Lost on the Floor

I've been having a bit of an almost existential crisis regarding work. There are days I feel like there is not way I can continue, that I chose the wrong profession, that I suck at my job and feel like there is no way on God's green Earth that I'm going in to work. I have yet to call out, just to call out, but there are days when I feel that it is what I have to do. But I go on. There are events that contribute to this feeling, then in a wonderful way, prove that I'm doing the right thing, the thing I was meant to do.

For some reason room #66 has it out for me. Of the patients that I've had go south on me to one extent or another have been in that room. Something abnormally high like 90%. I'm about ready to stop accepting assignments that include that room, it's got my number.

And that's where he was that night. Hanging out in his room with his wife. Came from an outside hospital for an angio due to increasing anginal symptoms. Cardiac history? Check, the thing was as long as I am old. Not pretty. CABG x4 last year, CHF, HTN, elevated lipids, smoker...at least he wasn't diabetic. Plus, he was young, at least relatively so. I got in report that it looked like 3 of the grafts had closed off completely and the fourth was pretty occluded. He was doing OK, his last bit of chest pain had been controlled with nitro paste and morphine. The docs didn't know what to do, really what can you do?

He was stable, blood pressure a little on the high side with a splitting headache from the nitro. So I did my nightly nursing thing. Kept my eye on his pressures all night, watched his heart rate and rhythm on the monitor at the nuurses station and let him sleep. I'm doing rounds at 0400 when his wife calls out to the nurses station that he's having severe chest pain, worse than before. I hit him with MONA, nothing. DOesn't even mae a dent in the pain. BP is way up, HR too. One of my colleagues gets a 12-Lead EKG, I'm calling the doc. One thing that sucks about nights is that a doc is a little harder to get hold of. Finally get hold of him, get new orders. I'm feeling a bit frantic now. I'm hoping this fear does not show on my face or through my actions. I'm already getting tired from having to run down the hallway from the med room and phones. His wife is really getting agitated now, she's questioning if coming to our hospital was the right thing, if I was the right nurse for the crisis.

Give him Metoprolol x3...maybe that will bring down the BP and rate, ease off the oxygen demand of the heart, maybe help to bring down the pain. Nope. Barely dents his BP or rate. I've got a nitro drip running now, it's helping a bit, but not much. Mind you he's also getting morphine and extra sublingual nitro, anything to get this pain under control. I keep upping the rate of the drip, anything at this point. His wife, well, she's very upset now. She doesn't see a doc around, wants to see one, even though it is 5am and any sane cardiologist is asleep at this point. I'm doing what I can to calm her down, calming myself at the same time. His BP and rate if coming down now, but the pain is still there, he's calling it 9/10, nothing seems to be working. I max him out at the level we can give on my floor. I'm calling the doc back saying, "We need to go to ICU." Luckily, he agreed. Thankfully, I had kept my charge in the loop to what was going on and as soon as the doc said to ship him, we were ready to go. After 3 hours of fighting on the floor, we shipped him to the Unit.

It wasn't what I did, or didn't do that shook me so hard, it was the things that his wife was saying. I know that it was a stress reaction and that I was doing everything I could do, but it still hurt. Here I was trying to save her husband's life and she was still calling me incompetent and that our hospital and floor was worthless. And those were the nice things she was syaing...it was not pretty. Looking back, I probably would have changed the sequence couple of things and tried to get him to the unit earlier, but I know I did my job right that night. Funny thing though, the 12-Lead we ran, didn't showed anything different from one previous in the day. When I got in the next night, I looked at his labs. There it was, jumping off the screen at me: Troponin I: 5.82ng/ml. His cardiac enzymes had literally gone through the roof. It wasn't a small infarct, it was the big one.

Lucky for me, I had a couple of nights off after that. Time to forget and forgive. "One day I will get the hang of this," I told myself. My shattered confidence was slowly coming back, I was feeling better about it all, not great, but OK. Then I the other night I saw a familiar figure. "No way," I thought to myself. Sure enough it was the very same guy. Up walking in the halls. Pink, warm, talking and walking. He had survived a serious infarct. He said the docs figured that night, the last of the open grafts shut off, leading to his pain and infarct. He told me he appreciated everything I had done for him that night and that he knew that I had done everything I could to help him. Talk about shock. I was amazed, in shock and nearly speechless. He thanked me again and we went back to our night.

Crisis not totally solved, but I do feel much better about work. I know I chose the right profession, it's just taking time to really feel like I'm actually getting it. I know I am and when I have a night like that, I feel it. But seeing the positive outcome afterwards made me realize why I chose this in the first place: to help people.

Sure I'm still Lost, but I'm finding my way. It's what I'm meant to do.