one essential piece of the puzzle: NURSES. It might be impossible to give them enough credit for the many important jobs they do - from the Emergency Department to the clinics. They literally see it all, and regardless of how intense the situation might be, somehow always seem to keep their cool.
Emergency Department nurses are a special breed and the backbone of hospital emergency care, and in Episode 10, we'll be joined by one of these unsung heroes. Kara Fussy (BAN-RN, CCRN) is a Critical Care and Emergency Medicine nurse, working in the Emergency Department of HCMC, a major Level I Trauma Center. In our conversation, we'll get insights and stories from what can be one of the most intense places in the hospital. We'll learn about the personal and professional challenges of the job, what it takes to thrive in this position, and also hear stories about a few of the more interesting patient cases she's seen over the past few decades. It's safe to say this job is not for everyone, and this is an excellent chance to learn about the role and experience from someone who lives this job day in and day out. We hope you'll join us.
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilden .
Speaker 2 (00:18):
Hey everyone.
Welcome back to the HealthyMatters podcast, where we dive
into the world of healthcarewith the experts who live it
every day . I'm Dr. DavidHilden , and today on episode
10 we'll have a look at thefast-paced front lines of one
of the most intense and highstakes environments in
medicine, the emergencydepartment. And we're gonna do
this through the lens of one ofthe most beloved, trusted, and
(00:39):
just plain awesome healthcareprofessionals we have and that
in our nurses. So our guesttoday is Kara Fui . She is a
critical care nurse. And let'sjust say she's seen it all from
traumas and medical emergencyto the completely unexpected in
both the ICUs and what we'regonna talk about today, the
emergency department. So she'shere to share her experiences,
(01:01):
insights, and what it takes tothrive in this challenging
role. Kara , thank you forbeing here.
Speaker 3 (01:04):
Thank you so much for the invitation.
Speaker 2 (01:06):
It's great to have you on the show. I always love
to talk to nurses becausefrankly, you're the heart and
soul of medicine. And so startus off, if you could describe
just one of your emergencydepartment shifts, in a few
words, what would they be?
Speaker 3 (01:20):
Well , um, I think the first thing that came to my
mind was that friends episodewhere Ross is moving the couch
down the stairs, screaming,pivot, pivot, . And
Speaker 2 (01:31):
That as they're moving the couch,
Speaker 3 (01:32):
As they're moving the couch, that's kind of what
we do in more of a humancapacity. We're always
pivoting, looking for whatneeds to be done first and
down. Also, crazy train also isconstantly replaying in my head
because we're always kind ofoff the rails with whatever's
coming through the door. Wehave to be ready for,
Speaker 2 (01:54):
It's gotta be one of the most intense jobs where you
don't know what the next hourof your life is gonna be. A lot
of us have jobs , uh, e even mewhen I'm practicing in clinic,
at least I know, okay, I've gota patient at this time and this
time and I roughly know whatthey're coming in for. You
probably don't know what'swalking through the door or
maybe not walking through thedoor.
Speaker 3 (02:12):
Right. We can go from no one in triage to 40 in
triage, waiting to be seen andstabilization cases through the
rigs rolling in nonstop. And itcan really put pressure on all
of the staff because we have toband together and work as a
team always and have eachother's backs.
Speaker 2 (02:34):
When you went to nursing school, is this what
you knew you wanted to do orwhat drew you to this?
Speaker 3 (02:38):
I've always been kind of drawn to Hennepin. Um,
originally my family had someconcerns about me working
downtown Minneapolis. In whatdo you mean?
Speaker 2 (02:47):
It's a garden spot of the
Speaker 3 (02:48):
Country. The glorious Hennepin County
Medical Center. They're on thenews a lot. I've always been
drawn here. So I finally camedown here with LifeSource,
Speaker 2 (02:58):
The Oregon Procurement Organization.
Speaker 3 (03:00):
Yeah, correct. I was working with them and I was
spent a lot of times in thesurgical intensive care unit
evaluating patients and spentso much time down here and I
found myself lost in theemergency department, wandering
through it and went, oh, thisisn't so bad. Saw they had some
openings, was feeling a littletired in my intensive care
(03:20):
career. So I applied andfortunately got hired and I
really haven't looked back.
This has been my jam.
Speaker 2 (03:27):
Anything surprise you about it? I mean, because ,
'cause people who haven't beenin emergency department, except
as maybe a patient when you'rewield in on a gurney or you're
scared and sick and you , butthose of us who work there,
I've been practicing medicine25 years and I'm a little bit
intimidated by it. The theenvironment is high energy most
of the time.
Speaker 3 (03:46):
The most surprising thing to me has been my
coworkers stories and howthey've gotten to the place
where they're at in their life.
A lot of them have had somereally significant major life
events that have been traumaticfor them. And I think that
makes them more relatable toour patients, myself included.
(04:06):
When we look at each other, wejust see, you're my nurse,
you're my doctor, you're myrespiratory therapist,
whatever. But a lot of thesepeople have been through some
major traumas that they'veovercome and now are using all
that life experience to betterother people's lives. And the
other thing that alwayssurprises me is even our
nursing assistants, they'relike advanced practice nursing
(04:29):
assistants. They have gotmilitary training, they have
got multiple bachelor'sdegrees. Many of 'em are trying
to get into medical school orPA school or their nurses in
training. Really, really highlevel at all levels of care
there. I
Speaker 2 (04:46):
Haven't thought of that so much. Um, when you
think of an emer , when peoplethink of an emergency
department , you , you don'tthink as much, I don't think
about the experiences of thepeople that are caring for you
and how that might make thembetter. Yeah . To care for
whatever is bothering you thatmoment, whether it be just a ,
a little pinky finger youbroke, or whether you were in a
bad car accident or something.
I really like that, that yourpersonal lives can, can make
(05:09):
you a better nurse, a bettercaregiver, a better doctor in
the hospital. Is it possible tosay what a typical day looks
like?
Speaker 3 (05:17):
Um, it's never typical. It always is changing.
Some days it seems like we'reheavy on maybe chemical
dependency or mental healththings. And then the next day
it's traumas, car accidents ,um, you know, some of that can
be predicted by the weather.
Outside in Minnesota, we havethe beauty of four glorious
(05:41):
seasons and a lot of outdoorsypeople. So we, we do see a fair
amount of exposure to theelements. Traumatic injuries
just from either carelessnessor chemical dependencies. Just
a lot of variety can happen inone little tiny setting.
Speaker 2 (05:59):
Yeah, that's, that's incredible. So Kara , since you
are also a critical care nursein ICUs Yes. At this hospital
and others, you see whathappens to patients who are
critically ill. I'd like you totalk us through one type of
critical illness that beingtrauma. If you could talk us
through what happens whenyou're in that emergency room
(06:20):
and the ambulance shows up whatyou call the rig. I love that,
that people in e emergencymedicine call 'em the rigs. So
when the rig pulls up with apatient on a gurney with some
trauma, let's say it's a badcar accident or something, what
happens? What processes get putin place in those first few
minutes?
Speaker 3 (06:36):
Well, the staff all does a lot of training on
trauma care and how to look atthat patient. And we start the
second, we get what we call azip it , we'll get a little
brief from our EMS dispatch ,um, on who it is that's coming
in, what kind of scenario we'relooking at. Very brief , um,
(06:57):
maybe the age, and this is
Speaker 2 (06:58):
Before they arrive .
Speaker 3 (06:59):
This is before they even come in the door and we
know that they're gonna go tothe stabilization room where
the most critical people go to.
