Dan Heath: For a nurse, code blue is a call to arms. A patient is in bad trouble. Four years ago that happened at the outpatient surgery center in Florida where Teresa Shuster works. Shuster's been a nurse for nearly 40 years. That day a patient's heart had stopped during a procedure, that sparked a code blue. The medical team used a defibrillator, got the heart beating again, and all of a sudden the patient--

Teresa Shuster: Woke right back up and he's like, "Hi, what happened?" We're like, "Hello, Mr. Smith, how are you doing?" He's like, "I'm doing great. Why are you guys looking at me?

Dan Heath: Because you were dead for a few seconds?

Teresa Shuster: But it's just his heart kind of stopped for a second, and then we just brought it back to life.

Dan Heath: But not every code is life and death. Some are kind of tongue in cheek.

Teresa Shuster: So this pertains mostly to the operating room. I know it's probably on other people's badges, but we say code brown.

Dan Heath: Code brown?

Teresa Shuster: Most of the people in the surgeries don't go number two. And if it happens sometimes when people are relaxed or they're paralyzed, then that's what we say.

Dan Heath: That when they soil themselves, it's code brown.

Teresa Shuster: Code brown.

Dan Heath: That's so funny. When you first said that phrase, that was what popped to mind. I was about to make a joke, and then I thought it would be in bad taste. But that's in fact what it means.

Teresa Shuster: No, it really is. It is really in bad taste. And that's really in the OR because it's not something that happens on the floors, the patient need the bed pan and yes, we never say code brown, we'll say get a bedpan, but it doesn't happen in the OR, so yeah, we say code brown.

Dan Heath: I am Dan Heath and this is What It's Like To Be. in every episode we walk in the shoes of someone from a different profession, a stadium beer vendor, a mystery novelist, a piano teacher. We want to know what they do all day at work. Today we ask Teresa Shuster what it's like to be a nurse. We'll talk about how a patient changed the course of her career, what it's like to work 24 hours straight, and why nurses do that thing where they check and recheck what operation you're getting. Stay with us. Teresa's nursing career actually began at a burn center in Ohio in the mid-1980s. And just a heads up to listeners, some of the stuff coming up is pretty rough to hear. People came in with sometimes very serious burns. It was intense work.

Teresa Shuster: The one thing that was probably the worst, and I don't smell it anymore, but was when they would come in, and they would be charred, and it's the hair.

Dan Heath: Ah.

Teresa Shuster: I know that sounds really disgusting, but it was the hair, the smell of burning if you've ever smelt it, hopefully not. That is quite nauseating, and that was hard. But we have had a couple, one that stuck in my head was, he was riding those go-karts in Ohio, the ones that are gas powered. And somebody came up from behind him and hit him and caught his legs on fire. He was a 14-year-old boy who was probably 6'2". He had the longest spindly little legs, and he was severely burned. He was with us for a good three months, but did well.

Dan Heath: My goodness. I mean, how long did it take you to stop having like the emotional reaction? I suspect a lot of our listeners are having, like, is it weeks or months or does it never go away, or what's the process of acclimating like?

Teresa Shuster: For me, what I tried to put the narrative in my head was, I'm helping them. This kid, for sure, that was 14, he was gonna get better. He just needed to be able to get his skin grafts on, and be able to move and maintain the coverage on his legs and not get tight, not get contracted, and he was terrific. I mean, he'd say, oh no, here comes Teresa again, I have to walk, I'm like, yep, get your butt up. Let's-- Let's get up. Almost, you really have to keep your spirits up too with them.

Dan Heath: Mm-hmm.

Teresa Shuster: And there was another patient that really kind of got to me. He was a Florida power and light? No, not Florida, it was California. And he had his repair helmet on, they were trying to fix something on an electric pole. And instead of having the repair helmet with the visor in the front, he flipped it backwards, kind of like we do with our baseball caps.

Dan Heath: Uh-huh.

Teresa Shuster: Well, when we went up there, one of the electric lines hit him in the head and came out his arm.

Dan Heath: Ah.

Teresa Shuster: So we ended up having to amputate his arm. He, gosh, he must have been with me for a good five months. We took a piece of his bone out from his brain. 'cause we needed to let the swelling heal. Finally we were able to put the bone back, and it's a very slow process. And then he got cataracts from the electricity going onto his eyes, so in the evening shift, these guys get really bored. He had a nice family, he had two children, but at nighttime I would go in there, and I'd just read him stuff, and we would just talk while I would do my notes, filling out my paperwork and doing everything. So I knew he was gonna make it, but that was the one great thing about being with them. You really get close to them. You really got to know your patient. It wasn't somebody that's just coming in for surgery like now and then leaving. I got to really spend some time with them. I got to know them.

