My first CPR experience: Beautiful Sinus Tachycardia

It is not clear to me why all nurses cannot support each other. I mean, why is it so hard to try to make another nurses life easier. We are all in the same boat after all. In my experience I have learned some nurses will go the extra mile for you and some will not. Some nurses in particular do the exact opposite and seem to want to do nothing to help you but in fact they may want to impede your happiness. On this particular night the ER nurses seemed to have beef with the ICU nurses. They just kept sending up sick sick sick patients one after another. This one patient had coded twice in the ER and they were nice enough to temporarily stabilize them and then ship em to us! Well I happened to be on the opposite side of the unit from this particular patient but from the looks of it I would be meeting them soon since I attend all code BLUEs while on orientation.
Since the patient was declining quickly I decided to go over to see if I could help. There was a crash cart in the doorway and a Respiratory therapist with a doppler trying to get a femoral pulse to get an ABG. hmmmm. I know all of my readers are not medical people but in my experience a doppler is not often needed for a femoral pulse unless it is during a code situation. After trying for a bit the therapist gives up and I am becoming increasingly more uncomfortable with the situation. I mean PEA anyone? So i decide to check on the other nurses and just as I round the corner they decide to call the code! Alright man some action! I grab some gloves and hurry in the room for some face time. I am standing around helping when I can when I notice a bunch of nurses looking in from the hallway. Then I notice their name tags and see that they are new graduates. What?! fresh meat! So I am thinking I am all high and mighty with my big 1 year of experience and I’m trying to be all involved. When suddenly for round 5 of CPR one of these new grads jump in there. Holy moly! I’ve never done that. Geez how embarassing! When the doctor says to hold compressions and the nurse giving CPR asks for relief I jump at the opportunity. The ER doc announces we are only doing one more round and then she is going to call it if we don’t have a rhythm. By this time I am sweating bullets because I am so scared to look dumb while doing CPR. I just keep thinking someone is going to laugh at me for doing it wrong. One of the CPR instructors at work told me one time to do compressions to the beat of the song, “Staying Alive.” So here I am feeling like a rock star compressing along then the doctor says, “HOLD COMPRESSIONS!” I look up to the heart monitor and there it is the most beautiful Sinus Tachycardia I have ever seen and someone says, “Good compressions Melissa you brought him back to life!” The rest of that was a blur. I was on cloud nine. My first time doing compressions and the patient got a heartbeat. It was such a wonderful moment. I will never forget that beautiful rhythm that I compressed back into that lifeless heart.

The night I watched a heart stop beating.

Sometimes you get to work and you receive report and it’s not real clear whether it is going to be a good night or a bad one. Ya know your patients aren’t necessarily the greatest but you have definetely seen worse. Other nights it is glaring obvious that it’s gonna be one of those tough need to debrief at breakfast type of nights. Well this night was the later of the two. As I turned the corner to go to the break room to put my lunch in the fridge there was the shiny red indicator. A open crash cart sitting in a patient’s door way. (DING DING DING) If that wasn’t clear enough I could also see a clearly distraught family in our solarium and a ton of wore out day shift nurses. Oh joy let the fun fest begin… Soon I heard a familar story. This patient had cancer. Wasn’t feeling well. Came in through the ER and was admitted into ICU just in time to go into cardiac arrest. The doctors weren’t hopeful. They are waiting for all of the family to arrive. This was not my patient but I knew this nurse was going to need a lot of help. The phones were ringing off the hook and she was talking to a million doctors already… As soon as I assessed my patient and got everything up to date there I checked on her she was fumbling with the computer looking for a doctors number I offered to find the number and put out the page for her. When that doctor called back she and I were hanging blood. He ordered a ton of things then another doctor called and next thing I know there were three nurses running around just trying to keep this patient stable. Just at the moment I thought we were getting things under control the rest of the family arrived and we paged the chaplain because they decided to stop treatment. The chaplain arrived respiratory extubated the patient and then the moment of truth. All eyes were on the heart monitor. For 13 excruciating minutes I watched as the heart beat got slower and slower and started to get very irregular and then it just stopped beating all together. At that moment I decide now would be as good a time as any to do post mortem care. I offered to help and the nurse was happy to have the help. I was not ready for what was waiting in that room. I was not prepared for the cold skin or the still chest. As I took out the IV’s I didn’t know what to expect. I mean if the heart is not beating does the skin still bleed? The answer is yes and I couldn’t get it to stop. When holding pressure didn’t work I did the next thing all nurses do to stop bleeding. I held the arm in the air. Only this time the arm was rigid and slow to move. As we turned the patient over to change the sheets I could feel that the sheets underneath were still warm. I am thankful that this patient didn’t have to suffer too long and I’m glad I got to have this experience on a patient that was not mine. I was not personally attached and I didn’t even know an extensive history and it was still so hard.

