December 4, 2008

Lesson #1 Trust Your Instincts

I had to send a 59 year old patient to ICU at 5am this morning. I thought he was going to die. I'm so stressed that I'm having chest pains. Too much responsability and too much pressure.

He had a thoracotmy because of some metastisis of a cancer that they'd found. He was doing ok at the beginning, a little sob with exertion, but I knew he was missing part of a lung so it was expected. He was on 4 liters of 02 and his sats were
93-94%. I kept a close eye on him because he was a bit of a nervous nelly. "I have a pain here (pointing to pinky toe) what does that mean?" And such...

He goes to restroom and calls the desk...can't breathe. Go to his room, get him into bed...sats are now 84% and he's very labored....gasping...becoming mottled and cyanotic. Call lights are going off from other patients... "Christy, Christy!". My patient can barely talk, I sit him up, get vitals, call an MRT (medical response team). They suggest anxiety caused by some difficulty breathing..... ya think? Pulse 138, respers 32. Something is just not right. Call doc....says do this do that, monitor him. So I monitor and watch my pt gasps for air like a fish out of water. Put him on a partial re-breather, set 02 to 100%. Sats go back up in the 90's. I take a deep breath myself. I had a hunch he has COPD. It wasn't diagnosed, but just my own theory, which means if you give them too much 02 they lose the drive to breathe. I knew this, but without the 02, he wouldn't be breathing..AT ALL!

There was a nagging in my tummy. It kept tugging at me and whispering...Hey! Hey You! Nurse! LADY!
Something was not right...I felt it...Patient turns to me, grabs my arm, looks me straight in the eye gulping...."Christy." Call doc again...this time I get annoyed...."Listen up doc." He tells me to send pt to the unit. I pack up the chart and off we go. He's turning more dusky now, can't get air....we're running and bumping into a lot of things on the way there. Hey, it's me remember?

Bust threw ICU doors, just like in the movies. He looks me in the eye and apologizes....poor guy, tihnks this is somehow bothering me. As if! Well, I take that back, it did bother me a hell of a lot because I was afraid he would die! ICU nurses get to work quickly. He's intubated and is now on a ventilator. Diagnosis....Flash Pulmonary Edema.

Back on my lights. "Christy! Where's Christy? Where's my nurse? I need a shot!" Well I need a shot too...of LIQUER! Running to rooms, here is your shot, here is your blanket, here is your dilaudid, here's a bucket for you to puke in, here's the bedpan to poop in. Trying to chart and cover my lights. I want to hide under my desk and cry. I didn't, but I sure wanted to!

Time to give report...
Me: "I have no idea what I did last night. I think I gave him something for pain, not certain." Bwaaaa! Ha! Ha! Ha! <-- that was me cracking the F up.

My floor sucks. Too many high acuity patients, not enough staff, not enough rescources and if you forget to chart something it's your ass. They don't care about us. It's all about the budget.

I can't wait for my cake nursing job to find me. I can picture it now.....soft elevator music is playing in the background...I'm filing my nails and having a bon-bon in the comfort of my little office filled with photos of my children and nice cards from my patients. I see them into the exam room. Have time to do a thorough assessment because they had an appointment, I know they're coming and I'm prepared. I give them a lollypop for being good. We talk about how nice the weather is and I ask them to wait patiently for the doctor to come see them. There is a receptionist who is answering the phone calls AND stuffing the charts. Sigh. How lovely. that the sound of a balloon deflating? Oh yea....reality. Bah! pbbbbllllt!

I will call and check on my patient later. Still concerned. Hope I did enough.....

And as I'm typing this my fav song comes on....Touch of Grey. Yes Jerry...I will get by, I will survive.


Drofen said...

That's one of the things I worry about...will that gut instinct be there?