adventures in disaster

In the beginning

I am tired. The kind of tired where day and night are the same. I feel like I have been awake for days.Well, I have been really. Night shift is painful when you can't sleep.
It gets me thinking about why I started all this.
I started out being a nurse because my sister told me it was a steady job with pretty good money. I liked the idea of having a regular pay cheque.
I also didn't mind blood, guts or gore. I was made to be a nurse.
What a fool. I never even thought about feces, sputum or vomit.
They don't really talk about that in nursing school either. In nursing school it was all nursing care plans and " being a professional". No mention that most of your time will be spent cleaning up the messes sick people cannot control.
I sailed through nursing school, ridiculously naive and bright eyed.
I got my first job and I was excited.
I had a ton of responsibility. A crazy amount for a brand new grad but I thought I was more than up to the task.
I was an ICU nurse and a house supervisor. I put out fires. My first fire seemed like nothing. A lady having a little trouble catching her breath. Her daughter was with her and both were cheerful, helpful and honestly not in the least alarmed.
I called the doc and arranged for a breathing treatment as she was a little wheezy.
The breathing treatment didn't help. I put her on a little oxygen and sat her up. She was a very big lady. Very, very big.
I put her on telemetry and a monitor to check her oxygen saturation. Her vitals seemed okay..not great but certainly nothing alarming for her medical history.
She settled and seemed comfortable so I gave the standard call if there is anything else blah, blah and I left the room.
I went to the desk, called the doc with an update and charted, Twenty minutes or so passed and the call bell rang.
I went back to have a look. This lady who was incidently sitting in a recliner looked awful.
She was gasping and had a blue tint.
I knew I had to get her to the bed before she arrested or she would die in that damn recliner. Her daughter and I heaved that woman out of the recliner and pivoted her onto the bed where she collapsed as I hit the code button.
She was purple. Purple like grape juice purple. I was rooted to the spot for a horrible second.
I then checked for a pulse and found nothing.
I started CPR while her daughter wailed .
This woman weighed a lot. CPR was physically punishing. I also knew there was no way I was doing a very good job. My friend came running in with the crash cart. She ran to the head of the bed and attempted to intubate. She couldn't get the tube in. We set up the monitor , she was asystolic and I continued CPR. The doc came running in and tried to get the tube in and failed over and over again. Finally I offered to try. We all switched places and I tried to get the tube in. My patient was flat on her back, she had no neck at all. I tried every head position I could think of to create some kind of view. Finally I went in blind.
I was in.
It didn't matter, my patient was dead. We tried every algorithm available and we never got anything.
My patient was laughing with her daughter one moment and dead the next.

We found out later it was a pulmonary embolus, a huge one that killed her almost instantly.
We had failed before we even began.

I learned a very important lesson that night, well I learned more than one.
The first is no family member should ever have to witness a code first hand and I don't give a shit what some people say...All those "oh I would want to be there" bullshitters..No, no you wouldn't.
The other is every patient in the hospital no matter there diagnosis is at risk for clots. You sit or lay around long enough and clots will form and they will break off and travel to your lungs or your brain and they can kill you.
Every patient needs to have prophylactic treatment for clots.

I also learned to be afraid of fat patients.
I cannot stand having a morbidly obese patient. It's not about them being fat and "ooh gross'...It's about "oh dear mother of god they are going to die on me I just fucking know it" repeating in my terrified brain all damn shift.
I can't relax. I am sure I make them as crazy as they make me. I check their breathing obsessively, I pepper them with questions. I am sure I stare at them with fear in my eyes. I run their codes in my head trying to be prepared, to win this time.
It's not your weight that will get you a clot, it's your inactivity..Hell you can weigh 108 pounds...You lay in bed long enough you are all at risk.
But still I am afraid.
So, I think I stayed in nursing because of that woman. I wanted to save them all. She was my first and I never wanted to see that happen again.
Now I am older and wiser. I know I can't save them all. More often than not all I want is to keep my patient alive till I leave. What happens after I go home is no longer my concern.
You could literally drive yourself to suicide if you worried about these people all the time. And isn't it arrogance to think that somehow only your presence will avert death and disaster more than anyone elses?
I am not that fantastic and it's time to admit that.
So what is going to keep me in nursing now?
The money is still pretty good and the cheques are regular and sometimes I do a damn fine job.
That has got to be enough.

posted by adventures in disaster @ 8:53 PM