Finally a new post!

Finally A new post!

June19

So I am not sure why I thought it would be a good idea to start a new job just before summer got into full swing. Not only did I know I was moving in June but I knew that I would be on orientation on weekends! All this moving and crazy schedule stuff has got me all out of whack! Anyways I have had some seriously exciting melventures in the ICU in the meantime. I think I will pick up where I left off. Refresh with the last post Nights 4 and 5 if you have forgotten.
I continued to watch that patient deteriorate for the next 2 weeks. By the time I came in the next weekend the doctors were no longer aggressively treating this patient. I spent my first 2 shifts that weekend feeling, once again, very overwhelmed once again by the emotional strain involved with this assignment. After my first night that weekend I went home totally drained only to be greeted the next night with the same assignment and a new addition to the patients room: A CRASH CART! Apparently the patient had a very rough day… I learned in report that the patient had coded for close to an hour that morning and had been shocked 12 times! The family still insisted that they wanted everything done for the patient. At this point the patients had spent a long amount of time in the ICU – much of that time not breathing on their own. They had experienced cardiac arrest a total of 5 times and was dealing with several broken ribs from the CPR and a pretty extensive wound from an infiltration of emergency medicine at the IV site. I won’t get into specifics but from a medical standpoint it was becoming very clear that this patient was only further deteriorating and not showing any signs of improvement.
In my short nursing career I have experienced this scenario several times already. There often comes a time when doing what is best for you patient may not be directly caring for your patient. Let me explain: Sometimes the best thing for your patient is to attend to their family. It is a strange thing when advocating for your patient involves putting that purple DNR band on their wrist. When support is no longer the norm. Instead of insisting they take this pill or helping them to stick to strict fluid restrictions – You switch the focus from getting them better to letting them rest. Not giving up on them or stopping treatment. Just letting them rest finally. Stop with the tubes and the drips and the painful treatment. Stop with the unnecessary surgery and long hospital stays. What kind of quality do you want for your loved one?
So this was my assignment for the night.
After receiving a briefing from my trusty preceptor we started on a game plan. We decided she would do the talking. We were waiting for visiting hours to end when one of the family members approached us and summoned us into the waiting room. The family wanted to talk. We didn’t even have to bring up the subject. We were greeted with it right here. They wanted to make some decisions. We started the conversation and after many tears and a box of tissues at 2230 the family decided they wanted their loved one to relax. No more shocks. No more rib cracking CPR. No more emergency medicines. Not stopping treatment just no heroics. We spent the rest of the night caring for this precious patient and after we left the next morning all of the pain ended for that patient. We returned the next night to an empty room. Finally the patient and the family could rest. No more long nights sitting in the waiting room. No more worrying. No more questioning whether this was treatment or torture. Finally rest for one and all.
My next set of nights was heart wrenching and uplifting. I had a patient who was quite young for the situation that was presented. By the time I was lucky enough to take care of this patient they had already been through surgery and they were none the better because of it. The patient was not off the ventilator and I received them post op day 4. After report and my patient assessment I prepared myself for a grieving family- just then the double doors swung open and in came a group of 3 smiling from ear to ear. Just as I was thinking to myself, “They must be with a patient who is getting transferred out…” They introduced their selves as my patient’s family and even presented me with a basket of treats. After the family had thanked me several times I finally got a chance to introduce myself. I worked with this family the whole weekend and I am proud to say every member of the family was just as sweet. Even the ones who called to check on the patient took time to say thank you. They treated everyone this way from doctors to CNAs to the housekeepers. That patient received excellent care and actually last I heard they transferred to an extended care facility.