Dan Heath: I'm just picturing that moment when somebody like that man comes into the hospital, it's an emergency, just in a terrible state. What's going on in your mind at that moment? Like, are you having to fight panic, or does it become autopilot where you're kind of instantly all business or how does it feel?

Teresa Shuster: So in medicine especially, we have these logarithms, if someone stops breathing, what's the thing you do first? Or if they restart breathing, what's the next steps you go to? If his heart stops, what's the next steps you go to? So you do go on an autopilot, and then sometimes when you go home, then you can process it.

Dan Heath: Hmm, so in the moment it's almost like you're so locked into adrenaline and habit and training. It's like you're not--

Teresa Shuster: Correct.

Dan Heath: Even thinking about what you're doing?

Teresa Shuster: Right, and that's when you know you've done great training and that you feel comfortable because you don't have to think about it. Oh, what am I supposed to do now? You just automatically do it. And it's great when you work with a team like that. And there was one that I worked with in California, Suzy and I would look at each other, and Sue she gave me just a look, I don't think anybody else noticed it. But as soon as she gave me a look, I'd come right over there with a crash cart. Just say kind of what you need in a calm voice. And we just had this sense which is amazing to be able to have like that with coworker.

Dan Heath: Were there any patients that particularly stand out from you, from your time in the burn centers?

Teresa Shuster: I had a hard time with one baby. This was in California. And for the most part, the little babies, they get a little burn on their hands from the stove or rice cooker or whatever. But there had been some abuse cases, and one really stuck out to me because I knew the ones that were abused. And I know this sounds really strange, they have this wall about them. So they've kind of made a resilient, what do I gotta say? They know that someone's gonna hurt them. So they put a protective barrier up. They put that protective barrier up. So it's not gonna be as bad. I know that sounds weird that I'm like, I'm glad when they've reached that point 'cause then I think that they're not gonna get us hurt. Well, the one kid we had came in, he had cigarette burns, they had scalded him for going to the bathroom, I think he was maybe two and a half. But they put 'em in hot water and set 'em down so we could tell that if someone's getting hot water, you're not gonna have your butt marks impressed on there, not getting burned because someone's holding you down. Do you know what I mean?

Dan Heath: Yeah.

Teresa Shuster: There are signs. So when you see the kids, you're like, oh, someone really held him underneath because that's not burned. Everything else was scalded around him, but not there. So there were signs and symptoms that you could look up, but he was so friendly and so sweet that he only wanted to be held. So a lot of times I would just take him and carry him around for my shift, and I would bring him in McDonald's, whatever I could get him to eat. And he was just such a special kid. It ended up being that they did prosecute the mom and the boyfriend, but that one broke me. So probably about, I can talk about it now without crying, but six months or more if I would think about him, it would just break me, and at that point I said, okay, I think I need to leave the burn center and go to someplace else. I love nursing, but the children there were really killing me, and I didn't have children of my own at the time. So I went to the PACU and pre-op and operating room, and I flourished there. But that baby, that two and a half year old really changed, changed probably the trajectory of my nursing. 'Cause I probably would've stayed in burns and trauma and maybe even got a clinical nurse specialty in burns and trauma, but went the other way.

Dan Heath: Boy, I can completely understand. I mean, that would just be a crushing thing to witness and to feel so little control over the situation.

Teresa Shuster: Yeah, that was the case. And during that case, I remember specifically we brought the baby in, and then you still have to get the information from the mom, blah, blah, blah. And I went in, I'm courteous, every single person deserves to be respected, and I'm taking history, blah, blah, blah. And then she says, oh yeah, and I'm eight weeks pregnant.

Dan Heath: Oh no.

Teresa Shuster: Yeah. I went outside to my boss, who I loved very much so, but I didn't pull Andy Reed specifically, but I did do a tap, you're in, WWE style, you have to finish this one because I'm gonna kill her, I think. And she's like, Teresa, I don't think I've ever heard you say that in a few years. I was like, yeah, I just need a break for five minutes. I'll come back. So she did the rest of the interview with her.

Dan Heath: After Teresa left the burn center, she moved around a bit. And for many years now she has worked for an outpatient surgery center. Outpatient, meaning that people come in and get their surgery and go home. They don't stay in the clinic overnight. And part of her job now is just doing the basics to prepare patients for surgery.

Teresa Shuster: We have to make sure that the consent, whatever surgical procedure, the doctor has talked to them previously and has sent us in. It's we're double checking the, I'm gonna do my right hip, not my left hip. So we do these certain things with the doctor, and we have to make them, they take a marker and put their initials or their like left, making sure it's left or right, whatever it is, they mark it at that side. So there's no more wrong side operations.

