Friday, September 11, 2009

Horrible nursing moments...

As I was remembering the various things I've done with nursing, I started reminiscing about my days as a floor nurse. The constant busyness. The endless medications. Talking to 12 different doctors on a daily basis, sometimes all for the same patient...Toileting. Toileting. Toileting. Did I mention toileting? The continuous adrenaline rush I had become accustomed to, and apparently a little addicted to... I had a hard time adjusting to the relatively stable environment of Interventional Radiology. When I first tried the area, I felt like I wasn't really nursing because I wasn't constantly adjusting medication drips, cleaning up body fluids, and basically chasing my tail all day. Isn't that kind of sick? Anyhoo, I started thinking about some of my experiences, and I decided to share some of the more horrific ones with you. Aren't you excited?

Last year I was studying for my ACLS course, and my niece Molly asked if I had ever had to do any of that stuff....I guess she never thinks of me in life and death situations, because when she usually sees me I'm either stuffing my face, or wondering when the next opportunity to eat will be.

Unfortunately, I have dealt with those situations. The bad thing is, they really are scary. The good thing is, that in a hospital you are never alone. A whole team of people arrives to help you out, and hopefully your patient will be okay...

Of course in the stories that are burned into my brain, and have played themselves over and over, the patients have not been okay.

Okay. Are you ready? Because this is pretty awful. I'm not joking. It is truly, horrifyingly, awful. That's my warning to you.

Mrs. "Smith" was an elderly patient (I think late 80s) with end stage lung cancer. She was gray haired, and had that gray skin tone that patients often get when they are extremely ill, and their demise is imminent. Even worse: I remember she was alone. She was in a semi-private room with a comatose patient (see, I told you this was awful) and she had been hallucinating all day long. She would scream and yell. "You are killing me! Why are you trying to kill me? I can't breathe! I'm suffocating! I'm dying! Help! Help!"

And it went on and on. For 12 hours. It was truly awful, because this is not at all a normal occurrence. Yes, we have confused patients. Yes, they yell and holler. But to be endlessly spouting doom and gloom, and to have the patient screaming at me that I was killing her? That was horrible. I tried every sedative under the sun that wouldn't completely knock out her respiratory drive. I tried pain medication. I tried breathing treatments. Her heart rate was very rapid, so we tried fluid boluses thinking she was dehydrated. I called the doctor at least once an hour for the entire shift. I bullied him into coming to see her at least 4 times during the shift. "Andi, she is dying. There is very little we can do for her at this point, but try to make her passing as peaceful as possible." I kept wondering what was calm or peaceful about any of this for this poor woman, or, selfishly enough, for me.

Finally, the end of my shift was nearing. I had paged the doctor to come see her again, and he had instructed me to call the intern on duty (read here: first year out of medical school being bathed in fire, as all doctors must be.) The intern arrived. I drug her in to see the patient, who immediately began to scream at us that we were killing her. I began to explain everything that we had tried, and the results (lack thereof in this case.)

Suddenly, Mrs. Smith sat bolt upright in bed. Her face turned an awful shade of grayish blue. She opened her eyes wider than I thought possible and contorted her face into a silent scream. Her lips were pulled back so that every tooth was showing, and her mouth was open as wide as it could go...

And she collapsed onto the bed. Dead. There was nothing we could do.

It was truly the most awful moment and most horrific thing I have ever witnessed. We are guessing that she died of a pulmonary embolism (PE). A PE is a large blood clot, tumor, or air that travels to your pulmonary artery, and if it's severe enough completely obstructs it, and when that happens, there is nothing to be done. The death is quick, but not usually this horrific. Usually the patient turns blue and collapses. The silent scream and horror movie experience seem to be specific to this patient. Thank goodness.

Of course this was a learning experience for me: The three hallmark signs of a pulmonary embolism are: rapid heart rate (tachycardia), rapid breathing(tachypnea), and sense of impending doom.

This was a horrible, horrific thing. But guess what? I have caught 3 pulmonary embolisms (PEs) before they even entered the doctor's mind since then. Of course, I'm at the bedside, the doctor isn't. As soon as a patient would develop that sense of fear and their heart rate and breathing would kick up (they each had other risk factors that had my radar up too,) I started calling doctors and making a general pest of myself until they ordered what I wanted. We did the test that is used to diagnose PEs, and we were able to treat the patients with clot busters and save their lives. Of course, these PEs were relatively small too. But, still, if I had not been so terrified by my first experience with one, I may not have caught them so soon. So, through one truly awful, nightmarish event, I learned something very valuable to my nursing career, and I've been able to help save other's lives.

And why I'm sharing it with you now, I have no idea.

But there you have it.


Becky said...

Wow, what an odd experience. Glad you were able to bless others through your experience.

Dawn said...

Ooo. I'm glad to be told 'you're killing me' by kids who think I'm mean by making them cite their sources, push in their chairs or put their phone away. I'll take teen drama any day over real.... You're very brave!

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