And that's the place that Igravitate to just because of my
critical care background. Itmakes the most amount of sense
to me. So once those patientsroll through the door, we do a
kind of across the roomevaluation. Is there anything
that we need to reprioritize?
(07:20):
Are they breathing, are theyawake, are they bleeding? And
the rig rolls in the EMS , theyare EMS are amazing. They have
patients so kind of buttoned upfor us to really succeed in the
stay room . They usually haveIVs that , um, they usually
have fluids going and they havea great history for us. So they
(07:41):
will tell us what the scenelooked like. They'll tell us
any extra factors that wereinvolved, you know , people,
weather conditions , um, whowas on scene, what was done
before they even arrived to us.
We get 'em on the cart and wedo head to toe. Head to toe is
always what we're doing.
Getting 'em on the monitor. Thenurses especially are more
(08:03):
involved on the medicationside. We get IV access first
and foremost. We get 'em onmonitors, constant
communication in that area. Wehave such a great team of
medical physicians, theresidents, ultrasound people.
We have pharmacy usually withus. We always love to have
(08:26):
pharmacy there, especially withpediatrics because of the
weight-based dosing ofmedications. But the whole team
knows their role and areheavily involved in that. And
we're always triaging, doesthis patient need to go back to
the beginning? You know, arethey still breathing? Is their
hearts still beating? Is thebleeding under controlled? The
(08:48):
big things
Speaker 2 (08:49):
I've been there , uh, many times and, and
listeners, I have nothing to dowith any of this. I treat
diabetes. I don't, this isn'tanything I have anything to do.
So I'm just in awe of the stabroom process. Stable , short
for stabilization. In some waysit's a teeny bit like the TV
shows what you see, but in mostways it's not. Because when you
go in there, there are, there's3, 4, 5, 10, 12 professional
(09:13):
caregivers all with theirvarious jobs. And they're not
yelling and screaming at eachother. There's not blood flying
across the room for the mostpart. I mean, sometimes
, but, but it's a , it feelscalmer than you might expect,
but yet a high intensityenergy, I dunno if I , if that
sounds right, it's like a calmenergy when you're in there.
(09:33):
There aren't people yelling andscreaming and it's not chaos
like on the TV shows, butpeople are just as sick as they
are on those TV shows. How doyou maintain that sense of calm
professionalism when someonemight be bleeding or, or
frankly their belly might behanging open or they're
unconscious and you've gotseconds to act. How do you keep
that calm?
Speaker 3 (09:53):
I think there's a lot of confidence in our
teamwork. We do go through alot of training, a lot of
certifications. I have thebenefit of my life experience
in the emergency department andcritical care that helps me
kind of run the algorithms. Iknow what's going to come next.
And then really having thatstrong team atmosphere. Always
(10:18):
consistent layout. We knowwhere our equipment is. We all
are trained on how to use it.
And I think that's where thecomfort level comes. And really
being focused on, we're gonnabring our A game to this
person. They are our main focusright now. They're the sickest
in the department. They deserveour 100% attention and we have
(10:40):
all these brains, eyes and earson them to get them to the best
place that we can.
Speaker 2 (10:45):
Yeah, I like that about the teamwork that you
said and everybody knows theirjob. And you briefly commented
about the paramedics. I do wantto give a shout out to first
responders, the paramediccommunity at Hennepin
Healthcare. Hennepin EMS is thebest in the business. When you
see a Hennepin ambulance showup, you're in good hands,
everybody. Absolutely. And Iwould say that it's also true
for other EMS services in town.
(11:07):
Paramedics in general areawesome. But just a , a shout
out to our Hennepin EMScolleagues. They're fantastic.
And if you want a little bitmore about EMS, I'm reminded of
the last episode, the bonusepisode of season one, where I
did a ride along with our EMSand we recorded some of what
they do. So could you, withoutobviously violating patient
(11:27):
confidentiality, are there anycases that stand out to you
from the stay room ? And I knowthat the vast majority of
patients who come through theemergency department leave
better than they came in thevast majority. You save
people's, literally you savetheir lives. Not all, not all.
Um, are any cases doing anystand out to you that were sort
of career defining for you? Orat least ones that stick with
(11:50):
you?
Speaker 3 (11:50):
There's many that stick with me. Um, a lot of the
peds cases are really tough nomatter what the outcome is.
Children,
Speaker 2 (11:58):
Children, children.
Speaker 3 (11:58):
Yeah. Um , they're always tough. But on a
different note, we had twodifferent cases one summer
where both of these people wereflown in from a different
state. The same state. Both ofthem were farmers. Both of them
had been working on theirtractors. One of them, his
tractor started on fire anddrove over him. He was flown to
(12:22):
us for burn . He also hadtrauma, but burn was his top
priority. The other was also afarmer working on his tractor.
That tractor drove over him andhe was more trauma
traumatically injured than burn, but was also here with burns.
And it was the same summer,same state out of state . I'm
Speaker 2 (12:43):
Surprised that farmers came in. There's an old
joke that the farmer like couldhave their arm half hanging off
of them because of some injury,but they finished milking the
cows before they come .
Speaker 3 (12:52):
A hundred percent true. Both of these guys . But
these guys got rough over .
Yeah. Both of these guys werelike, please don't give me
narcotics. Can I have someTylenol? Actually, no. They
asked for aspirin and we'relike , uh, no, with the aspirin
and the bleeding
Speaker 2 (13:05):
Aspirin's gonna make you bleed worse . Yeah . That
would be so good . There is notougher individual than I've
ever met than a farmer.
Speaker 3 (13:12):
Agreed. Except for maybe the farmer's wife. Just
Speaker 2 (13:14):
For maybe. Exactly.
So both these guys got run overby their tractor.
Speaker 3 (13:19):
Yep . And both had burns and both had traumatic
injuries one . Oh , they do.
They both did great. I thinkthey were both discharged
within a , probably aridiculously short amount of
time for their injuries. So
Speaker 2 (13:30):
Did they get flown in? Did they get driven in on
by the ambulance or how did
Speaker 3 (13:34):
They get here? I think both of them were flown
'cause they were from adifferent state. So
Speaker 2 (13:37):
We do have , uh, two helipads here at Hennepin
Healthcare. Mm-hmm . One'sright on the roof, right above
you guys. I love that thatthing is right on top of you.
And so they can go from thehelipad to the emergency
department, do not pass go donot stop at any floor. It's
just the elevator goesdirectly.
Speaker 3 (13:51):
Right. Yes. Whoever got funding for that genius.
Speaker 2 (13:54):
So I'd like to pivot a little bit, as long as we're
talking about the word pivot,about how the nursing staff
specifically manages thatstressors in their own life.
When a lot of people go homefrom their jobs, they didn't
see people having all theseproblems. They didn't see
people not always surviving.
They didn't see childrengetting hurt. They didn't see
(14:15):
people with, with the severityof what life throws at them. As
you do. So specifically fornurses, because I'll also say
that doctors tend to come andgo, you know, we're in there
with you for five minutes andthen we go to the next patient
. The nurses are with you allyour stay the whole time you're
there. How do you cope withthose stressors either during
the day or when you go home?
Speaker 3 (14:36):
Um, during the day, I am able to pretty well
redirect because I always haveanother person that needs me.
There's always a need thatneeds to be addressed. And I
can stuff my own thing .
Speaker 2 (14:47):
You mean the other rooms aren't just vacant?
