Posted on by jparadisirn

Beer for Breakfast (The night shift goes out for breakfast)

Chapter 11

Fortunately, the next two shifts are uneventful, which actually feels weird after a traumatic shift like the last one. There’s not enough time in between to process what happens to our patients, and the role nurses play.

Every so often, someone in hospital administration suggests holding “debriefing” meetings for the nurses after a particularly distressing patient death, but the meetings never develop meaningfully. In my opinion, this is because the meetings happen on day shift, which is too busy for those nurses to leave the unit to attend, and too late in the day for night shift to stay up. Besides, in units requiring ICU technology skills, many a nurse’s days off are consumed at the hospital in the form of mandatory in-services, skill competency workshops, CPR renewal, PALS re-certification, staff meetings, etc. We get paid for the time spent attending, but at a certain point, it’s a case of diminishing returns to spend more time at the hospital. So I don’t attend the few debriefings that occur. Besides, I don’t want to talk about my feelings and sing Kumbya in front of my coworkers.

What I do enjoy with coworkers is going out for breakfast after a shift, especially if I don’t work the following night. This morning, a few of us are meeting at a popular diner a few blocks from the hospital to do just that.

Besides Corey from ER, Gerald the respiratory therapist, and Liz join us in the booth. The guys order large, while Liz and I share an omelet, and order coffee. Corey and Gerald drink beer. When Liz comments on this, Corey speaks up,

“Because Liz, that’s what dudes do after work. We go out for beer.”

“If I have a beer after a twelve hour night shift, I’ll have to sleep in my car before driving home,” I laugh.

“That’s because you’re a light weight female nurse Niki,” Corey teases. “ER nurses are manly men, despite the media’s and society’s feminization of our kind.”

We laugh.

Changing the subject, I interject:

“Hey Gerald, guess what happened last night in the PICU.”

“Buh.”

“No really, Gerald. You know that mom from bed two? Well, she came over to the nurses’ desk, and told me,

‘I don’t know who to report this to, but someone working in this hospital is hitting a child on the chest and back in room seven.’

So I get up and look in room seven, and Gerald, it’s YOU, giving chest percussion to a toddler!! I almost burst out laughing trying to explain to her that you’re a respiratory therapist, and what you were doing helps the patient breathe. I told her the kiddo’s doctor prescribed it.”

“Gee thanks, Niki. I owe you one. Probably saved me from being arrested as a child abuser or something. You nurses complain about not getting recognized for your work, but when was the last time you saw a respiratory therapist character on a TV show?”

“Whatever possessed you to become a respiratory therapist anyway, Gerald? You hold nebulizers in patients’ faces, and then suction snot out of their tubes. I nearly gag just listening to someone with a wet, hacking cough. How can you stand your job?”

There’s laughter around the table.

“Well, Niki, it’s because I want to work ‘in the exciting world of doctors,’ and have my life choices questioned by bitchy nurses like you. Keep your opinions to yourself girlfriend, and kindly ask the server to bring me some coffee while I go use the head, okay?”

There’s more laughter, followed by a brief silence while the server brings our food, and Gerald’s coffee.

Corey asks, “Does your husband take your daughter to school in the mornings after your shift Niki?”

“Yeah, and brings her home. Simon’s a school teacher.”

“And what about you, Liz, do you have kids?”

“Yes, a son. His name is Nathan. He’s fifteen, and takes the bus. Next year, he’ll learn how to drive, and I won’t have to depend on other people to shuttle him to baseball, and basketball practices while I work.”

“How long have you been divorced, Liz?”

“Seven years.”

“Are you dating anyone?”

“On nightshift?”

“It’s probably hard being a single mom, but on the other hand, maybe it’s not so bad having control over your own life,” I realize I’m musing out loud.

“There’s a lot to be said for marriage, Niki, like having someone there to divide up the work. Sometimes I think people are too caught up pursuing happiness, and it gets in the way of commitment. Maybe being happy isn’t the most important thing in life,” says Liz.

“I don’t know, that’s sort of heavy,” says Corey. “Just because you’re married doesn’t mean you have a partnership. I think it depends on expectations. Sometimes one spouse has more expectations than the other. It doesn’t always work. I don’t know if sticking it out for the sake of commitment is the right answer.”

“I’ve always felt that a happy marriage or partnership is a wonderful thing,” says Gerald. “But it’s better to single than married and unhappy. Nothing is lonelier than an unhappy marriage.”

“You can say that again,” I mumble while shoving a bite of omelet into my mouth.