With patients like the one above are providing awesome care is easy. A family that is so overwhelming nice you feel the need to go above a beyond for their loved one. Unfortunately more often than not you either have a not so supportive family or maybe no family at all. The next thing I want to mention is an even different scenario. As I was typing this I remembered something a coworker mentioned to me one night. There was a patient on the unit who was experiencing an esophageal bleed. This patient was a known alcoholic and that is what caused the varices in the esophagus that had now ruptured and were bleeding. The situation was quickly turning emergent and the endoscopy team was being called in at 0300 to perform a procedure. The patient was not mine but I was trying to help in anyway possible. I was getting suction equipment when someone made a passing comment about not knowing why we were making such a big fuss over someone who did this to themselves. This comment stuck in my head and I just couldn’t stop thinking that it is not our place to pass judgment. We are nurses and we need to give each of our patients equal treatment. And I obviously struggle with it just as much as the next one but seriously this patient is vomiting copious amounts of blood! So you want us to sit there and watch it? Maybe wave and say something like, “HA! That sucks for you! Guess you should have thought of that while you were drinking!” Of course we all want to say that from time to time but we are talking life threatening amounts of blood loss here! The family is at the bedside witnessing it because no one is sure if this person will be alive in the morning! Seriously? Anyways that’s my soap box about that. What if that was your loved one who had made some detrimental choices? Do you want me to watch them bleed to death? Just saying…
I had another quite interesting patient a few weeks ago. I came into work and received a strange report from the day nurse. This patient was orally intubated and mechanically ventilated but alert and oriented X 3. Which basically means they know who they are, where they are, and what day or at least year and month it is. OKAY so I don’t know about you but if I have a tube down my throat blowing up my lungs and what not I do not want to be aware of it!! I don’t want to know anything! So I pranced on into this room to do my assessment not really knowing what to expect when I arrived! Much to my surprise this patient was propped up on pillows, remote in one hand, and the yaunker suction in the other suctioning oral secretions out of their mouth! I tried my best to hide my shock but I am sure it was written all over my face! I continued on and conducted my assessment and when it was time for me to leave the room I offered my usual parting statement, “Is there anything else you need?” I have had some interesting answers, some very inappropriate, though most of the time its your basic run of the mill waitress duties: more ice more water… So this patient nods YES and writes on a piece of paper (GET THIS!)… A SACK OF MONEY!! Hahahaha omg intubated and ventilated and still has a sense of humor! The entertainment continued this patient requested a cheeseburger, a steak, carrot cake, and even promised to take me dancing before my weekend was over. That patient was the picture of humility for me. I have said it once and I will probably say it many more times I would probably be the worst patient ever. There is NO way I would be thinking of cheeseburgers or dancing if the roles were reversed.
While we are on the topic of things I am not good at… I am not sure if I have mentioned this before but our hospital is set up sort of weird. The structure actually consists of 2 buildings united by a sky bridge. The way it works out the old building holds orthopedics, respiratory, oncology, nephrology, gastro and pretty much all of the “floor” stuff minus cardiology. All cardiac and the ICU’s and the ER are located in the new addition. This is all fine and well but it is 0.5 miles round trip from one side back to the other. Once again this cool with me too. I mean I am tipping the scales for my height and the good lord knows I can use the exercise. But seriously a girl can only take so much! Now that I am an ICU nurse I think I am all high and mighty and I get to be part of the CODE team! (OMG honor, right? WRONG!) Congratulations Melissa now no matter what you are doing if the words CODE BLUE are announced overhead (and you are on the code team-which I ALWAYS am on orientation) you get to drop everything and RUN! (YAY my favorite thing- not- but I will save that for the weight loss melventures that are coming up!) So everyone holds their breath and hopes for a floor in the Critical care towers (or the pavilion) but alas I have journeyed to 5 codes so far and they have ALL been on the other side! And granted that is still cool with me. But the story gets more interesting. 4 of those codes were not even codes at all! One never lost a pulse – therefore no cardiac arrest. That is bradycardia and not considered a code BLUE! One was a DNR (DO NOT RESUSCITATE) also known as you don’t need me! And the other was breathing really slow so they called an anticipatory CODE! When I arrived the lady was talking! I RAN FOR THAT? Seriously? I don’t sweat! I’m a lady. Dewy at best. GAH!
That’s enough of the melventures for now. I hope I still have some readers left. Sorry I have been absent. I hope to start writing about more than work. Like maybe my awesome new apartment or my adventure to the SHRIMPOREE!! Thanks for reading. Goodnight.

