Monday, October 14, 2013

MICU: no babies allowed!

We were going to admit a woman on propofol and pressors who was 27 weeks pregnant. This was not MY patient, but she was coming to my side of the unit so my hands were starting to sweat just thinking about it. I mean... little baby heartbeats that could stop any minute, emergency c-sections, placentas flying, baby coding. Just no, no, no, no, no. 
The baby may be "viable", but just the thought of participating in this made me want to run down the hall, perhaps to the safety of inpatient dialysis, where nothing (much) ever happens. Or at least, I wanted my 77-year-old, lots-of-secretions, q1 hour suctioning patient to have a HUGE code brown so I could stay in his room and do NORMAL stuff.
So there I was, being a team player and priming fentanyl and versed lines for the nurse assigned to this pregnant nightmare patient, and the L&D nurse is putting on the tocos, to monitor the baby's heartbeat, and what do I hear? NOTHING. I said to L, the assigned nurse, "oh my god please don't tell me they can't find a heartbeat." She saw that I was poised to run out the door and expel the contents of my meager lunch, and quickly reassured me that they had already found it and were just making adjustments.
Ok. Fine. But here's your fentanyl and versed and I'm outta here. Not to mention the fact that nobody likes a birth center nurse sitting around with huge clueless eyes, eating pizza, and trying to figure out if the vent alarm means that the patient is waking up or dying. Oh well... at least if a head drifts out of a vagina, someone will be around to do something about that, cause it sure as hell won't be us MICU nurses!

Sunday, October 6, 2013

the demons under the surface

We think we have this built-in immunity, us ICU nurses. We watch people die, and although we may shed a tear or two, especially if we knew the patient for a while, for the most part we maintain an unflappable appearance. In fact, I usually maintain an unflappable attitude as well. It may be sad, I may feel bad for the family, I may sigh or shake my head. But at the end of the day, I'm exactly the same as I would've been if no one had died at all.

We're not cold and heartless, we're just used to it. We separate the life and death of a patient from our personal, inner worlds. This is so that we can cope, carry on, come to work and do our jobs well. We can't run a decent code or resuscitation if we're about to have a good cry over the impending death of someone's child, parent, sibling, etc.

We go into the hospital room of the deceased nonchalantly, tossing the body bag kit onto the bed. We hum or sing to ourselves while yanking out lines and catheters. We laugh and joke about our day as we turn the body from side to side and wrap it. We think nothing of it.

Or so I thought.

One night after vacation, I was home alone (with the baby) and feeling a little scared of the creaks and sounds of the darkness outside. I tried to relax, tell myself all the doors were locked, and fall asleep. Suddenly, before sleeping, my anxious mind began showing me a slideshow of all the dead people that I've either been a nurse for, or helped with post-mortem care for their bodies. I saw their jaundiced skin and eyeballs, their purple fingers, their bloated bellies and stick-thin arms. I was flooded with visions of the crusted blood around their nostrils, and the river of stomach contents that poured into the bed as they were turned.

These images frightened and surprised me. I never thought these things bothered me, but there in my moment of vulnerability, I was horrified by the monstrous images playing through my brain.

I guess I don't brush it off the way I thought. I guess it's down there somewhere afterall.