Friday, January 27, 2012


Today I admitted a rapid response patient from the floor. He was struggling for each breath, and decided he wanted to be intubated. He was a cancer patient, age 60, and had previously been a DNI/DNR. When they can't breathe, it's so scary many patients change their mind. As we were preparing to intubate, he told us that he did not want ACLS, compressions, defibrillation, etc if for some reason his heart couldn't take it.

I explained everything in a calm voice while chaos swirled around him. I told him we were going to put him to sleep and he wouldn't feel the breathing tube being put in. That he wouldn't remember it and would wake up later. But he didn't wake up later. Anesthesia intubated, he bradied down, dropped his pressure... we gave fluids, 1 of epi, and 200mcgs of phenyl. He lost his pulsed. We stopped. He was pronounced.

It doesn't usually happen like that in my unit. People usually come to us almost dead, or they slowly slip away throughout their stay with us. They aren't usually talking to us one minute, dead the next.

The daughter almost threw up when she came in, she was crying so hard.

My other patient's daughter said to me later, "I think I saw a dead body being wheeled out of here, oh my god that was horrible." I said, "yes, that was my patient from this morning. He didn't make it." Her jaw dropping, "How do you do this job?!?!?! I'm so glad I'm a teacher!"

Thursday, January 26, 2012

by the way

I just realized that I never mentioned that I passed my CCRN. With a terrible migraine, I might add. Wow, it's a hard exam. About half way through I started making guesses, because my head was pounding. It's a miracle that I passed, but I did. Damn, I must be smart! Heh heh...

I've been making some sweet overtime money, but I'm about to go on a four day stretch, which I haven't done since Thanksgiving, and man that was rough. I just go into it like a soldier going off to war. If I'm lucky, I'll stay at a friend's house near the hospital for optimal sleep time.

Yesterday, I was singled with a patient with a wound vac. The wound vac cannister was filling up hourly, she was weeping from everywhere, and leaking from her Dignicare (rectal tube). So, she was busy. But for some reason known to the charge nurse only, I was given a second patient at 3pm. I guess I didn't look busy enough with the one. The 2nd patient was also very busy. Bleeding out, in fact, with a case of refractory ITP that no one knows what to do with anymore. So JUST because she was a DNR/DNI, did NOT mean that she was comfort care! Which means she was still a lot of work because I was massively transfusing, using pressure bags for the blood products and fluids, just to keep her pressure up. Because of course it bottomed out, and the family started arguing about using pressors, and I had to stop the whole show and get the (still mentating) patient to make her own wishes known. She didn't want pressors. Which is fine, but that's actually MORE work for me, not less, because that meant 6 liters of fluids to pressurize into her lines. All the while delegating everything for my other patient to other very helpful co-workers.

Anyway. She stabilized but I don't know what ended up happening. All I know was that I got out a half hour late. And that annoys me. Also, the honey nut cheerios I finally opened, and had a mouthful of when her pressure tanked, were just a cupful of soggy mush when I finally got out of the room.

Just another example of a day in the life of a nurse like MOI!