Dan Heath: It's so funny, I had a surgery a couple of years ago, and they must have asked me 48 times, like, what are you here for? Point to the part of your body. I was like, okay, 47 was enough, but I guess it's better not to make the mistake.

Teresa Shuster: Did they tell you they were doing that?

Dan Heath: Of course.

Teresa Shuster: Okay. I was gonna say, 'cause sometimes one patient asked me, are you sure you guys know what you're doing? You keep asking me the same question. And then we ask you what's your date of birth? Just to make sure, how do you spell your last name? This is you, and they're like, are you sure you guys know what you're doing? Some of the older patients are very funny.

Dan Heath: It's better to be a little bit annoyed than to have the wrong leg amputated.

Teresa Shuster: Oh, a hundred percent, I think all the time.

Dan Heath: How do you handle young doctors, maybe fresh outta med school 29 years old that may be higher on the org chart, but probably don't know a 10th of what you do? Like what is that dynamic like?

Teresa Shuster: Okay, so that happens a lot, especially in California. The guys were from Stanford, are residents. So they came from great medical schools Cornell, NYU, and then they come to Stanford for the residency. For the most part, they were good because once they know that you've been in charge, they actually will ask you questions. I've had one doctor call me and goes, okay, so now we've increased this with him, whatever, pain medicine, do you have any other suggestions? And I'm like, wait, who are you? What, are you asking me--

Dan Heath: I'm so heartened--

Teresa Shuster: For my ideas?

Dan Heath: To hear that.

Teresa Shuster: Most of the time the doctor would be more arrogant and say, I need this and this, and Teresa, why are you calling me for that? And some of them were really patient and say, oh, but for the most part, if we knew that there was either gonna be a resident that's like that, I would jump above him and go to the attending. So if he didn't wanna give me the order that I thought was appropriate, I would call the attending, and say I called Dr. Smith, and he didn't wanna do this, but here's my rationale for why I wanna add this. And he'd say, oh okay, yes, I'll give you that order. So if you don't get what you want from the physicians, you can always go above them.

Dan Heath: Hey, Dan here, can I ask a favor? If you like the show, will you rate it on the app you're using right now or give us a review if you can? There's a million podcasts out there, as we all know. And when people shop for a new one, they ask their friends advice, and they check out the reviews. So you can help this show thrive with a rating and a review and maybe a nudge to a friend or two. I know it sounds like little stuff, but folks, that's the marketing plan. Like there's no global influencer campaign coming. The marketing plan is you. So regardless of the review, thanks for listening. And now back to the show. Psychologists talk about the flow state. You've probably heard the term, it's like when you're so absorbed in what you're doing that you just kind of lose track of time. It doesn't mean it's like pleasurable or euphoric, it just means like you're so absorbed, time disappears. Like what are the times when that happens for you as a nurse?

Teresa Shuster: Oh, sometimes they'll ask you to do extra. Like if big burns came in, oh! One in particular in Miami Valley in Ohio, they were having fireworks from a barge on the river there. And one of the fireworks, the barge fell, the cannon or whatever that they were shooting them out of, and it went into where the people were sitting. So instead of going up, it went into the embankment by the river.

Dan Heath: I feel like after this episode is over, like I'm not leaving my house again for the rest of the year.

Teresa Shuster: I know, I'm really telling you really bad stories. I've had some great ones too, and you know what, for the most part, the good always outweighs the bad. When I've had patients come and hug me, and say, you've been awesome to me, that is the best, that's the best.

Dan Heath: Hmm.

Teresa Shuster: But I am telling you really bad ones, but this one was crazy. So we had burns from the fire, but it was shrapnel because those chunks of fireworks dispersed. And we probably had 23 patients come to us. And then also other patients went to disperse to other hospitals, and moving our burn patients out who were stable enough to be able to get these patients in. I think I worked 24, almost 25 hours straight.

Dan Heath: What?

Teresa Shuster: Yes, it was crazy, but it was like we had all these patients going, I mean, you couldn't leave.

Dan Heath: Wow, and did you know you were in like hour 23 at the time, or was it just all hands on deck?

Teresa Shuster: Oh yeah, after a while you really feel it. I mean, they'll bring you some food. There have been times when we have a really big burn, and we're doing all this stuff, and it's 13 hours, and I'm like, oh my gosh, I haven't eaten anything. I haven't drank anything. I never went to the restroom, you do get really absorbed, but for the most part, like, especially at some of the PACUs, we have enough staff, you have a scheduled break. So some person comes on at 11 o'clock. At 11:15, they relieve you, you get a 15 minute, then you come on, you relieve somebody else. They get 15 minutes, you take over their assignment.

