New- Old

Afraid to lose control
And caught up in this world
I’ve wasted time, I’ve wasted breath
I think I’ve thought myself to death

- Kongos

The shuttle bumped across the gravel, my bag shifting in my lap.  I tightened my arm around it so it wouldn’t hit the lady sitting beside me.  I willed my grip on my phone to relax and my face to erase the feeling of panic.  I stared at the dark buildings we approached, the headlights cutting through the humid morning air. 

The herd of navy blue flowed into the building and I walked in unison, blending with the crowd.  I exited the elevator, my feet carrying me into the new portion of my life. I walked with all the confidence I could muster into the room where the nurses were gathered.  

The day quickly spiraled, report was fast and the charting archaic. I struggled.  For the first time in 3 years, I struggled.  I felt helpless and lost.  I went from being confident and prepared to confused and unsure.  I left that night with a knot in my stomach. I hadn’t felt so terrified in years.  I took a deep breath and curled up in my bed.  My head was filled with things I should have known, done, initiated but had been so bogged down in figuring out the charting that I hadn’t seen it.  I hated myself for it.

Day 2 was better but I was still feeling lost.  

I finally shook myself. I had to give myself a break-  I was in a new state, a new city, new apartment, new hospital, new unit, new charting system…with only 2 days orientation.  I realized then and there what is worse than being a new nurse.

It’s being a new-old nurse that has to backtrack and unlearn and relearn everything you thought you knew.  

That

"Can I bribe you into writing orders with some cake?" I joked with the cardiologist as he wandered through the unit.  He laughed and proceeded to chat for awhile as we swapped stories of triumphs and failures. 

That is what I’ll miss.

The sunshine blinded our eyes as we walked outside.  He had been in our unit for a few months and the walks outside were his only break from the four walls of his room.  He was feeling sad, not smiling or joking like usual, after the doctors talked to him about limited options regarding his heart.  I talked and chatted to him about life and my new boyfriend until I was able to sneak a smile out of him.  Pretty soon we were laughing and joking like we always do.  He is a bright spot in my day- the 1A’s always are. 

That is what I’ll miss.

The hallway’s bright light and poorly buffed floors contrasted as I helped guide the patient’s bed to CT.  The entourage of wires and tubes spilling out into everyone’s personal space took effort and considerable time to control.  I smiled and waved as people I recognized passed.  A few doctors grinned and jokingly said, “You lost?  Far from home aren’t you.”  I smiled back and nodded. 

That is what I’ll miss.

"Code Blue 5th floor" The eerily calm operator stated overhead.  I jumped up and speed walked upstairs to respond.  The PA handed me a contact gown as I strode into the room, my eyes taking in the scene.  I talked to the nurse briefly, jumped into the code and  helped stabilize the patient.  I joked with the doctors and a few unshaken nurses afterwards as we pushed the bed down to the ICU.

That is what I’ll miss.

The grouping of navy huddled around the charge desk.  We all giggled and whispered as we exchanged horror stories of the previous shifts.”Remember 8204?”  Someone said and I laughed and told the story.  A new nurse smiled without knowing and had a look of bafflement as we talked of patients in the past and that have passed.  

That is what I’ll miss.

The familiarity.  The camaraderie. The expectations.  The comfort.

The feeling of knowing and being known.  The feeling of belonging and readiness. The feeling of respect and openness.  The history, the moments, the memories.

THAT….is what I’ll miss.

That last connection

And I will swallow my pride
You’re the one that I love
And I’m saying goodbye

~ A Great Big World

The tears were threatening.

I have heard that phrase so many times but it took my job to help me understand it.  

He walked in with such courage, his pace steady.  He started out so strong and then faltered.  His hands.  The  strong hands that once grasped her hands, shook as he set the donuts on the table.  He smiled.  A ghost of the one he would flash at her. 

He cleared his voice and shakily said, “These are for you all…”  His hand absently patting the box.

There was a pause.  A long one.  We all stood there numbly.  I wanted so much to tell him how much she had meant and how much we had all loved her… I knew it would mean nothing to him right then.  I stayed silent and hugged him.  