If only I could sweat luxuriously like this girl!

so this is an aerial of the place I work the tower closest is where I physically work the tall one in the back is where I often run to

Nights 4 and 5

am finally used to hitting 4 on the elevator. I am used to all the new faces and they are friendly enough. What I am still working on is the patients. I can study all I want but there is no way to prepare yourself for the emotions you face when you care for a patient on a ventilator. That is just what I had to face on nights 4 and 5. And to further complicate matters I knew this patient. I knew this patient pre-ventilator. I knew this patient before it took 5 drips and a breathing machine to keep them alive. I knew them when they were talking, laughing, and eating. Now they are being fed through a tube that goes up their nose and down into their stomach. Now their family comes in shifts to see them and there is no laughter. This patient cannot even turn from side to side to keep from getting sores on their backside. This patient has to have a bed to do that for them. This patient has no idea that life is passing by right outside their eyelids. Time is going on without them. This is not the patient I know.
All of this hit me the minute I walked away from report and into that 10 x 10 room. That tiny space held 1 mechanical ventilator, 5 IV pumps, 1 feeding pump, 1 cardiac monitor, and one extra large Hill Rom total care bed. There was so much to do I didn’t really have time to think about the situation. Every tube must be labeled and placed perfectly to avoid causing tension when the bed turned. And they were tubes in every orifice: one in the mouth, the nose, the neck, the groin and even the rectum. That was just the first of my worries. I had 5 IV drips that I had to keep an eye on. Each bag had to be specially mixed by the pharmacy so if I let it run out I would be in big trouble. I had oral care and suctioning to perform every 4 hours and as needed. And then there is the family.
ICU stays are very stressful for the patient and many times even more stressful for the family. I want to do my best to make this time easy on everyone. If brushing my patient’s hair, cleaning their face and hands, and throwing on a clean sheet can bring them any solace I am going to do it if I can. So I brushed and I scrubbed and I sprayed on deodorant and misted some air freshener just in time for visiting hours to begin.
Every new family member that came in wanted an update. So I looked for the glimmers of hope in this dreadful situation and I repeated it over and over to every expectant family member. “No fever all day long.” “The heart rate is more stable than yesterday.” “Labs are holding steady.” I was trying to give them the information that they so desperately wanted but I was also trying to convince myself. This particular patient had a really rough time and had many preexisting conditions and it seemed like the situation was looking up for a while. The patient was extubated and seemed to be doing well and then everything changed and now they were back at square one.
So I spent night #4 with an intubated patient. I titrated drips until I went cross-eyed. I turned and I scrubbed and I tried to get the patient clean. I gave meds through an IV and through an NG. I did oral care and charted vitals and at the end of the night I still only had the gentle hum of the respirator whoosh as it breathed life into my seemingly lifeless patient. No big miracle. No flicker of hope. Just the mechanical whoosh of air in and out and in and out.
Nights 4 and 5 were back to back and I slept restlessly knowing I had to go back to care for the same patient again.
So we rushed through report and I flitted off to the 10X10 space to freshen up the patient before visiting hours. It had become my reprieve. The one thing I could do the entire night that gave me instant results. I was used to instant gratification. My patient has pain. I give the meds. All is well. Now my patient is sedated and intubated and I cannot always see the fruits of my labor. But I can tidy up my patient and see the eyes of the family light up when they come in. It is my salvation and it may seem like nothing but it is something I can do.
We were assigned to CODE team #1 for the night so if there is a cardiac arrest in the hospital tonight I AM YOUR GIRL! OH yeah now the fun starts. First night on the code team! Ok so truth is every night I am on the code team. I am the grunt on the floor and in order to learn I have been instructed to attend any and every cardiac arrest whether on the team or not. But still I am officially on the team tonight!! J
