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