Speaker 3 (14:49):
? Boy, that
would be nice. That'd be
amazing. But I think I'd be outof a job.
Speaker 2 (14:55):
. That never
happens, folks. Emergency
room's , the busiest place inthe hospital.
Speaker 3 (15:01):
I think that some of us cope with things very well
and some of us cope with themvery terribly. And there's a
whole spectrum. Some days I'mthe one that's coping poorly. I
have had a therapist on andoff. I have ran too many miles.
I have gone home and just beensilent in the corner. Um, I'm
(15:23):
not a huge crier, so when I docry, my family doesn't know
what to do with me.
Speaker 2 (15:29):
Yeah, that's a , that's not the norm.
Speaker 3 (15:31):
No, no. Um, and I think that no one understands
outside of the people thatactually work in that situation
day to day . So we really kindof lean on each other. We try
to keep our eyes open to eachother's struggle. Our
chaplaincy group here, amazing.
They will seek you out if theyknow you have been in a
(15:54):
difficult case and just offertheir support. Just a really
amazing group of people to workwith. And we also do a fair
amount of debriefing ondifficult cases. Some of the
more challenging cases, theywill do a STA conference with
where the attendings willattend. Um, the residents that
were involved will present alot of times the , um,
(16:16):
ancillary staff and the nurseswill be there as well. Just to
review what happened and how itwent. Right, how it went wrong.
Speaker 2 (16:23):
I'll bet there's a ton of peer support in mental
health resources, but maybe notadequate to the job. I don't
know. Um, if, and I'm talkingnot specifically about my
hospital, but in general, Iwonder if our healthcare
systems and our societyrecognizes the toll that
healthcarers and in , in thiscase, emergency nurses are
(16:43):
doing.
Speaker 3 (16:44):
I think that in years past, it has really been
a neglected area. And I thinkthat Hennepin especially has
stepped up to the plate forthis. We've had more than I
care to talk about staff thathave suicided. Mm-hmm
. Um, mostrecently, Carl, Chelsea, Ryan.
(17:09):
These are people I worked sideby side with. These are people
that were at the top of theirgame. Really great humans. And
I never wanna their names , um,because they were my coworkers
, they were my friends. Um, weloved them . And I, I don't
know that if the support wasthere, if they would've taken
(17:30):
it. And I think that's a bigpiece of being, having some
self-awareness, knowing thatyou need to reach out and ask
for help because sometimes thesupport can be there and you
are, you know, I'm, I'm thetough ER nurse or the tough EMS
medic. I, I can do this day inand day out. But we've started
(17:51):
talking more about thesecondary trauma that the staff
feels. They um, just fromwitnessing it, you know, the
secondary and tertiary trauma.
So I really believe thatHennepin Health is trying to
get us the support that we needin the ed. Especially I've
noticed our leadership, theyreach out also now on difficult
(18:13):
cases and they circle back withus and just really try and get
us what we need to bring usback to a fully functioning and
feeling good about what we doat the end of the day.
Speaker 2 (18:26):
Yeah, those are great comments. I agree. It's
been neglected over years andI'm glad to hear at least some
progress is being made tosupport the team down in the
emergency department. So we'regonna take a quick break and
when we come back, Kara isgonna share some of the biggest
challenges emergency nurses arecurrently facing some advice
for aspiring nurses. And we'llalso see if we can throw a few
more fun questions their way aswell. So stay with us. We'll be
(18:48):
right back
Speaker 4 (18:52):
When Hennepin Healthcare says we are here for
life. They mean here for you,your life and all that it
brings. He up and healthcarehas a hospital HCMC and a
network of clinics bothdowntown and across the west
metro. They provide all theprimary care and specialty care
you would expect to find. Butdid you know they also have
services like acupuncture andchiropractic care available at
(19:14):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis. Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (19:30):
And we're back talking with fui . She is a
critical care and emergencymedicine nurse at Hennepin
Healthcare here in downtownMinneapolis. And we're talking
about life in the emergencydepartment. So now I'd like to
talk a little bit about some ofthe challenges of the intensity
of the work in the emergencydepartment. A lot of my
patients are worried about thewait times. Those are real. A
(19:51):
lot of us in hospitaladministration in emergency
medicine know that there's noplace to put patients, so
therefore they board or theystay in the emergency room for
a long period of time. Couldyou talk to us about that
reality and what that feelslike to you?
Speaker 3 (20:05):
Yes. Um, I think pre pandemic, we still had some
generous wait times , um,depending upon what was going
on in the department because weare that safety net level one
trauma facility where we takeeveryone and we don't really
close our doors ever, butduring the pandemic we had, you
(20:26):
know, this unnerving lull whilepeople were kind of sitting at
home sick and then , um, wouldcome in really sick or with
really critical emergencies,which was an interesting turn
of events. And then , um, oncethe pandemic really started
cooking, we saw all these, youknow, really sick people with
respiratory illness afterpandemic. We are still seeing a
(20:50):
lot of people very ill. Theyhave many, many medical
problems in general that cankind of complicate their whole
stay. So they come in verycomplex but have one emergency
that we need to address whileyou can't ever just address
that one piece because allthose other factors play into
it and really kinda guide theircourse and whether or not they
(21:14):
needed to be admitted. We havebeen seeing people staying in
the emergency department for acouple of days, which is never
ideal. We always hate that'cause we feel like we're not
doing them justice because weare emergency based and we
wanna put a bandaid on it andget 'em going. So we really try
(21:34):
as hard as we can to eitherroom them within the facility,
find them another facility thatthey can transfer to if it's
not appropriate for them tostay. And the wait times really
wildly vary. Always know thatwe never want you to wait, we
don't want you to wait for ahangnail, but much less a
emergency. But we're alwaysgonna take those true
(21:55):
emergencies first.
Speaker 2 (21:57):
You triage everybody.
Speaker 3 (21:58):
Yes. Everybody gets triaged and they get re triaged
and we're always looking totake the top priority first.
Speaker 2 (22:06):
If you're having a heart attack, you're not
sitting in the waiting room.
Speaker 3 (22:08):
Right. And we don't want you to sit in the waiting
room, like I said, no matterwhat your concern is, we don't
want you sitting in the waitingroom being uncomfortable and
ill and unhappy with your carebecause you're waiting. Our
staffing always in theemergency department is kind of
at a par level. Sometimesthey'll have more for events
(22:28):
that are happening in townwhere we think there might be
an influx of
Speaker 2 (22:32):
Patients zombie pub crawl.
Speaker 3 (22:33):
Oh my gosh. Do
Speaker 2 (22:34):
You know about zombie pub call ? I
Speaker 3 (22:35):
Do. I actually have that on my notes . You do. As
one of my most traumaticevents, we had a zombie pub
crawl pre pandemic where we hadan influx of people who were
very intoxicated
Speaker 2 (22:49):
And they're dressed like zombies and
Speaker 3 (22:50):
They have this really elaborate makeup we had
to scrape off because weweren't actually sure if they
were injured with a trauma orif they were just drunk or
chemically impaired in someway. And it was really
challenging because some ofthese people had such amazing
costume makeup on that wereally had a hard time
(23:13):
differentiating between a trueinjury and
Speaker 2 (23:18):
Makeup . It is a little bit funny, it's urban
legend. I don't know if it isin other cities, but in the
Twin cities in towns toMinneapolis, they used to have
the zombie pub pub crawl whereyou'd go from pub to pub and
drink too much and dress like azombie. Yeah. So that really
cracks me up that you stillremember the zombie pub pub
crawl situation. Yes.
