Night and Day

One of the aspects of my job that makes it so weird is the randomness of it all. You can be pretty sure a normal shift will include all the usual suspects such as back or abdominal pain, headache, car accidents, cardiac events and the like. But you never really know what is going to walk in that door at any minute. It's this uncertainty that keeps you perpetually off-balance. Things may be quite calm right this second, but it can change on a dime. And the unwritten rule is that things almost never change for the better. I get very cranky with this rule.



Some days are mostly bad. Some days are mostly good. Then there are the days that include such a dramatic combination of the two that it takes your breath away. I had one of those this week and I'm just can't shake it. Everywhere I look...there it is.



The first patient was mine. A woman brought in by her husband because all of a sudden she started talking funny and her right side got really weak. Not an old woman either, no more than fifty-five. No other in-your-face stroke symptoms, but we swung into our protocol to rule it out. Many (speedy) tests later the verdict is in - this woman is having a massive brainstem stroke in front of our eyes, and her time is running out fast. Sounds odd to say, but she's got a few things going in her favor. She is a perfect candidate to undergo treatment with TPA, a kind of stroke miracle drug. It's been called the clot buster, because that's what it does. There are three catches. First is that you have to use it within three hours of the event. Three hours and one minute and you are no longer eligible. And the second is that up to five percent of the people who receive the treatment die as a direct result. The third, and most important, catch is that you have to be having exactly the right kind of stroke to qualify. She met all of the criteria and we put the plan into action.





It was this lady's lucky day. We administerd the drug with all the meticulous attention to detail of a shuttle launch. Then we monitored the bejeezus out of her to see how she would react. We had a bad moment about two minutes in when it looked like she was going to be one of the unlucky five percent, but it was very brief. And then I witnessed an absolute miracle. This woman started moving her right arm and leg and began speaking normally and with full mental functioning. Within ten minutes she was talking about what she wanted to eat for dinner that night. And by the time we sent her up to ICU she was calling me sweetie and telling her husband to remember to walk the dog. He stopped in the next day to tell us she was ready to be discharged. With no residual effects. At. All. It was the first time I've ever given this drug and it was the most amazing thing I've ever seen.





Several hours later we get an ambulance call that EMS is coming in with a young man having seizures. This is a college town and we're all cynics, so the first thing we think is drugs or alcohol or some combination of the two. The guy comes in actively seizing and none of the meds are touching him. He looks very young and very business like in his dress, but hip and trendy with his hair and soul patch. His nurse races him to CT Scan just as his parents fly in the door to see what in the world is going on. No outward hysteria, just puzzlement. The patient gets back to his room and there are tons of people in with him. Respiratory therapists, doctors, nurses, EKG techs, lab techs...and his parents, huddled against a wall, shoulders touching, trying to stay out of the way. With enough meds on board to stop a tank he's still seizing.




A few minutes later his CT comes up on the screen in the doctors station and there is a collective gasp from everyone looking at it. This kid has a huge mass in his brain. Totally clean history, no drugs or alcohol, no signs or symptoms. Before today. The ER doc took his parents into a private room to talk and then we prepared to send him to ICU. His parents stayed by the bed the whole time, each one gently stroking him. When he went upstairs they followed the bed, holding hands, shoulders still touching. It looked like they were holding each other up.



As I was walking in to work the next day I saw his mom in the hall. She was walking toward the exit carrying hospital bags full of his belongings. I couldn't help but notice that she was wearing the same clothes she'd had on the day before. As we got closer she smiled gently at me and wished me a good morning. And kept on walking.


I had tears rolling down my face as I walked into the ER. And I couldn't have stopped them if I tried.


The young guy with the seizures... should never have even been there. He should have been planning his weekend or washing his car or playing basketball with his friends. The lady with the stroke should have died, but didn't. I've been a nurse long enough to know that miracles don't happen as often as we'd like and that she really had found the golden ticket.


So why is it his face I can't get out of my head?