Visiting hours are over and it is time for assessment #2. While I am conducting this assessment I noticed my patient’s heart rate is up. Time for more titration. Heart medicine up. Of course if the heart medicine goes up then the blood pressure goes down. So blood pressure medicine goes up too. It is like this intricate little dance and there are no right answers. Just try it and see what happens. I am sitting in the room with my patient charting and pondering my next titration move when I hear the page overhead, “CODE BLUE 3 EAST SPOHN, CODE BLUE 3 EAST SPOHN!” OMG OMG OMG.
The time has come. I am on the code team and it is time to go NOW! My preceptor and I (well mostly her) sprint the 0.25 miles all the way across the skybridge to the other side of the hospital. She shows up first and then I huff and puff my way in, dripping with sweat, but ready to go. My preceptor starts recording what is going on and instructs me to watch. So as I am watching I notice my roommate, Brittani, standing squished in between the crash cart and the wall. We wave and then listen to what’s going on to see if there is anyway we can help.
Codes are crazy crazy times. There is someone doing CPR and someone intubating the patient. There is a doctor yelling out orders and about a million other people (mostly respiratory therapists) standing around waiting for the chance to save a life. “Give EPI now. Give ATROPINE. Anyone got the latest labs? What was happening when this occurred? What medicines is the patient on? What time did we give EPI? Is it time for atropine again?” Things can get pretty crazy. But then you hear “I feel a pulse! Someone get the blood pressure!” and everyone races to get the patient transferred to ICU in the few moments of stability. That is exactly what happened in this situation. And I just stood there and watched.. Talk about ANTI-CLIMATIC! I ran for this?!
My preceptor and I took our time going back. Even took the stairs once we got back to our side of the hospital. I am beginning to think she is trying to tell me something with all this exercising stuff. All was well when we got back to our floor so I decided to take lunch. During lunch I heard the nurse who was on code team with us talking about how the patient “coded” on the way to the ICU and she had to climb on the bed do CPR while going down the hallway. Ugh I officially missed all the action. FAIL.
Speaking of action, after lunch it is bath time. So we are going about our business bathing and what not when the ventilator starts singing. DEEDLE DEEEDLE DEET DEET! Oh no. Singing ventilators are NOT good. I look over and see a red flashing light on the machine. EEEEEEEK if singing is bad red flashing lights combined with singing is really really bad. I quickly give the tubing a once over and see nothing wrong but it is STILL singing and flashing. The patient’s oxygen level is dropping. OK there has to be something. Breathe and look for the problem Melissa! Then I see it the tube is disconnected. After a quick adjustment all is well and we can go about the business of bathing. Guess that’s what I get for moping about missing all the action.
The rest of the night goes by quickly and I am free at last. I am excited that these two nights are over. I can relax and sleep because I am tired! Honestly, at the end of the day, it wasn’t the hourly finger sticks and insulin titration that wore me out. It wasn’t bathing of the 300-pound patient. And it wasn’t the constant worry that I had titrated the medicine too low or to high and I would cause harm. See I could handle the manual labor and mental worry. It was all the emotions that wore me out. This is a new kind of nursing. The kind where saving the patient is not always the right answer. I had dealt with this before but usually the decisions are already made when they got to me on the floor. Now I am dealing with the intubated patient who has a family considering the placement of a permanent tracheostomy and feeding tube. These are big decisions and for once the decisions are not up to me. I am used to deciding whether or not to hold the heart medicine because the blood pressure is low. I am used to calling the doctor when I don’t know the answer. I am not used to standing back doing nothing. I am usually the decision maker and now I am forced to put my emotions on the back burner and carry out the family’s wishes. And it has worn me out.