Speaker 3 (23:36):
Yes. I think it's coming back. Oh , good
Speaker 2 (23:38):
Grief. I'm you think it would be the rock concert at
the stadium or the Vikings gameor, or something else? No, it's
zombie pub crawl . Yes . Thatsticks in your mind.
Speaker 3 (23:47):
Yes. Yep . I also had a traumatic St Patrick's
Day too, where there were musthave been a large delivery of
designer drugs into the TwinCities metro area. And there
were a lot of intoxicatedleprechauns in the Oh gosh . In
the department. Oh no . And wehad beds in the hallway and
(24:09):
there were people havingmyocardial infarctions and you
know, there was so many really,really critically ill patients
and a lot of it was fromchemicals that they had
ingested on the St . Patrick's.
Speaker 2 (24:22):
You do indeed. See it all. There you go . Um, let
me, let me pivot again to yoursafety and the safety of all
the staff in the emergencydepartment. It might not be
well known to people that beingin healthcare has evolved over
the last decade or so into aplace where workplace violence
is not uncommon. Mm-hmm . Nurses,
(24:42):
paramedics, security people,physicians maybe to a little
lesser degree are subject toviolence. Yeah . Could you talk
about that, what that feelslike?
Speaker 3 (24:51):
You know, early in my critical care career, I was
assaulted by someone who wasunder the influence. Um, they
didn't have any idea what theywere doing, but they really
injured both myself and mycoworker . And I, I'm sorry. I
almost thought that was gonnabe the end of my career. And I
was a little bit reluctant totake care of patients who had a
(25:13):
violent history after that. Um,it was a little bit triggering,
if I'm honest. When I came downto Hennepin, I was a little bit
concerned that those feelingswould come back. But Hennepin's
security has only been improvedupon. The security guards are
at our back nonstop. They arealways present. Um, we usually
(25:36):
have a fair amount of sheriffpresence in the area for
whatever reason. So we reallyget a lot of support by the
community and our in-housesecurity. We love that we're
downtown Minneapolis. We loveour clientele, but we also
wanna make sure that the staffis safe to take care of them.
(25:57):
We also wanna make sure thatthe people that come in are
safe. And we know that in thisera some people don't have good
intentions and mm-hmm . We just wanna
make sure that everybody's welltaken care of.
Speaker 2 (26:09):
Yeah. And and the the , you can't take care of
others if you're not physicallyand psychologically safe.
Correct. So , um, thank you forcommenting on that. Could you
give some advice to people whowant to go into nursing and
particularly or any career inthe emergency department? What
does it take to thrive downthere? A
Speaker 3 (26:27):
Huge amount of empathy and understanding of ,
um, what these people arecoming from and some of the
challenges they face in theirown life, whether it's poverty
or health crises, their ownpersonal history. Um, there's
so many different variablesthat each person really has to
(26:48):
live through and overcome toget to where they're at. Even
if they look like they have itall together, they have a
history, usually a backpackfull that we need to sometimes
go through and talk with about.
I think that you have to have agood understanding of yourself.
I really hate it when peoplesay you must see a lot down
there. Well, I'm not actuallystanding around spectating,
(27:11):
, it's bring my a gameevery shift that I'm there or
someone's going to not do wellbecause of it. It's a team
effort and we really need toband together and collaborate.
So knowing yourself and usingyour tools to help people is
really what you need to do.
Check the pride at the door.
'cause you're gonna learnsomething and usually an
(27:33):
unexpected ways . It might befrom a new grad, it might be
from your patient. When youfeel like you're the clinical
expert, someone will prove youwrong.
Speaker 2 (27:44):
, I bet
you're great at what you do,
you know, , um,
Speaker 3 (27:47):
Some days ,
Speaker 2 (27:48):
Some days. Uh , yeah. You know. Wow. Um, what,
what great advice. Um, I thinkthat's just incredibly good
advice. You know , Kara ,before I let you go , uh, I
have a few questions I'm surelisteners might like to hear a
little bit about. Um, so what'sthe most unexpected or unusual
thing that has happened on oneof your shifts?
Speaker 3 (28:05):
I think it's the zombie pub crawl. I think that
was so unusual for all thesefake injuries to come in. And I
truly believe that we, I don'tremember having an actual
trauma from there, but manywere considered like kind of
worked up as a trauma.
Speaker 2 (28:25):
I wish there were video of that. No, but we can't
because you know, like there'slike patient privacy. We never,
ever, ever will divulge yourpersonal information on this
show or anywhere. Right. Itstrikes me as like that's a TV
show waiting to happen.
Speaker 3 (28:38):
Yes. And it speaks to our theater community here
and amazing Tail
Speaker 2 (28:43):
Wind , . It
was realistic. One .
That's so real. Those arepeople living their best life
right there. So speaking of TVshows , um, ER was Big then
came Grey's Anatomy and Life inthe ER and all the other shows,
Boston Medical or whateverthat, so do they get things
right? Do you watch these showsand go, oh, come on. Or do they
get it right?
Speaker 3 (29:03):
I used to watch them more. Um, my family doesn't
like the commentary that Iprovide for that . Oh
Speaker 2 (29:09):
Yeah. I bet you're real fun to watch a emergency
medicine show on.
Speaker 3 (29:13):
Um, I think they always get the resuscitation
piece wrong. They always showit and nothing against my
physicians 'cause I love themand I think they're amazing,
but they always show thephysicians doing everything
while the nurses are juststanding there watching
Speaker 2 (29:30):
'em . Yeah. That isn't how it goes is.
Speaker 3 (29:33):
Um, they never have the breathing tubes, the
intubation. Correct. They'reeither just a piece of hose
sticking outta their mouth oryou know, attached to nothing.
Speaker 2 (29:45):
I love that comment.
They always have the physiciansdoing everything. Yeah . And
the nurses standing around. Iam here to tell you it's the
, it's the reverse.
Usually the doctor standingthere, probably the one sort of
standing off to the side, youknow , maybe they're thinking a
lot, but it is the nurses whoare doing all that.
Speaker 3 (30:01):
Yeah. Yeah. We do a lot. Um, but our residents are
also very hands on .
Speaker 2 (30:06):
Yeah . Residents, physicians in training. Yeah.
Speaker 3 (30:07):
Yeah. They're amazing.
Speaker 2 (30:09):
Alright . Lastly, what's the most rewarding part
of your job that people mightnot expect? That
Speaker 3 (30:15):
People trust me with their life. They let me in and
I once told somebody that Ifeel like I am heavy because of
the weight of the secretspeople tell me. Mm-hmm . I have
so, so much that I take in thatpeople just divulge I'm a
stranger and they are trustingme with this information.
(30:37):
They're trusting me to providethe best care, bring my a game
to get them to the healthiestthat they can be in that
situation. And a lot of timesI'm seeing them maybe at the
worst point in their entirelife or their family's worst
point in their entire life,which is an extremely stressful
position for anybody to be inand then see strangers and
(31:02):
allow them into that scenariowith 'em .
Speaker 2 (31:05):
That's powerful. And what meaningful work It is.
Meaningful work. Thank you.
Thank
Speaker 3 (31:09):
You for having me.
Yeah,
Speaker 2 (31:10):
It's been great having you on the show. We've
been talking with Kara Fusi ,she's an emergency medicine
nurse at one of the nation'spremier level one trauma
centers here at HennepinHealthcare in downtown
Minneapolis. And listeners, ifyou happen to need to go to the
emergency room, I hope you getKara , uh, you would be very
fortunate if she were to beyour nurse. Thank you. So I
(31:30):
don't think we can give anurses enough credit. I started
the show and I'm gonna end it.