Dan Heath: What makes a nurse great at her or his job?

Teresa Shuster: I think wanting to be there for one and a true love of taking care of people, like I envision it, for me, is I want to think of that person as, someone's taking care of my mom or someone's taking care of my father, or someone's taking care of my aunt or my sister, or the neighbor that I love so much. They need to be treated the same way. Everyone needs that kindness. And not every nurse has that now, I think, but that, to me, makes a great nurse when you really try to be that advocate, to be that caring person for that patient.

Dan Heath: What you said reminded me of, there's some research that was done by a business school professor named Morten Hansen about the distinction between purpose and passion in people's jobs where passion is sort of like, passion is personal. It's like excitement to go to work. Like work is fun. I can't wait to get to work. Versus purpose is more outward directed. It's like I am serving someone, and sometimes it's hard, but that's a source of great meaning. And it strikes me that nursing is a high purpose job. Would you agree with that?

Teresa Shuster: Oh yeah, for sure. It is a high purpose job, but for some of us that have that passion, it is great.

Dan Heath: So for you it was both?

Teresa Shuster: Yeah, it really does have both.

Dan Heath: That's interesting 'cause my stereotype is maybe the purpose is so intense that it kind of redeems the fact that maybe you don't get out of bed in the morning, like eager to go to work. But it sounds like you were able to get both, which is incredible.

Teresa Shuster: I was, but I did step back from the ICU setting 'cause I don't know whether when you're that intense, and you have somebody crashing all the time, and you're continuously on an adrenaline, like okay, what can I do next, what do I have to do next? And people don't really understand. The doctors aren't usually there, we're the ones calling the doctors for the orders. And if you're not very educated, they're not gonna be able to give you, a lot of times I know this is kind of weirdly interesting, but they give you a range. So they give you a medication range. If my blood pressure is below this, start this medication, and you can put it at so many drops until it reaches this.

Dan Heath: Oh, that's interesting, I didn't know that you had those kind of autonomy within certain ranges.

Teresa Shuster: Yes, in the ICU.

Dan Heath: Okay.

Teresa Shuster: In the ICU, and I don't know about every state, but I do know that Ohio was one and so was California.

Dan Heath: So from everything we hear in the news, it seems like a hard time in the industry for nurses. Like there's a nursing shortage, it seems like people are leaving the industry. What do you attribute that to? Like what's changed?

Teresa Shuster: High stress, and not the pay for the higher stress jobs.

Dan Heath: But you were certainly stressed 30 years ago. Is it the pay that's changed or have other conditions about the job changed?

Teresa Shuster: Yeah, 30 years ago when I was in California, our pay rate was great. If I would've stayed there now, I would be making probably 125, 130 an hour. When I left there, I was making 50 something an hour. I took a pay cut to go to New York where I made $34 an hour. And then when we came down here in '02, I was making $24 an hour.

Dan Heath: 24 an hour are you serious?

Teresa Shuster: Yes, I'm very serious. And then one of my friends just asked me now, she goes, "Okay, so at a surgery center, and you have all this years experience, how much are you making? I said, 42.65. She goes, "Are you serious?" Just exactly like you. And I go, yeah, they pay nothing. And if I make a mistake, you could, you know, not die, but it could be catastrophic.

Dan Heath: I mean, there are Starbucks baristas making 20 an hour, and if they make a mistake, like you're okay, you're okay without your oat milk.

Teresa Shuster: Spit out the coffee.

Dan Heath: Yeah.

Teresa Shuster: Yes, isn't that crazy?

Dan Heath: It's crazy!

Teresa Shuster: And I guess that was the second thing of that. The California pay was great, and it's because it's unionized. I know no one likes to hear that. But here, if you go to an ICU in Florida, and you have seven patients and a nurse calls in sick, and you don't have another help, you're gonna have to be four and three. And I don't think that's right with these sick patients in the ICU. We've only either been one-on-one or two-to-one at max. You cannot under the California law, give me more than that because that puts pressure on me, and it does not give me good care to that other person when you increase my work area.

Dan Heath: Hmm. So Teresa, we always end our episodes with a quick lightning round of questions.

Teresa Shuster: Okay.

Dan Heath: Let me fire away here. First, what's the most insulting thing you could say about a nurse's work?

Teresa Shuster: I think, oh, you're just a nurse. Why didn't you go to medical school?

Dan Heath: Hmm.