Posted on by jparadisirn

Something Goes Wrong (Nice families always have the sickest kids)

Chapter 8

Besides my fourteen year-old head trauma there is only one other patient in the PICU.  Because that one is stable and expected to transfer to the regular pediatric unit in the morning, staffing for our night shift dropped down to two nurses, Kathy, and myself.

The fourteen year old’s parents had been at the bedside since his return from the OR. Throughout the evening his siblings, grandparents, and extended family visited two at a time until visiting hours were over at nine o’clock.  His parents, who really are very nice, took advantage of our empty waiting room across the hall, deciding to spend the night sleeping on the sofas. Kathy and I outfitted them with sheets, blankets, and a couple pillows. I promised to wake them if anything happened.

Around two am, Corey came up from the ER on his break. “Hey Niki, let’s have breakfast after our shifts in the morning, okay?”

“Sure Corey. That sounds great.”

Corey and I met at New Employee Orientation when we were hired. He’s married with two small kids. He’s become one of my best buddies at work. We regularly go out for breakfast after our shifts.

***

The shift nearly passed without mishap.

Around six am, I was taking vital signs on the fourteen year-old. Nothing changed all night. I charted the oxygen saturation and TCO2 monitor readings to check against the results of the arterial blood gas I’d just drawn with his morning labs. Suddenly the monitor alarmed loudly.  Glancing at the screen, I see the ICP numbers are rising, and then out of the corner of my eye I see bright red blood pulsating inside the clear plastic ICP device in the kid’s head and backing up into the tubing it connects to. What the Hell?

Then I shout,

“I NEED HELP!”

Kathy runs in, sees the blood, and says, “Oh my God, what’s happening?”

“I don’t know! I’m not even sure what to do. Should his head go up or down?”

I pondered this while quickly verifying his peripheral pulses and blood pressure manually. I take him off of the vent and begin hand-bagging him, hoping to control the rising ICP. Then I hit the code button. Meanwhile, the boy starts seizing.

Immediately, Gerald, the respiratory therapist runs in. The blood pressure and pulse are high, not low, so we don’t begin chest compressions, but Gerald takes over the hand bagging.  Dr. Polk runs in from the call room as the dayshift nurses begin to arrive.

Dr. Polk orders ativan and a loading dose of phosphyenatoin, which I run to retrieve from the automated drug dispenser.

Immediately, Kris is at the bedside:

“Keep his head up! Call CAT scan. Tell them we’re coming down NOW, this is an emergency. Draw a type and match too,” she commands.

Dr. Polk is entering orders for the scan, and phones the neurosurgeon.

“Should we clamp the ICP tubing?” Kathy asks.

“NO!” both Kris and Dr. Polk yell out.

Dr. Polk asks, “Niki, what happened?”

“Nothing. He was stable all night, then this.”

Meanwhile, the rest of day shift arrives, and a team of nurses flurry into action, transferring the boy’s monitor leads to a portable unit, drawing more labs, and gathering equipment. A green O2 tank is slid into a rack on the bed for the ambu bag. Gerald continues hand-bagging him for the trip downstairs. Another respiratory therapist appears to roll the ventilator down with us.

“Has anyone told the parents yet?”

I awaken them in the waiting room, and bring them back to the PICU. When we get there the team has already wheeled the boy in his bed out the door, with Kris at the helm. Trailing behind, I explain what’s happening. The three of us take a second elevator to CAT scan. Once the parents are seated in the anteroom, I help Kris and the radiology techs transfer the boy onto the narrow table that slides into the tube-like machine.

Behind me, Dr. Polk and the neurosurgeon view the black and white images with grave expressions. The neurosurgeon makes a phone call and instructs OR to prepare a suite.

The CAT scan reveals the cause of the bleeding is an ateriovenous malformation, an AVM, deep in the boy’s brain. Most likely, it’s lurked there undetected since birth. Though no one knows for sure, it’s assumed that when the boy hit his head against the wall, the AVM began leaking, causing the original small bleed, but wasn’t picked up on the original CT. Apparently the bleeding continued, the pressure building until the AVM blew like an old rubber inner tube.

The boy is rushed to OR. I return to the PICU, where I struggle to grasp the medical terms I need to document the incident in the nurse’s note. My adrenaline level is so high, I have difficulty concentrating and keeping the events in order.

Kris comes back up for report. “You did okay, Nik. It wasn’t anything you could control.”

“Thanks Kris. I appreciate that, and your help too. I really do.”