They are the heart and the soulof our medical system
listeners, I hope you'veenjoyed the show and I hope
you'll join us for the nextepisode, which will drop in two
weeks time. And in themeantime, be healthy and be
welcome .
Speaker 1 (31:46):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(32:09):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At Highball Executiveproducers are Jonathan, CTO and
Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(32:30):
time, be healthy and be well .
Welcome to the Healthy Matters podcast with
Dr. David Hilden , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilden .
Speaker 2 (00:18):
Hey everyone.
Welcome back to the HealthyMatters podcast, where we dive
into the world of healthcarewith the experts who live it
every day . I'm Dr. DavidHilden , and today on episode
10 we'll have a look at thefast-paced front lines of one
of the most intense and highstakes environments in
medicine, the emergencydepartment. And we're gonna do
this through the lens of one ofthe most beloved, trusted, and
(00:39):
just plain awesome healthcareprofessionals we have and that
in our nurses. So our guesttoday is Kara Fui . She is a
critical care nurse. And let'sjust say she's seen it all from
traumas and medical emergencyto the completely unexpected in
both the ICUs and what we'regonna talk about today, the
emergency department. So she'shere to share her experiences,
(01:01):
insights, and what it takes tothrive in this challenging
role. Kara , thank you forbeing here.
Speaker 3 (01:04):
Thank you so much for the invitation.
Speaker 2 (01:06):
It's great to have you on the show. I always love
to talk to nurses becausefrankly, you're the heart and
soul of medicine. And so startus off, if you could describe
just one of your emergencydepartment shifts, in a few
words, what would they be?
Speaker 3 (01:20):
Well , um, I think the first thing that came to my
mind was that friends episodewhere Ross is moving the couch
down the stairs, screaming,pivot, pivot,
Speaker 2 (01:31):
That as they're moving the couch,
Speaker 3 (01:32):
As they're moving the couch, that's kind of what
we do in more of a humancapacity. We're always
pivoting, looking for whatneeds to be done first and
down. Also, crazy train also isconstantly replaying in my head
because we're always kind ofoff the rails with whatever's
coming through the door. Wehave to be ready for,
Speaker 2 (01:54):
It's gotta be one of the most intense jobs where you
don't know what the next hourof your life is gonna be. A lot
of us have jobs , uh, e even mewhen I'm practicing in clinic,
at least I know, okay, I've gota patient at this time and this
time and I roughly know whatthey're coming in for. You
probably don't know what'swalking through the door or
maybe not walking through thedoor.
Speaker 3 (02:12):
Right. We can go from no one in triage to 40 in
triage, waiting to be seen andstabilization cases through the
rigs rolling in nonstop. And itcan really put pressure on all
of the staff because we have toband together and work as a
team always and have eachother's backs.
Speaker 2 (02:34):
When you went to nursing school, is this what
you knew you wanted to do orwhat drew you to this?
Speaker 3 (02:38):
I've always been kind of drawn to Hennepin. Um,
originally my family had someconcerns about me working
downtown Minneapolis. In whatdo you mean?
Speaker 2 (02:47):
It's a garden spot of the
Speaker 3 (02:48):
Country. The glorious Hennepin County
Medical Center. They're on thenews a lot. I've always been
drawn here. So I finally camedown here with LifeSource,
Speaker 2 (02:58):
The Oregon Procurement Organization.
Speaker 3 (03:00):
Yeah, correct. I was working with them and I was
spent a lot of times in thesurgical intensive care unit
evaluating patients and spentso much time down here and I
found myself lost in theemergency department, wandering
through it and went, oh, thisisn't so bad. Saw they had some
openings, was feeling a littletired in my intensive care
(03:20):
career. So I applied andfortunately got hired and I
really haven't looked back.
This has been my jam.
Speaker 2 (03:27):
Anything surprise you about it? I mean, because ,
'cause people who haven't beenin emergency department, except
as maybe a patient when you'rewield in on a gurney or you're
scared and sick and you , butthose of us who work there,
I've been practicing medicine25 years and I'm a little bit
intimidated by it. The theenvironment is high energy most
of the time.
Speaker 3 (03:46):
The most surprising thing to me has been my
coworkers stories and howthey've gotten to the place
where they're at in their life.
A lot of them have had somereally significant major life
events that have been traumaticfor them. And I think that
makes them more relatable toour patients, myself included.
(04:06):
When we look at each other, wejust see, you're my nurse,
you're my doctor, you're myrespiratory therapist,
whatever. But a lot of thesepeople have been through some
major traumas that they'veovercome and now are using all
that life experience to betterother people's lives. And the
other thing that alwayssurprises me is even our
nursing assistants, they'relike advanced practice nursing
(04:29):
assistants. They have gotmilitary training, they have
got multiple bachelor'sdegrees. Many of 'em are trying
to get into medical school orPA school or their nurses in
training. Really, really highlevel at all levels of care
there. I
Speaker 2 (04:46):
Haven't thought of that so much. Um, when you
think of an emer , when peoplethink of an emergency
department , you , you don'tthink as much, I don't think
about the experiences of thepeople that are caring for you
and how that might make thembetter. Yeah . To care for
whatever is bothering you thatmoment, whether it be just a ,
a little pinky finger youbroke, or whether you were in a
bad car accident or something.
I really like that, that yourpersonal lives can, can make
(05:09):
you a better nurse, a bettercaregiver, a better doctor in
the hospital. Is it possible tosay what a typical day looks
like?
Speaker 3 (05:17):
Um, it's never typical. It always is changing.
Some days it seems like we'reheavy on maybe chemical
dependency or mental healththings. And then the next day
it's traumas, car accidents ,um, you know, some of that can
be predicted by the weather.
Outside in Minnesota, we havethe beauty of four glorious
(05:41):
seasons and a lot of outdoorsypeople. So we, we do see a fair
amount of exposure to theelements. Traumatic injuries
just from either carelessnessor chemical dependencies. Just
a lot of variety can happen inone little tiny setting.
Speaker 2 (05:59):
Yeah, that's, that's incredible. So Kara , since you
are also a critical care nursein ICUs Yes. At this hospital
and others, you see whathappens to patients who are
critically ill. I'd like you totalk us through one type of
critical illness that beingtrauma. If you could talk us
through what happens whenyou're in that emergency room
(06:20):
and the ambulance shows up whatyou call the rig. I love that,
that people in e emergencymedicine call 'em the rigs. So
when the rig pulls up with apatient on a gurney with some
trauma, let's say it's a badcar accident or something, what
happens? What processes get putin place in those first few
minutes?
Speaker 3 (06:36):
Well, the staff all does a lot of training on
trauma care and how to look atthat patient. And we start the
second, we get what we call azip it , we'll get a little
brief from our EMS dispatch ,um, on who it is that's coming
in, what kind of scenario we'relooking at. Very brief , um,
(06:57):
maybe the age, and this is
Speaker 2 (06:58):
Before they arrive .
Speaker 3 (06:59):
This is before they even come in the door and we
know that they're gonna go tothe stabilization room where
the most critical people go to.
And that's the place that Igravitate to just because of my
critical care background. Itmakes the most amount of sense
to me. So once those patientsroll through the door, we do a
kind of across the roomevaluation. Is there anything
that we need to reprioritize?