His blue eyes sparkled.  Not with the jokes and mischievous looks that he used to share with her, but with the tears threatening to fall. 

He cleared his throat again and nodded, whisking the tears away with a calloused finger.  With a nod of his head and a small farewell wave, he walked away. 

My heart ached for him as I watched his retreating form leave.  His shoulders hunched with raw emotion.  His beloved wife had died with us mere days ago and he had come back to thank us personally.  She had been a patient off and on with us so long that he had come back partially, I believe, because he didn’t know where else to go.

He wanted that familiarity, that last connection.  

I couldn’t say goodbye

The wind outside the window swirled violently.  The storm we were promised was way less dramatic than we had thought but still whipped the trees into a frenzy.

It was eerily quiet in your room. A stark contrast to the day outside. People whispered and furtively glanced at you to ensure you stayed asleep.  They congregated in the hall and lingered by your door.  They all gathered for one reason.  Their eyes watery, their words tinged with a forced brightness. 

One by one they sidled off after whispering the words they came to say. 

"I love you.  Goodbye"

You were aware but unaware.  We had you comfortable but teetering on incoherent.  You saw hallucinations in the corner and on ceiling thanks to the concoction of anti-emetics and pain medicine. 

I got texts from co-workers throughout the day asking if you were ok and how you felt.  I replied generally.

I didn’t want to admit that I couldn’t go in your room.  I could barely look your husband in the eye.  I couldn’t help but swallow tears when I went to your room and helped reposition you.  I had refused to take care of you.  I couldn’t watch you die.  

I watch many people die.  I watch death happen over and over.  

But, with you… I was watching a friend suffer. You had been around when I first started in that unit.  You were someone I talked about music to and showed pictures of my art work.  We joked about doctors and you laughed at my impersonations of their antics.  Your husband brought us chocolates and taught me the right way to cook a soft shell crab.  You are a frequent flyer, a known entity.  We love you.  You are always smiling and upbeat.  You know us on sight and are always interested in our lives. You see us as humans.

You told your husband, when given the chance to transfer, that you wanted to stay with us.  You loved us, too.  

Today I left my unit and couldn’t say good bye.  I couldn’t see you like that.  I couldn’t see the pain and hurt.  I want to remember you smiling at me and waving hello.  I want to remember the time you told me that you liked Pit Bull as a singer and thought Snoop Dogg was “neat”.  I want to remember that beautiful human that we all loved so dearly.  

I walked away and know I’ll never see you again. I am crushed and devastated.  

But, your memory, your sweet spirit will always be present. And that, is how I’ll make it through another shift.

Your life, My hands

But my dreams
They aren’t as empty
As my conscience seems to be

~The Who

The call came at about 1030, just after we had settled into our roles for the day.  The calls that send me jogging up the stairs and hurtling into an unknown crisis.

I rarely pause when walking into the room and people make room for me automatically.  They know me.  I am the MRT nurse for the day.  Not to sound cocky or obnoxious- but, the MRT nurse is one of three people who respond to the MRT that actually matter.  The other essential personnel are the supervisor and the doctor.  Neither one was present as I walked into the room.

I glanced at the patient in the bed and the first words that came out of my mouth sounded harsh.

"Is she even with it?" I said with my eye brows up in question.  The patient lay in the bed, her brown eyes deviated to the right and her body still other than the labored breathing.

"Umm… She was…" The hesitation from the nurses gave me pause.  I got the scoop and then took up post at the patient’s side.

The primary nurse was paging doctors and I kept a close eye on the patient.

"Dr. B. will be here to evaluate." the nurse said with relief.

I nodded and then eyed the patient as people milled around the room and outside the room.

"Is she…She isn’t breathing…" I said and quickly raked my knuckles across her sternum.  She startled awake and stared blankly before lapsing back into apnea.  

After the third aggressive sternal rub to keep her breathing, I looked at the nurse.  ”When is the doctor coming?”

"Umm… Soon.." She stuttered nervously.

"Can I get the code cart in here and some pads on her, please?" I said as the patient went apneic again.

An ICU nurse from the neighboring unit stood next to me and we shook our heads.  

