Sunday, July 11, 2010

that was good times!!!

I'm on night shift now, and it's not as terrible as I thought. I had a crazy day when I was withdrawing on one patient (only 53, very sad) and he was quite difficult to sedate, the new interns don't know which orders to write and need hand-holding, and he wanted to die NOW. I asked him if he wanted me to put him to sleep, and he said yes. I didn't have orders for fentanyl or versed drips, so I kept pushing them plus ativan and morphine. While I waited for pharmacy to make me drips (after I insisted the docs write for them), I had to keep running in there and push more because he kept waking up. It was horrifying, really, because who would want to wake back up and see your loved ones all hovering around crying???

In the meantime, my other patient was in respiratory isolation way down at the other end of the hallway, and I couldn't really keep my eye on both of them at the same time. To make matters worse, this patient was very unstable, and I would get stuck in his room for long periods of time and couldn't tend to the grieving family or dying patient the way I wanted to. The unstable patient had a blood pressure that bounced around from 60s systolically up to 220 in a heartbeat. I was chasing my tail all night with pressors on, pressors off. I got very frustrated by the end because I kept thinking, am I doing something wrong?? But another nurse came and looked over everything and assured me I wasn't.

The last three nights I took care of one patient, mainly, who wasn't quite as exciting, except for one 5am episode when his trach site started gushing blood. Next thing we know we're getting blood in the vent tubing, blood out of his mouth, he's spewing huge clots across the room, everyone is covered in it. The surgeons who did the trach and anasthesia are all at the bedside, while we're bagging him, considering cutting him open right then and there! My co-worker, who was a godsend, was guiding me through it. She was like, oh we're doing surgery right here right now? Here's some propofol. No, just push it. Let's give him a bunch of versed while we're at it. More fentanyl. She gently nudged me in the right direction throughout the crisis and eventually the patient was whisked off to OR where they found.... nothing. But the bleeding stopped with no more events.

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