(07:20):
Are they breathing, are theyawake, are they bleeding? And
the rig rolls in the EMS , theyare EMS are amazing. They have
patients so kind of buttoned upfor us to really succeed in the
stay room . They usually haveIVs that , um, they usually
have fluids going and they havea great history for us. So they
(07:41):
will tell us what the scenelooked like. They'll tell us
any extra factors that wereinvolved, you know , people,
weather conditions , um, whowas on scene, what was done
before they even arrived to us.
We get 'em on the cart and wedo head to toe. Head to toe is
always what we're doing.
Getting 'em on the monitor. Thenurses especially are more
(08:03):
involved on the medicationside. We get IV access first
and foremost. We get 'em onmonitors, constant
communication in that area. Wehave such a great team of
medical physicians, theresidents, ultrasound people.
We have pharmacy usually withus. We always love to have
(08:26):
pharmacy there, especially withpediatrics because of the
weight-based dosing ofmedications. But the whole team
knows their role and areheavily involved in that. And
we're always triaging, doesthis patient need to go back to
the beginning? You know, arethey still breathing? Is their
hearts still beating? Is thebleeding under controlled? The
(08:48):
big things
Speaker 2 (08:49):
I've been there , uh, many times and, and
listeners, I have nothing to dowith any of this. I treat
diabetes. I don't, this isn'tanything I have anything to do.
So I'm just in awe of the stabroom process. Stable , short
for stabilization. In some waysit's a teeny bit like the TV
shows what you see, but in mostways it's not. Because when you
go in there, there are, there's3, 4, 5, 10, 12 professional
(09:13):
caregivers all with theirvarious jobs. And they're not
yelling and screaming at eachother. There's not blood flying
across the room for the mostpart. I mean, sometimes
, but, but it's a , it feelscalmer than you might expect,
but yet a high intensityenergy, I dunno if I , if that
sounds right, it's like a calmenergy when you're in there.
(09:33):
There aren't people yelling andscreaming and it's not chaos
like on the TV shows, butpeople are just as sick as they
are on those TV shows. How doyou maintain that sense of calm
professionalism when someonemight be bleeding or, or
frankly their belly might behanging open or they're
unconscious and you've gotseconds to act. How do you keep
that calm?
Speaker 3 (09:53):
I think there's a lot of confidence in our
teamwork. We do go through alot of training, a lot of
certifications. I have thebenefit of my life experience
in the emergency department andcritical care that helps me
kind of run the algorithms. Iknow what's going to come next.
And then really having thatstrong team atmosphere. Always
(10:18):
consistent layout. We knowwhere our equipment is. We all
are trained on how to use it.
And I think that's where thecomfort level comes. And really
being focused on, we're gonnabring our A game to this
person. They are our main focusright now. They're the sickest
in the department. They deserveour 100% attention and we have
(10:40):
all these brains, eyes and earson them to get them to the best
place that we can.
Speaker 2 (10:45):
Yeah, I like that about the teamwork that you
said and everybody knows theirjob. And you briefly commented
about the paramedics. I do wantto give a shout out to first
responders, the paramediccommunity at Hennepin
Healthcare. Hennepin EMS is thebest in the business. When you
see a Hennepin ambulance showup, you're in good hands,
everybody. Absolutely. And Iwould say that it's also true
for other EMS services in town.
(11:07):
Paramedics in general areawesome. But just a , a shout
out to our Hennepin EMScolleagues. They're fantastic.
And if you want a little bitmore about EMS, I'm reminded of
the last episode, the bonusepisode of season one, where I
did a ride along with our EMSand we recorded some of what
they do. So could you, withoutobviously violating patient
(11:27):
confidentiality, are there anycases that stand out to you
from the stay room ? And I knowthat the vast majority of
patients who come through theemergency department leave
better than they came in thevast majority. You save
people's, literally you savetheir lives. Not all, not all.
Um, are any cases doing anystand out to you that were sort
of career defining for you? Orat least ones that stick with
(11:50):
you?
Speaker 3 (11:50):
There's many that stick with me. Um, a lot of the
peds cases are really tough nomatter what the outcome is.
Children,
Speaker 2 (11:58):
Children, children.
Speaker 3 (11:58):
Yeah. Um , they're always tough. But on a
different note, we had twodifferent cases one summer
where both of these people wereflown in from a different
state. The same state. Both ofthem were farmers. Both of them
had been working on theirtractors. One of them, his
tractor started on fire anddrove over him. He was flown to
(12:22):
us for burn . He also hadtrauma, but burn was his top
priority. The other was also afarmer working on his tractor.
That tractor drove over him andhe was more trauma
traumatically injured than burn, but was also here with burns.
And it was the same summer,same state out of state . I'm
Speaker 2 (12:43):
Surprised that farmers came in. There's an old
joke that the farmer like couldhave their arm half hanging off
of them because of some injury,but they finished milking the
cows before they come .
Speaker 3 (12:52):
A hundred percent true. Both of these guys . But
these guys got rough over .
Yeah. Both of these guys werelike, please don't give me
narcotics. Can I have someTylenol? Actually, no. They
asked for aspirin and we'relike , uh, no, with the aspirin
and the bleeding
Speaker 2 (13:05):
Aspirin's gonna make you bleed worse . Yeah . That
would be so good . There is notougher individual than I've
ever met than a farmer.
Speaker 3 (13:12):
Agreed. Except for maybe the farmer's wife. Just
Speaker 2 (13:14):
For maybe. Exactly.
So both these guys got run overby their tractor.
Speaker 3 (13:19):
Yep . And both had burns and both had traumatic
injuries one . Oh , they do.
They both did great. I thinkthey were both discharged
within a , probably aridiculously short amount of
time for their injuries. So
Speaker 2 (13:30):
Did they get flown in? Did they get driven in on
by the ambulance or how did
Speaker 3 (13:34):
They get here? I think both of them were flown
'cause they were from adifferent state. So
Speaker 2 (13:37):
We do have , uh, two helipads here at Hennepin
Healthcare. Mm-hmm . One'sright on the roof, right above
you guys. I love that thatthing is right on top of you.
And so they can go from thehelipad to the emergency
department, do not pass go donot stop at any floor. It's
just the elevator goesdirectly.
Speaker 3 (13:51):
Right. Yes. Whoever got funding for that genius.
Speaker 2 (13:54):
So I'd like to pivot a little bit, as long as we're
talking about the word pivot,about how the nursing staff
specifically manages thatstressors in their own life.
When a lot of people go homefrom their jobs, they didn't
see people having all theseproblems. They didn't see
people not always surviving.
They didn't see childrengetting hurt. They didn't see
(14:15):
people with, with the severityof what life throws at them. As
you do. So specifically fornurses, because I'll also say
that doctors tend to come andgo, you know, we're in there
with you for five minutes andthen we go to the next patient
. The nurses are with you allyour stay the whole time you're
there. How do you cope withthose stressors either during
the day or when you go home?
Speaker 3 (14:36):
Um, during the day, I am able to pretty well
redirect because I always haveanother person that needs me.
There's always a need thatneeds to be addressed. And I
can stuff my own thing .
Speaker 2 (14:47):
You mean the other rooms aren't just vacant?
Speaker 3 (14:49):
amazing. But I think I'd be outof a job.
Speaker 2 (14:55):
room's , the busiest place inthe hospital.
Speaker 3 (15:01):
I think that some of us cope with things very well
and some of us cope with themvery terribly. And there's a
whole spectrum. Some days I'mthe one that's coping poorly. I
have had a therapist on andoff. I have ran too many miles.