Teresa Shuster: Like you're not smart enough to go to medical school, it's been said to me,

Dan Heath: That's a slapable comment, I would think.

Teresa Shuster: Yes, yes, it was. I was one of those, I'm like, I don't think I'm gonna reply to that.

Dan Heath: What's a tool specific to your profession that you really like using?

Teresa Shuster: I know this sounds kind of weird, but in all these years, standing on your feet with your back and your hips and working, the tool that I think is the best thing is your shoes. I happen to wear the, chefs wear them, nurses wear them, some salespeople wear them, but they're called Dansko, D-A-N-S-K-O, not a plug, they're not paying me. Dansko clogs, and they are the most comfortable, they actually align your feet to align your hips and align your back to stand straight. So no matter how many hours I'm on my feet, they are a godsend. That's my only tool that I don't think I could work without.

Dan Heath: Would you recommend this profession to a young person?

Teresa Shuster: It's funny 'cause I remember your welder said, abso-freaking-lutely, and I was thinking abso-freaking-lutely not! Not a hundred percent. I would say think long and hard about this. Your hours are long and hard, especially when you start out at a hospital, it's every other weekend. It is every other holiday. There are gonna be some holidays where you're not gonna be spending it with your family. You're gonna have to be into the hospital. Birthdays, sometimes when you wanna take a vacation, somebody else has already put in for that, you don't get that vacation. I mean, there's a lot of negatives of working that in the area that I'm now in, I'm very happy that I'm no weekends, no holidays, I'm at a outpatient surgery center. But you have to really put in your dues, you have to do the 3 to 11 shift. You have to do the 11 to 7 shift. Or like at Stanford, they had you rotate 7:00 AM to 7:00 PM for three months, and then you'd go back to 7:00 PM to 7:00 AM for three months. And talk about your rhythm and how amazingly off your body was.

Dan Heath: So if you could go back in time, would you still become a nurse?

Teresa Shuster: Yeah, I actually think that in our lifetime to go back, and do, well, what if and what if, I wouldn't be the same person I am right now if I didn't have all these experiences.

Dan Heath: Hmm.

Teresa Shuster: So, I don't think I could change anything.

Dan Heath: What do you think it's changed about you? Like how do you think the profession has shaped you?

Teresa Shuster: I think it has made me a better person, and to really, even when I'm at like the drug stores or whatever else, I see somebody being really not put upon, but no one's explaining things to them. I think it helps me step back, and say, can I help you with that? Can I help you explain something? Is there something that you're not understanding? So I still try to do that and step back, and make it a little bit more uncomplicated for them.

Dan Heath: I would think it would also give you a sense of perspective in a way. Like with what you see every day people's lives at stake and enduring, in some cases, horrible things. I mean, it must make you less likely to be the kind of person who would complain that the wireless isn't working on the flight or whatever. It must make you more tolerant of little life annoyances.

Teresa Shuster: Yes, it is true, you do see the big picture. You're like, okay, I just had this other person come in for another port who beat cancer, beat her breast cancer, and now this time it's metastasized to her brain, and she's like 79 years old, and she's still willing to work at it. And for someone who you know, oh no, the WiFi's down, or oh no, this isn't working right. It does put things in perspective, it's true. Don't sweat the little things. There are plenty of other things that probably could use to be sweat, but not that.

Dan Heath: Teresa Shuster is a nurse at an outpatient surgery center in Florida. I don't know if you've caught Teresa's comment, but she actually called back to the welder episode of this show. I had asked Lucky Reed the same question I asked her, "Would you recommend this profession to a young person?" And he said,

Lucky Reed: Abso-freaking-lutely!

Dan Heath: It was interesting to me that Teresa's response was more like abso-fricking-maybe? The phrase that kept coming to mind when I thought about the conversation with Teresa was high importance, low control, and you'll have to forgive me here, I'm a business writer, so jargon-rich labels like that come naturally to me. But the point is that her work is really, really important. People's wellbeing depends on her. But as a nurse, there's so much that's out of your control. The patient's circumstances, like that story of abuse she told, is one I will not soon forget. And the patient's ultimate health outcomes? Those are certainly things you can influence as a nurse, but not control. Even the circumstances of your job may be out of your control, like the warning she gave about scheduling issues, and missing holidays, and the day-to-day confines of your role working tightly within what the doctor authorizes. It's a noble profession with high importance, but soberingly low control. And folks, that's what it's like to be a nurse. This episode was produced by Matt Purdy, and a shout out to Elizabeth A., who recommended Teresa to us. Thanks Elizabeth. This is the first episode when our guest was sourced from a listener. That feels to me like a breakthrough. May there be many more to come. Thanks for listening.