"She needs intubated.  She can’t keep this up for long." I said and glanced at the nurses hovering at the door.  "Is the Doc out there yet?"  I asked as I pulled my charge phone from my pocket.

"No…" They said, their eyes wide.

"Ok.  Can someone set up some suction and get the red box in here?" I said and dialed the emergency line.

"Emergency hotline- can I help you?" The pleasant operator asked.

"Hi, This is Kari. Can you please page Anesthesia to the 5th floor, room 45, stat?"  

The call echoed down the hall as my knuckles continued to be the only reason the patient stayed awake for mere seconds.

10 minutes ticked by as we waited.  Anesthesia and the doctor arrived simultaneously.  I was relieved.  It was an internal medicine doctor who had been with my favorite critical care group originally and we had a good rapport.  She listened to my rationale and nodded assent to the intubation.

As the anesthesiologist readied her meds, the other ICU nurse and I directed traffic.  For an intubation on a step-down floor it was calm and well orchestrated. I was wholly impressed with the relaxed and yet quick responses of the nurses to the immediate crisis.  

We settled the patient into my ICU and I left her with my coworker and walked into the unit.

I stood for a brief moment and just took a breath.

I had made the calls.  I had decided.

I have called anesthesia before, but usually after a doctors evaluation. If the doctor had turned up seconds later than she had, it would not have been her call.  It would have been mine.

 I have made split decisions many, many times that I don’t have time to consult doctors for… But, it was different.  Those decisions usually were in my patient’s room and it was just me.

I was calling the shots while 8 other nurses, a nursing student, a manager, 3 respiratory therapists and a chaplain were watching me. 

It is tricky moments like that… moments where you realize the gravity of your job that can make or break a nurse.

Tricky moments when you have to be the voice for the ones who aren’t speaking.

Moments when you don’t have time to let someone else decide.

Moments when someone’s life rests completely and utterly…in your hands.

Strike 3 and you’re… alive.

The sun was hanging at the perfect angle to start shimmering in your window.  The room was cool and closed off.  You were isolated.  

The monitor in front of me began its sinister scream and my charge nurse and I looked up.  Your heart was slowing.  Dramatically.

I jumped up in unison with my coworker and rushed into the room.  You had no pulse.  I began compressions as my coworker rushed for the code cart.  We called the code overhead and seconds passed as I did the pumping for your heart.

Another nurse switched out but in transition you regained a pulse.  You were alive.  The doctors arrived in time to do nothing but stand and look confused as to why you would suddenly go bradycardic and asystolic and then have return of circulation with just compressions.  I went back to my own patients.

You did the same thing the next day.  I again did compressions as myself and another nurse struggled to regain a heart rate.  

You came back again.

You took one day off from death and then attempted to code again for me when I was actually your nurse.  As your heart rate hit 15, I crammed atropine into your body and you regained a strong pulse. The doctors shook their heads…it shouldn’t be happening.  There was no reason.  

I agreed.  You had been with us for days, weeks even and now suddenly you were coding.

You were unpredictable and labile.  You had some of the most brilliant doctors I know shrugging in confusion.  You had been intubated because you were hypoxic and agitated.  It took nearly a week to get the bronch results back that you had a viral pneumonia and +flu. You were a transplant patient so your immune system was suppressed and it took time to get your infection better. You remained ventilated.

Today your oxygen level plummeted and we couldn’t get it back up. I asked for inhaled flolan and you responded well immediately.  We started continuous dialysis for your kidneys and increased your sedation.  You started running fevers on dialysis and I shook my head.  You were going septic.

I left your night nurses with a physicians assistant halfway through new central lines and the dialysis paused.  I left them with everything I knew about you.  I left them with one of the most unusually sick patients I have had in a long time.

I left them with a patient I did not know personally but that had tried 3 different times to die on my shifts before we snatched him back.  

I left them with a patient that I somehow felt personally responsible for.

I left them with a sense of relief and chagrin. I wasn’t back for 5 days but, I wanted to see him improve and get better.  I wanted to ensure he was getting what he needed and that he wasn’t neglected.  

But, a part of me wanted to leave the room and never come back. Because part of me knows the ending isn’t always happy.