Lost on the Floor

The other night started off like any other. Got my assignment, looked...OK, at least everyone is A & O and mostly independent. "So far so good." I thought to myself. It's funny, I no longer look to see what the actual reason they are admitted for anymore, just if they are going to either:

a. curse me out
b. try to get out of bed and go boom
c. yank at their lines
d. all of the above (usually the most popular.)

Good nursing practice? Maybe a little judgmental, yes, but this is tempered by experience. I figure, more than likely, I can deal with their admitting diagnosis, but if they are demented or delirious or just plain psychotic, that task just became a whole lot harder. But I digress.

So I was going along, and everything was actually OK. Then someone mentioned the "q" word. A chill swept over the nurses station as we all looked at them and in near unison said, "Did you just say the "q" word?" Mentioning the "q" word in the medical world is akin to mentioning "MacBeth" to a stage actor. Not sure what else we could say, for sure the alternative for the actor is far worse. Who really goes on a nursing unit and tells someone to "break a leg?" No one in their right mind. But it brought me back to the time that I had used it.

I was a senior nursing student doing my senior preceptorship in the ER of a smallish rural hospital. On the night shift. At the beginning of the month. During a full moon. Surrounded by black cats and broken mirrors ( OK the last part wasn't quite true.) But there I was. It had been a slow night, nothing too crazy. So I said it. the "q" word. No more than 30 seconds later we heard the tones come over the radio,

"Rural ER, this is unit 55, how do you copy?"

The nurse sitting there, "We copy, over:"

"55 y/o male, found down in apartment, in full arrest, we're coming code 3."

I looked over at my preceptor, she said, "You're on compressions, OK?"

As the thought ran through the back of my head that this was all my fault for saying that dreaded word, I said, "OK." Lead vest on, shoe covers, gown and mask, gloves and goggles. We had just barely gotten the trauma bay ready when we heard the sirens outside in the bay. They piled out of the unit, one in front, one in back, one surfing the gurney performing compressions. Rolled them into the trauma room, stopped compressions only to transfer to the table.

Now it was on me. I started, feeling the ribs grate under my hands, just keeping my mind on the rhythm, 80 a minute. I heard report in the background.

History of esophageal varices and alcoholism. Found down in apartment after wife had called it in after the patient had passed out while talking on the phone to her. 80 a minute.

1 and 2 and 3 and 4 and...keep the rhythm.

7 french ET tube, 21 at the lips. Left and right EJ IVs, got 3 liters in the field. RT is standing to my left bagging as I do compressions. The doc holds compressions for a moment to find the femoral vein. Then back at it. 1, 2, 3, 4,...

I'm hearing orders being given, rapid infuser, get 6 units of blood ready, continue NS until the blood's ready, get me an ultrasound machine. The doc calls out again to hold compressions. Has the femoral line. Compressions resumed.

I'm getting tired now, starting to look around for someone to spell me. Arms feel like lead. Now I look down and see with every compression fluid spurting out of the ET tube, a pink mix of blood and saline. But I keep going. As a student I can't do much, but I can do this.

The monitor shows asystole. The doc halts again, uses the ultrasound to see if the heart is doing anything. Nothing, just a little bit of movement. Finally, I switch out with another nurse. I can't feel my arms, sweat runs down my back and face. And then it is over. The doc calls it. I look at the clock, 7 minutes since they arrived in the ER. Then I nearly lose it. I run out the door to the ambulance bay, into the cold night air overwhelmed by the fact that we couldn't save him. Someone's father, husband, son. In spite of our best efforts, we couldn't save him.

That wasn't the worst. That came when his wife showed up. He came in covered in blood, I mean caked on. The police had said the scene looked like a murder scene there had been so much blood. So we cleaned him up as best we could. Cleaned his hands, his head, his hair. Made him presentable so that his wife could come and say good-bye. My nurse gave me the rest of the night only giving me the easiest cases. As we sat down and talked about it I asked,

"Does it ever get easier?" To which she replied, "Not really. You just forget to feel it anymore."

I knew she meant that you insulate yourself as you get exposed to it frequently, but it sounded a little cold, but I understand it much better now. Rationally, I know that even though I said, "quiet" that didn't cause this to happen, it was bound to happen regardless, sometime. It just happened when I was there. So I never say, "It's kind of quiet tonight." Not anymore.

Oh that other night? It went just fine.