We put on that strong face. Resilience. We learn to handle anything. But our outside appearance can fool you as our inner turmoil plays havoc emotionally.

I learned quickly that nursing was not all about holding hands with a sick child in the emergency room or fluffing up a pillow for a dying grandma. My initiation into the dark side of nursing began in the emergency department. I was fresh out of nursing school. The emergency room was fast-paced and exciting with a variety of health issues swinging through those doors. But 36 years later the haunting images remain. Maybe through time the pain fades but never disappears.

The little 6-year-old rushed into the emergency room by her mother. Mom’s boyfriend sexually assaulted her little girl while she was out playing bingo. Her long blond hair but eyes black as coal. Her catatonic body, stiff and rigid. Knowing later that “Billy” was convicted but got out of prison eight months later for “good behavior.” And little Susie forever tormented and scarred.

Or the little boy with fractured hips, “fell” out of the bunk bed according to the parents. Truth is: Daddy threw him down the staircase.

The older lady on the psych floor. Her husband left her after 35 years. We found her in a locked bathroom. Chiseled her neck down to her jugular. One more slice and game over. Her jugular exposed and pulsating.

Surgical-trauma was my nightmare. I was extremely experienced and knowledgeable by then. But nothing could prepare me for this.

The college girl jumped to her death five stories down from her dorm room. Dead on arrival but the surgical trauma team with their residents wanted to insert two chest tubes and then pronounced her. Her mother slowly walking to her daughter’s ICU room. I thought the mom would be hysterical; I braced myself for screams. But she sat in the chair I provided for her. And stared at her dead daughter. Catatonic-like. I placed my hand on her shoulder; the mom placed her hand onto mine. The sacred silence, as tears slowly ran down both of us.

The 18-year-old, no seat belt, drugs, crossed the line, head-on collision, killing the innocent driver. The 18-year-old paralyzed from the neck down. His mom calling every early morning in her shattered voice: “Is he any better?” EEGs showing no brainwaves. Plug pulled. Asystole. 18 years old.

The 82-year-old lady multi-organ system failure coming into our ICU. She had DNR/DNI papers. But her family members screamed, “Do everything,” or we’ll sue you. Rescinding her DNR. A code blue, CPR crushing her fragile ribs, ventilator, restraints, central line, and vasopressors. That blank stare. Fast and hard compressions on this fragile patient when we all knew this was futile.

The patient on the psych unit who punched me in the face with his fist. Punched me to the ground. The nurses rushed me to the emergency room for a CT of my head. I thought my jaw was fractured, but my CT was clear and I was discharged from the emergency room. Long-lasting PTSD, fearing a knock on my back door of this guy coming after me.

Moral demise.

Can we fix this?

Is there ever a time that this will all go away or do we suffer a lingering guilt and pain.

I took advantage of EAP (Employee Assistance Program) at the different hospitals I worked at. Going to someone who could listen to me as I would be in panic mode, or tremble or feel my tears slowly crashing down my cheeks. EAP was safe and confidential. With a good therapist I was able to sift through my emotional trauma as a nurse. Some hospitals offered a “review” of certain traumatic situations like code blues, CPR, and trauma patients coming to our unit, and we would do a debriefing when time allowed. Coworker support also helped in knowing you had a team that supported you and others. Camaraderie. And knowing that your very worst night could be your best night when your team all worked together.

Walking daily with my dog I rescued, but actually, he rescued me. My comfort and joy.

Through time, I healed and recovered emotionally. Sometimes the trauma lingers or every once in a while, the pain and trauma reappear when I least expect it.

We dedicate our lives in this medical profession but it is so important to remember our own self-care.

Debbie Moore-Black is a nurse who blogs at The Critical Care Nurse.