Saturday, May 24, 2008

dream girl

I do my best to not bring work home with me. Sometimes it works (usually, actually) and sometimes it doesn't (and these are usually the ones I blog about). When I lose my detachment, it manifests itself in different ways. Some people flit across my mind over the next few days while I wonder what the final outcome was. Some people cause me to pay close attention to the obituaries for a while. Some people make me smile every time I think about them. And some people keep me awake at night worrying about them.

This is one of those stories.

My patient was a lovely lady in her sixties who was having a severe allergic reaction. She was the dream patient - articulate, precise, appreciative without being cloying and able to express herself in a way that both stood up for her own best interests and let us know she valued out input. If she needed something she asked for it, with none of the pussy footing around that happens so often, with people taking five minutes to apologize for asking for something that they have every right to have in the first place. (I do this myself when I'm a patient, to tell the truth, even though it drives me nuts when people do it to me). She was a clear ten on my own personal perfect patient scale.

She was also, due to the allergic reaction, losing her airway. Her breathing was becoming severely compromised and the trauma room was full of people trying to figure out the best plan of care for her. The obvious answer was to intubate her and put her on a ventilator, but for a lot of reasons I'm not going to bore you with, all the specialists decided it wasn't warranted at that time. The plan was to stabilize her enough to get her to the ICU and watch her very closely to figure out the next step.

It was at about this point that she lost her ability to speak, but her brain was still firing on all cylinders. We got her a pad of paper and she peppered every person who came in the room with written out questions and comments and pieces of her medical history. She wrote me notes that said she was scared and that she hoped her daughter would get there soon and thanking me for the care she was getting. I kept trying to get her to just try and relax and breathe, but she wasn't having any of it. I kept trying to give her meds to force her to relax, but she wasn't having any of that either. It took us a while, but I got her up to ICU in good shape, and, crossing my fingers, said goodbye to her and wished her luck. She waved cheerfully to me as I left her room.

She had been a 1:1 patient, which meant I didn't have any patients when I got back from ICU. Since we were getting slammed at the moment, I cleaned the room she had just been in, stripping linens, tossing used equipment and picking up lots of her written notes. I glanced at one that she had written to a consulting doctor and stopped cold. It said:

This is really hard for me. I'm one of those people who always has to be in control.

My throat kind of clenched at that, not only at a kindred spirit, but also at the thought of how horrifying it would be to be in that situation - completely dependent on other people, terrified, betrayed by your own body and without a single element of control in your grasp. I mentally said a little prayer for her and then went out to get some new patients.

They called the ICU Code Blue twenty minutes later. When they said the room number overhead I felt sick. Guess who?

I got a grip pretty quick, since I was on the Code Team that shift and had to go with a doctor to respond. As we ran full speed up three flights of stairs, I formulated a pretty good idea of what I thought had happened. (In between thinking this through I thought about other things. How grossly unfair it is to hire doctors who run marathons in their spare time, for one. That it's physically impossible to run fast up stairs in Crocs, for another. That I really need to lay off the mint chip, for a third).

A Code Blue means that without immediate, intensive and almost always invasive treatment of some sort the patient will die. Sometimes they're already, for all intents and purposes, dead when the code is called. They may not have a pulse. They may not be breathing. You can taste the adrenaline in a room during a code. It permeates everything.

As we ran into the room, we saw all the usual sights of a code. Sheets were thrown off and the patient was completely exposed. Pharmacy had arrived and was cracking the case that holds all the special meds needed. They would be there to mix anything that was needed in the right concentration and to draw it up for the med nurse to administer. The Nursing Supervisor was there "scribing"- taking notes on everything that happened and the exact time it took place. Respiratory Therapy stood at the bedside. IV Therapy was right behind us, as was Lab. X-Ray was on the way with a portable machine. The Chaplain came in breathing hard right as our ER doc intubated the patient. She was awake for a good part of it, unfortunately. I watched her hands and feet twitching, her note running through my head.

This is really hard for me. I'm one of those people who always has to be in control.

As soon as she was stabilized, we left her in the capable hands of the ICU crew. I was still feeling a little sick when we got downstairs. I already knew that this patient was pushing all my buttons. I just wasn't sure how to deal with it.