I have gone home and just beensilent in the corner. Um, I'm
(15:23):
not a huge crier, so when I docry, my family doesn't know
what to do with me.
Speaker 2 (15:29):
Yeah, that's a , that's not the norm.
Speaker 3 (15:31):
No, no. Um, and I think that no one understands
outside of the people thatactually work in that situation
day to day . So we really kindof lean on each other. We try
to keep our eyes open to eachother's struggle. Our
chaplaincy group here, amazing.
They will seek you out if theyknow you have been in a
(15:54):
difficult case and just offertheir support. Just a really
amazing group of people to workwith. And we also do a fair
amount of debriefing ondifficult cases. Some of the
more challenging cases, theywill do a STA conference with
where the attendings willattend. Um, the residents that
were involved will present alot of times the , um,
(16:16):
ancillary staff and the nurseswill be there as well. Just to
review what happened and how itwent. Right, how it went wrong.
Speaker 2 (16:23):
I'll bet there's a ton of peer support in mental
health resources, but maybe notadequate to the job. I don't
know. Um, if, and I'm talkingnot specifically about my
hospital, but in general, Iwonder if our healthcare
systems and our societyrecognizes the toll that
healthcarers and in , in thiscase, emergency nurses are
(16:43):
doing.
Speaker 3 (16:44):
I think that in years past, it has really been
a neglected area. And I thinkthat Hennepin especially has
stepped up to the plate forthis. We've had more than I
care to talk about staff thathave suicided. Mm-hmm
(17:09):
These are people I worked sideby side with. These are people
that were at the top of theirgame. Really great humans. And
I never wanna their names , um,because they were my coworkers
, they were my friends. Um, weloved them . And I, I don't
know that if the support wasthere, if they would've taken
(17:30):
it. And I think that's a bigpiece of being, having some
self-awareness, knowing thatyou need to reach out and ask
for help because sometimes thesupport can be there and you
are, you know, I'm, I'm thetough ER nurse or the tough EMS
medic. I, I can do this day inand day out. But we've started
(17:51):
talking more about thesecondary trauma that the staff
feels. They um, just fromwitnessing it, you know, the
secondary and tertiary trauma.
So I really believe thatHennepin Health is trying to
get us the support that we needin the ed. Especially I've
noticed our leadership, theyreach out also now on difficult
(18:13):
cases and they circle back withus and just really try and get
us what we need to bring usback to a fully functioning and
feeling good about what we doat the end of the day.
Speaker 2 (18:26):
Yeah, those are great comments. I agree. It's
been neglected over years andI'm glad to hear at least some
progress is being made tosupport the team down in the
emergency department. So we'regonna take a quick break and
when we come back, Kara isgonna share some of the biggest
challenges emergency nurses arecurrently facing some advice
for aspiring nurses. And we'llalso see if we can throw a few
more fun questions their way aswell. So stay with us. We'll be
(18:48):
right back
Speaker 4 (18:52):
When Hennepin Healthcare says we are here for
life. They mean here for you,your life and all that it
brings. He up and healthcarehas a hospital HCMC and a
network of clinics bothdowntown and across the west
metro. They provide all theprimary care and specialty care
you would expect to find. Butdid you know they also have
services like acupuncture andchiropractic care available at
(19:14):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis. Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (19:30):
And we're back talking with fui . She is a
critical care and emergencymedicine nurse at Hennepin
Healthcare here in downtownMinneapolis. And we're talking
about life in the emergencydepartment. So now I'd like to
talk a little bit about some ofthe challenges of the intensity
of the work in the emergencydepartment. A lot of my
patients are worried about thewait times. Those are real. A
(19:51):
lot of us in hospitaladministration in emergency
medicine know that there's noplace to put patients, so
therefore they board or theystay in the emergency room for
a long period of time. Couldyou talk to us about that
reality and what that feelslike to you?
Speaker 3 (20:05):
Yes. Um, I think pre pandemic, we still had some
generous wait times , um,depending upon what was going
on in the department because weare that safety net level one
trauma facility where we takeeveryone and we don't really
close our doors ever, butduring the pandemic we had, you
(20:26):
know, this unnerving lull whilepeople were kind of sitting at
home sick and then , um, wouldcome in really sick or with
really critical emergencies,which was an interesting turn
of events. And then , um, oncethe pandemic really started
cooking, we saw all these, youknow, really sick people with
respiratory illness afterpandemic. We are still seeing a
(20:50):
lot of people very ill. Theyhave many, many medical
problems in general that cankind of complicate their whole
stay. So they come in verycomplex but have one emergency
that we need to address whileyou can't ever just address
that one piece because allthose other factors play into
it and really kinda guide theircourse and whether or not they
(21:14):
needed to be admitted. We havebeen seeing people staying in
the emergency department for acouple of days, which is never
ideal. We always hate that'cause we feel like we're not
doing them justice because weare emergency based and we
wanna put a bandaid on it andget 'em going. So we really try
(21:34):
as hard as we can to eitherroom them within the facility,
find them another facility thatthey can transfer to if it's
not appropriate for them tostay. And the wait times really
wildly vary. Always know thatwe never want you to wait, we
don't want you to wait for ahangnail, but much less a
emergency. But we're alwaysgonna take those true
(21:55):
emergencies first.
Speaker 2 (21:57):
You triage everybody.
Speaker 3 (21:58):
Yes. Everybody gets triaged and they get re triaged
and we're always looking totake the top priority first.
Speaker 2 (22:06):
If you're having a heart attack, you're not
sitting in the waiting room.
Speaker 3 (22:08):
Right. And we don't want you to sit in the waiting
room, like I said, no matterwhat your concern is, we don't
want you sitting in the waitingroom being uncomfortable and
ill and unhappy with your carebecause you're waiting. Our
staffing always in theemergency department is kind of
at a par level. Sometimesthey'll have more for events
(22:28):
that are happening in townwhere we think there might be
an influx of
Speaker 2 (22:32):
Patients zombie pub crawl.
Speaker 3 (22:33):
Oh my gosh. Do
Speaker 2 (22:34):
You know about zombie pub call ? I
Speaker 3 (22:35):
Do. I actually have that on my notes . You do. As
one of my most traumaticevents, we had a zombie pub
crawl pre pandemic where we hadan influx of people who were
very intoxicated
Speaker 2 (22:49):
And they're dressed like zombies and
Speaker 3 (22:50):
They have this really elaborate makeup we had
to scrape off because weweren't actually sure if they
were injured with a trauma orif they were just drunk or
chemically impaired in someway. And it was really
challenging because some ofthese people had such amazing
costume makeup on that wereally had a hard time
(23:13):
differentiating between a trueinjury and
Speaker 2 (23:18):
Makeup . It is a little bit funny, it's urban
legend. I don't know if it isin other cities, but in the
Twin cities in towns toMinneapolis, they used to have
the zombie pub pub crawl whereyou'd go from pub to pub and
drink too much and dress like azombie. Yeah. So that really
cracks me up that you stillremember the zombie pub pub
crawl situation. Yes.
Speaker 3 (23:36):
Yes. I think it's coming back. Oh , good
Speaker 2 (23:38):
Grief. I'm you think it would be the rock concert at
the stadium or the Vikings gameor, or something else? No, it's
zombie pub crawl . Yes . Thatsticks in your mind.
