The Beginning of the Rest

The surface is gone, we scratched it off
We made some plans, and let them go

~Sondre Lerche

The beep of the call bell broke through the bustle of the unit. 

I cringed.

I knew without looking it was my patient’s wife.  I took a deep frustrated breath and walked to the door.    The wife started chattering incessantly when I walked in the door, her eyes frantic and almost manic as she went on a tangent.  I internally tried to suppress my frustration.  She had called me into the room for the 5th time for a false alarm bedpan need.  Her confused husband looked at me with a look that told me he had forgotten who I was, again.

20minutes later I exited the room and returned to my other patient.  It was already 3pm and I had yet to finish even my 8am assessments.  I hadn’t eaten and my coffee level was low.

I finished with my other patient and sat down to chart.  Seconds later, the wife approached me. 

“He needs you again…” she said.  I stifled a groan and made my way towards the room.

The patient himself was a pleasant man in his 40s.  An unlucky chain of events had led to surgery, two codes and now an anoxic brain injury that left him forgetful and anxious.

He was tachypneic in the 30s, diaphoretic and febrile at baseline- related to his brain injury. I looked at him as I entered the room and tried to ignore the wife as she talked incessantly.   I quickly established that he now did not need the bedpan and that he wasn’t in pain like she had told me.  He let out a string of profanities and I went to get him an antianxiety pill.

30 minutes later, I again escaped the room and encountered my charge nurse. 

“Do you think he can lateral? We need surgery beds…” She said trying not to be pushy.  I looked at her gratefully. 

“Yes! I’ll page whoever you want.” I said.

An hour later I pushed him down the hall into his new ICU room.  The wife was anxiously trailing behind us.  I had tried to give the new nurse a fair warning about the situation.

As I said goodbye and walked out, I felt relief and a twinge of guilt.  They were encountering something I couldn’t comprehend.  From a medicine standpoint he was stable aside from a few issues with breathing and tachycardia.  To me he was the most stable patient on the unit with the most unstable family.   As we pushed the empty bed down the hall I realized she probably had no idea how to cope.  Her endless calls and nonstop questions and chatter were her coping mechanism. 

“Is he ok? Is that good?  That’s good right?  I think it’s good. Am I grasping… I am grasping aren’t I? I just want good news? Is it good news? What did the doctor say?”  She had barely allowed answers as she just continually spewed words.   But here she was facing a new life with a husband who forgot what happened 3 minutes before.  A husband who said whatever came into his mind because of damage to the frontal lobe.  I felt bad that I was so frustrated. I had only spent 2 twelve hour shifts with them.

 This was just the beginning of the rest of their lives.

 

nurserockout
Welcome To Ebolaville, Texas.  We are trained via a 7minute video and have the same precautions given to us when assisting with placing a line…but, whileThe cdc, doctors and experts huddle In fireman suits… We wipe, clean, culture, apply, insert, remove, address and comfort the sick and dying…And then they wonder why “nurses get infected”…maybe they were the only ones taking care of the patient.

Welcome To Ebolaville, Texas. We are trained via a 7minute video and have the same precautions given to us when assisting with placing a line…but, while
The cdc, doctors and experts huddle
In fireman suits… We wipe, clean, culture, apply, insert, remove, address and comfort the sick and dying…
And then they wonder why “nurses get infected”…maybe they were the only ones taking care of the patient.

Home

She’s fighting back tears, she’s fighting back years
Of the only life she’s ever known
There’s a future that’s bright in the dead of this night,
And all she’s gotta do is go

~Eli Young Band

"I am exhausted… day 3 of 3…day 7 out of the last 9 days" I whined to the nurse charting beside me.  I hadn’t done 7 straight but the days off had gone by far to quickly.  I stifled a yawn and looked down the hall.  A fresh post-op CABG was being wheeled into the unit.  I huddled behind my computer….

Maybe I can say I am watching the other patients… Maybe I can pretend I didn’t see him get admitted…Maybe  I can avoid helping this one time…

The thoughts circled in my mind.  Guilt settled over me as alarms started ringing in the room.  Unable to suppress my curiosity I walked to the doorway and hovered for a second before I grabbed gloves and jumped in to help.  Blood pressures alarmed as the patient grazed 45/20 and his heart rate jumped to 150. The tall surgeon shook his head and asked for fluids to be given and an epi push to handed to him.  I quickly settled into a chaotic camaraderie with the other nurses.  We pushed meds, flooded his body with fluid and blood and… made zero headway.  We worked with the surgeon, ICU doctor, and cardiologist as they scratched their heads while we drew labs, ran ABGs, titrated drips, and did everything short of compressions. Two hours rushed by in the seconds it felt like we spent at the bedside.  After 3 liters of fluid, 4 pressors, 3 units of blood, 3 amps of bicarb, 1 amp of calcium, 2 amps of epi….his pressure hit 90.  

The doctors shook their heads and rushed out of the unit exchanging high fives and acting as though the “stability” would last.

I glanced at the other nurses and laughed as the last of the white coats fled the scene.

"Goodness…they sure ran fast.  I hope they know he isn’t stable at all."

The charge nurse grinned and the primary nurse shook his head with a smile.  We lingered at the bedside to ensure we had done what we could.  The primary nurse was wide-eyed and nervous as we discussed different drips.  He was supposed to hang fentanyl to help with sedation.  I glanced at it and cringed… 

"That is going to make his pressure drop again… I would keep the dose low if you can…"

The charge nurse turned and looked at me with an appraising look. 

"You are really good.  It was like having one of us in here…"

The other nurse nodded and asked.

"You going to stay with us permanently?"  

I laughed and shook my head as they both looked at me expectantly.

"Thank you… I am glad I was able to help.. I don’t know what I am going to do…I am just a traveler…" I said averting my eyes.

The charge nurse shook her head.

"No.  You aren’t ‘just a traveler’.  We have had those… you are different,"

I blushed as I said thank you.

Relief flooded my body at their kind words. As I surveyed the destroyed room I realized… It was one of the few times that I had felt at ease in a month.  Discarded gloves littered the floor, syringes lay in disarray, empty medication vials cluttered the shelves and the trash cans overflowed with the relics of a disaster. The hiss of the ventilator and the beep of the monitor were soothing in a bizarre way.  

I had been feeling homesick but, I realized that the ICU is my home.

 No matter what state, what hospital or what occasion

Dream A little Dream

The screen lit up the dark room.  My only connection to the life I had left behind.  

"He got his heart"  the words said.  Simple.  No drama.  Yet- the impact resonated.

I jumped off my couch and threw my fist in the air.

I had been gone a week.  I had hugged him as I left the unit and told him confidently. 

"I can’t wait to hear about you getting your heart. I’ll do a victory dance in Texas for you."

He had laughed at me and wished me well.  

After months of waiting he had gotten the heart he so desperately needed. Goosebumps covered my arms as I recalled the dream I had the night before.  I never dream about patients, and yet I had dreamt of him. I had woken up with him on my mind.  It was mere hours later that the text had informed me that he had gotten his heart.

The reports trickled in over the next week…he was extubated…he was out of bed… he was eating well… he was walking the halls.

And then I heard the best report yet. 

He was being discharged…to home.  The home he hadn’t stepped foot into in almost 4 months… Home.

 As a nurse, it was the best going away gift I could have ever gotten.

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.