Heart-wrenching work as a CRNA at a Level 1 Trauma Center has caused me to consider ways I can improve my stewardship of the trauma that I witness on a regular basis. As I seek to sustain the energy that is necessary to do my best work, I have committed to personal mindfulness as well as empathy. Consequently, I've been more intentionally aware of the way the world looks and feels different to me because of the work I do. I would like to share a poem, Sanguine, displaying this process of personal reconciliation of a particularly difficult case on Father's Day where a young life was ended in the operating room despite my very best efforts. Writing the poem was therapeutic for me; however, in the sharing of it, I have found power to connect with peers about the challenges of working in critical care. I wish each reader of this letter all the best in finding your own work-life balance and the energy to restore and sustain the passion you have for this incredibly challenging and rewarding work.

Sanguine

I'm not in a hurry but the speed is a rush-

my personal grand prix.

I am team Ferrari. A flash of red.

Cruising in and out of the lanes

I push push push to get there

Work is waiting for me, it's my turn

having left the ones I love,

celebrating

a father is happy today.

I wonder

what trauma will come

to ruin the fun;

what Father will mourn,

what child will be fatherless by dawn?

This job has changed the way I see the world.

Don't work too hard tonight my friends casually say

They don't know how hard I work every day

Or what I do,

honestly.

But they should know, if it's

their father or their child who

is coming through the Trauma door

zoomed in like a race car to the pit.

This person, more than gore,

a human with a name

and a story that is unknown

Is brought through the emergency doors

by ground or flown.

I will watch and work, I will plan.

When they come through the operating room doors

I will work, I will lead, I will fix.

My friends don't know how I work

and think

and hold my breath and clench my jaw

until I'm worn out,

worn down to the brink,

but still winning

if it means less tears,

less fatherless children or childless fathers on Father's Day.

I work to preserve the celebration of fathers and mothers and children.

Late in the night a son arrives.

A young, beautiful, strong son with dark curls and long lashes

but that's not part of the announcement; only "modified trauma activation,"

ignored by most

until upgraded to "full trauma activation,"

which gets him a host

of attention

and an anesthesia advocate.

But I never got to say hello.

I heard how this unsuspecting fellow

had also been cruising the lanes

in a rush or having a rush,

like me just hours ago,

he thought he was at Monaco

but the speed mattered.

Car parts scattered.

Liver shattered.

Where he was headed I never learn, but where he ends up

is in a stretcher

strapped and surrounded

confused and cold

Shrinking privately.

I long to cover him but he is

exposed and emptying inside, literally,

as we check and scan and watch without knowing

until we know

from a picture.

I don't need a picture to know that we're

behind before we begin.

The speed will matter.

See, I understand the grand prix driver;

zero to high speed in a flash

from race to race

I do zero to high speed as I dash

from case to case.

We call time out for the operation game.

The hemorrhage doesn't stop for time out,

it's not even his real birthday and name

and this is not a game

this is not a practice

this is what I trained for

I am the principal and the driver

I lead the pit crew

they all know their job, fast and furious

exactly what they should do.

Precise. Practiced.

I have so much energy

Sanguine

Eagerly hopeful

Confidently optimistic

I try to drive my energy through the plastic tubes going into his veins the way I drive down

the interstate

Push push push

I rely on the physics

and the physiology

Please Ferrari, deliver this chemistry

then box box box

Reload and keep pushing

Round and round

The engineering is sound

Such elegant design

I'm convinced it's divine.

A splash of red.

So soon I see the shiny spilling loops of intestine

like the long slick curves of a track

bunching and slack

wrapped around and around the hands that are deep to the wrists in the now open space

and digging down to find the place

to repair what is irreparable.

Close it up so I can fill the pipes again,

until pressure is restored and stable

the heart engine is pumping so hard,

it's youthfulness still able

to shift gears higher and higher.

Although the wheels are spinning

I'm no longer winning

this is where the rubber meets the road but I can't get any traction

The power is failing

The future is fading

Silently

the life is lifting

into the air along with the words the surgeon utters

This is not survivable.

No. That is unbelievable,

don't say that.

We are champions.

Please Fix it.

I will fix it.

Sometimes the driver is helpless.

Still, silently, the life is falling with the fluid onto the floor.

The Italians build fast cars and fast words

Dissanguamento

It happened too fast. Wait.

I still have work to do

problems to solve

tricks to try that worked last time.

The driver is as good as his last race

the nurse anesthesiologist as good as her last case.

No podium.

My red uniform is sprayed with blood

instead of champagne

there will be tears tonight.

Mine will come later

I'm not allowed to talk about it

I honor the identity of this son and father

I will shrink privately

I never got to say goodbye

Or I'm sorry.

I will be able to leave this place,

It is not my final destination.

Driving home, this time on cruise control,

slow down, the speed doesn't matter

Think

But not for too long because the thoughts are heavy

Blink

But not for too long because my eyes are heavy

Sink

But not for too long because my Heart is heavy

This job has changed the way I feel about the world

But I am sanguine, sturdy

and I am still passionate for the race.