She coded again five minutes later. Marathon runner doc and I locked eyes and ran for the stairs. He beat me. Again.

And it was a repeat performance with the same cast and the same star. Stabilized. Again. Back downstairs. Again. Worried sick. Again.

I went home and for one of the few times in memory dreamed about a specific patient. I was worried enough the next day that I tempted the HIPAA gods to find out what was going on. I wasn't over the edge, but I was close. And it was all for naught, as there was nothing really concrete to learn. So for a full day I stewed.

Until a coworker came up to me and told me they had good news for me. Evidently, I don't hide my feelings as well as I'd like to, because enough people knew how freaked out I was that they went to the trouble to find out the rest of the story. And it was this:

She was extubated the next day. Her allergic reaction dealt with, she was discharged home directly from the ICU, which doesn't happen much. She left the hospital on her own steam with her daughter at her side. She waved cheerfully to the nurse who went out with her, and as she climbed into the car she said a very simple

Thank you all for taking such good care of me.

And you know what? It was my privilege.

For all you nurses out there - I know parts of this story don't add up medically. Blame it on the aforementioned HIPAA, but I'm afraid to get more specific. Trust me on the details. Weird as they are...


Maggie May said...

I was riveted to the seat while reading this! Talk about compulsive reading!
You all need medals!

Nora said...

I am so glad that this story had a happy ending. I am happy for the woman concerned and I am happy for you and the whole crew involved. It is amazing what you people do and I am sure not appreciated enough. It is only because we watch medical shows and read blogs like yours that we know anything of what goes on in life threatening situations.

Thanks for the happy ending.

softinthehead said...

What a responsibility! Congratulations for doing this a daily basis, I know I would not want to be in your "crocs".

Rudee said...

Here is my explanation for the connection; it was meant for you to be where you were, when you were as these are the patients who bolster our spirits and stay with us forever. I'm happy for you that she pulled through. And now, here is my guess at the culprit: ACEI.

Rose said...

You write so well; I was crying at the end of this. You really know how to show with words; I know that's not what you were going for here, but that's what I needed to tell you. You are a writer as well as an amazingly compassionate nurse. Thank you.

Anonymous said...

WOW, I was glued to my screen. You RC, are such an amazing writer, nurse and person. So glad that she left the hospital with her daughter. You were meant to be there for her.


aims said...

Still think you are an amazing and caring nurse.

Reading the news last night and today - hope you and all of yours are okay.

Mya said...

Great post,RC. Wonderful.For once, I'm going to keep my comment brief.

Mya x

ciara said...

i'm a little misty here, r.c. i'm glad everything turned out ok. they say things always happen for a reason :)

Kaycie said...

What an amazing story. I could never be a nurse. I'm wired in such a way that I could never have left her.

Thanks for sharing this with us.

the mother of this lot said...

Glad it had a happy ending. I was panicking a bit on the way down!

the planet of janet said...

an amazing story. if i'm ever in an er for something that severe, i hope there is someone like you there pulling, caring and fretting for me.

PixelPi said...

Great read, as usual, RC. I don't think there would have been any HIPAA issues in looking at the patient's record--after all, weren't you part of the treating team? From my perspective, you have every right to check the patient's record and chart for progress notes.

You must be a terrific nurse. There is no way I could ever deal with a situation like that.

There are times at work as a transcriptionist that I get emotionally shaky after typing a report with that kind of tension in it.

I think that's why we don't (as a rule) have our regular 80 or so transcriptionists type discharge summaries--you get discharged dead or alive, and the death summaries can be awful. Especially if they died in the trauma bay.

WT said...

Funny, but as I was reading the story, the word 'riveting' appeared in my mind's eye. I had decided that it alone would be my comment, that is until I scrolled past the very first comment!

Boy do I empathise with the being in control deal! I had the same experience when I ended up in in ICU, nowhere near as dramatic (or invasive) but I did leads and crap all over me, and I did have no control.

Carolyn said...

I have no idea how you do what you do every day. I'm just not cut out for the stress of it. I truly admire you. Thanks for the great read, as usual.

Jettied said...

i would want you as my nurse!!

Jo Beaufoix said...

Wow RC, that was amazing and awful and scary. I'm so glad she was ok, and I'm sorry you were so worried for her.