Speaker 3 (23:47):
Yes. Yep . I also had a traumatic St Patrick's
Day too, where there were musthave been a large delivery of
designer drugs into the TwinCities metro area. And there
were a lot of intoxicatedleprechauns in the Oh gosh . In
the department. Oh no . And wehad beds in the hallway and
(24:09):
there were people havingmyocardial infarctions and you
know, there was so many really,really critically ill patients
and a lot of it was fromchemicals that they had
ingested on the St . Patrick's.
Speaker 2 (24:22):
You do indeed. See it all. There you go . Um, let
me, let me pivot again to yoursafety and the safety of all
the staff in the emergencydepartment. It might not be
well known to people that beingin healthcare has evolved over
the last decade or so into aplace where workplace violence
is not uncommon. Mm-hmm
(24:42):
paramedics, security people,physicians maybe to a little
lesser degree are subject toviolence. Yeah . Could you talk
about that, what that feelslike?
Speaker 3 (24:51):
You know, early in my critical care career, I was
assaulted by someone who wasunder the influence. Um, they
didn't have any idea what theywere doing, but they really
injured both myself and mycoworker . And I, I'm sorry. I
almost thought that was gonnabe the end of my career. And I
was a little bit reluctant totake care of patients who had a
(25:13):
violent history after that. Um,it was a little bit triggering,
if I'm honest. When I came downto Hennepin, I was a little bit
concerned that those feelingswould come back. But Hennepin's
security has only been improvedupon. The security guards are
at our back nonstop. They arealways present. Um, we usually
(25:36):
have a fair amount of sheriffpresence in the area for
whatever reason. So we reallyget a lot of support by the
community and our in-housesecurity. We love that we're
downtown Minneapolis. We loveour clientele, but we also
wanna make sure that the staffis safe to take care of them.
(25:57):
We also wanna make sure thatthe people that come in are
safe. And we know that in thisera some people don't have good
intentions and mm-hmm
make sure that everybody's welltaken care of.
Speaker 2 (26:09):
Yeah. And and the the , you can't take care of
others if you're not physicallyand psychologically safe.
Correct. So , um, thank you forcommenting on that. Could you
give some advice to people whowant to go into nursing and
particularly or any career inthe emergency department? What
does it take to thrive downthere? A
Speaker 3 (26:27):
Huge amount of empathy and understanding of ,
um, what these people arecoming from and some of the
challenges they face in theirown life, whether it's poverty
or health crises, their ownpersonal history. Um, there's
so many different variablesthat each person really has to
(26:48):
live through and overcome toget to where they're at. Even
if they look like they have itall together, they have a
history, usually a backpackfull that we need to sometimes
go through and talk with about.
I think that you have to have agood understanding of yourself.
I really hate it when peoplesay you must see a lot down
there. Well, I'm not actuallystanding around spectating,
(27:11):
someone's going to not do wellbecause of it. It's a team
effort and we really need toband together and collaborate.
So knowing yourself and usingyour tools to help people is
really what you need to do.
Check the pride at the door.
'cause you're gonna learnsomething and usually an
(27:33):
unexpected ways . It might befrom a new grad, it might be
from your patient. When youfeel like you're the clinical
expert, someone will prove youwrong.
Speaker 2 (27:44):
you know,
Speaker 3 (27:47):
Some days ,
Speaker 2 (27:48):
Some days. Uh , yeah. You know. Wow. Um, what,
what great advice. Um, I thinkthat's just incredibly good
advice. You know , Kara ,before I let you go , uh, I
have a few questions I'm surelisteners might like to hear a
little bit about. Um, so what'sthe most unexpected or unusual
thing that has happened on oneof your shifts?
Speaker 3 (28:05):
I think it's the zombie pub crawl. I think that
was so unusual for all thesefake injuries to come in. And I
truly believe that we, I don'tremember having an actual
trauma from there, but manywere considered like kind of
worked up as a trauma.
Speaker 2 (28:25):
I wish there were video of that. No, but we can't
because you know, like there'slike patient privacy. We never,
ever, ever will divulge yourpersonal information on this
show or anywhere. Right. Itstrikes me as like that's a TV
show waiting to happen.
Speaker 3 (28:38):
Yes. And it speaks to our theater community here
and
Speaker 2 (28:43):
Wind ,
That's so real. Those arepeople living their best life
right there. So speaking of TVshows , um, ER was Big then
came Grey's Anatomy and Life inthe ER and all the other shows,
Boston Medical or whateverthat, so do they get things
right? Do you watch these showsand go, oh, come on. Or do they
get it right?
Speaker 3 (29:03):
I used to watch them more. Um, my family doesn't
like the commentary that Iprovide for that . Oh
Speaker 2 (29:09):
Yeah. I bet you're real fun to watch a emergency
medicine show on.
Speaker 3 (29:13):
Um, I think they always get the resuscitation
piece wrong. They always showit and nothing against my
physicians 'cause I love themand I think they're amazing,
but they always show thephysicians doing everything
while the nurses are juststanding there watching
Speaker 2 (29:30):
'em . Yeah. That isn't how it goes is
Speaker 3 (29:33):
Um, they never have the breathing tubes, the
intubation. Correct. They'reeither just a piece of hose
sticking outta their mouth oryou know, attached to nothing.
Speaker 2 (29:45):
I love that comment.
They always have the physiciansdoing everything. Yeah . And
the nurses standing around. Iam here to tell you it's the
Usually the doctor standingthere, probably the one sort of
standing off to the side, youknow , maybe they're thinking a
lot, but it is the nurses whoare doing all that.
Speaker 3 (30:01):
Yeah. Yeah. We do a lot. Um, but our residents are
also very hands on .
Speaker 2 (30:06):
Yeah . Residents, physicians in training. Yeah.
Speaker 3 (30:07):
Yeah. They're amazing.
Speaker 2 (30:09):
Alright . Lastly, what's the most rewarding part
of your job that people mightnot expect? That
Speaker 3 (30:15):
People trust me with their life. They let me in and
I once told somebody that Ifeel like I am heavy because of
the weight of the secretspeople tell me. Mm-hmm . I have
so, so much that I take in thatpeople just divulge I'm a
stranger and they are trustingme with this information.
(30:37):
They're trusting me to providethe best care, bring my a game
to get them to the healthiestthat they can be in that
situation. And a lot of timesI'm seeing them maybe at the
worst point in their entirelife or their family's worst
point in their entire life,which is an extremely stressful
position for anybody to be inand then see strangers and
(31:02):
allow them into that scenariowith 'em .
Speaker 2 (31:05):
That's powerful. And what meaningful work It is.
Meaningful work. Thank you.
Thank
Speaker 3 (31:09):
You for having me.
Yeah,
Speaker 2 (31:10):
It's been great having you on the show. We've
been talking with Kara Fusi ,she's an emergency medicine
nurse at one of the nation'spremier level one trauma
centers here at HennepinHealthcare in downtown
Minneapolis. And listeners, ifyou happen to need to go to the
emergency room, I hope you getKara , uh, you would be very
fortunate if she were to beyour nurse. Thank you. So I
(31:30):
don't think we can give anurses enough credit. I started
the show and I'm gonna end it.
They are the heart and the soulof our medical system
listeners, I hope you'veenjoyed the show and I hope
you'll join us for the nextepisode, which will drop in two
weeks time. And in themeantime, be healthy and be
welcome .
Speaker 1 (31:46):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(32:09):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At Highball Executiveproducers are Jonathan, CTO and
Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(32:30):
time, be healthy and be well .
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