ICU night 3

{Before you read this post let me explain my wordiness in some areas. in order to obtain confidentiality of my patient’s I am not using any gender specific terms in this post.Please bear with me.}
It’s time for my second night on the unit and I am not going to let the flow sheet or the tricky elevator fool me this time. I am competent. I am professional. I am a NURSE and I can do this. Okay elevator – check. One down one to go! In the locker room I meet up with my preceptor. As I am filling my pockets with mandatory nurse goodies she says, “Do you have a locker?” I reply, “Why no I don’t actually!” She promptly begins digging through unlocked lockers until she finds one with the name of a nurse she hasn’t seen in weeks. The removes the contents, rips off the name, pulls a label out of her pocket, and writes MELISSA on it! “Here ya go, Mel. She’s all yours!” I cannot contain my childlike excitement over locker #32! I let out a squeal and begin daydreaming of the treasures I can stash inside it…
This glorious beginning provided just the confidence boost I needed to saunter onto the unit and rock my way through report. After report I rush to meet my patient for the night. Whadd’ya know this one is actually in the same reality as me!! As I am conducting a thorough assessment of my patient I come across the part where I check the pupils to make sure they are equal and reactive to light. I reach into my pocket to find an empty space where my penlight should be. Okay what am I going to do now? Hmmm as I scour the room for improvisation ideas, I remember the big bright light above the bed that all my patients loathe. I peel back my patient’s eye lids and flip the red switch – KACHING – reaction. Score! another victory for Mel nurse.
I finish up and chart my assessment and vital signs then excuse myself from the room just in time for visiting hours to start. As I usher in the patient’s family I note that the patient seems drowsy but dismiss my worries since today was dialysis day. Off to work on my chart, check my labs, and organize my med times for the night. I finish these tasks then check my email and find myself twiddling my thumbs! Hmmm well it has been an hour since my last vitals.- off to pester my patient again!
While in the room the patient’s spouse asks me about the patient’s drowsiness. I run through a series of questions with the patient: something like: Are you in pain? Are you short of breath? Are you dizzy? Do you have numbness or tingling in your arms or legs? “No. No. No. No. I am just tired.” I reply, “Okay. Well your temperature is 101.0 so let me grab some Tylenol before you turn in for the night.” Before leaving the room I reassured the spouse that today was dialysis day and besides we don’t exactly specialize in providing a perfect’s night sleep for a patient in the hospital let alone the ICU! The spouse seems satisfied with my explanations and begins to gather belongings and say goodnight since visting hours are drawing to an end. As I round the corner coming from the med room I run into the spouse who still looks concerned. Being the ever-prudent nurse that I am, I stop the spouse and grab a scratch sheet of paper. Jotting down the number to the nurses station along with my name I say, “Here if you want to call and check in on us I will be here until 7 am.” In return I see a reassured smile and send a family on their way home.
When I return with the Tylenol something is still bothering me about my patient’s level of consciousness. Everything seems in order but I decide to query my preceptor for a second opinion. She agrees that the patient is obtunded but I decide to check a blood sugar just to ease my worry. Surprise the result is 142. No problem there. Well I guess its back to that nemesis flowsheet.
Around 0100 I receive a call from my patient’s spouse. “Just calling to check on that fever, Did it ever come down?” I fill them in then continue studying chest x-rays. Looking at the clock, I realize I should probably grab a lunch break soon since my preceptor likes to start baths around 0200. Luckily for me I have some friends working back on A6 that night so I run to check on my patient (who is sound asleep) before skipping off to have lunch with my friends. This is a good time to mention that I have a nasty habit of extending my lunch break beyond its allotted time. I have been known to eat lunch for as long as 45 minutes! SHOCKING – I know. Anyways I am trying to be punctual since it is only my second night on the unit. I scarf my food, hardly get a word in with my friends, and I sprint back to my new home just in time to see my preceptor finishing up the prep for my patient’s bath. Geez this lady is a slave driver…
During the bath my patient still seems very drowsy but it is 2 am. I suppose the fact that the patient isn’t exactly dying to have a conversation right now should not be so surprising. So we bathe my patient and hers and I am starting to feel the strain of this total patient care on my back just in time for my favorite part of the night – lab draws! Ok so maybe I am being a bit sarcastic. Another wonderful thing us ICU nurses do that I didn’t do on A6. Nothing like trying to retrieve those skills from nursing school that I have been trying to forget since graduation.
My first night I didn’t even try. So tonight I am determined to get it right. I have been feeling lucky tonight, in fact I am so fired up I volunteer to do my patient and my preceptors – Super Mel to the lab draws dadadadadaduuuuuuh! I gather my supplies and rush into do the preceptor’s patient first. I may as well have been wearing a cape because I was feeling UNTOUCHABLE! 3 blown veins and one extremely irritated patient later I drag myself out of the room to find backup and admit defeat. As I am sinking back into feeling like the most untalented nurse ever this strange energy comes over me so I scoop up my supplies and head to my patient’s room. I tie on the tourniquet and search ravenously for a big juicy geyser vein. Much to my dismay, all I find is a crooked little creek of a vein but it’ll have to do. Sweat drips down my brow as I grasp the wings of the butterfly needle between my thumb and forefinger. I mover closer and closer to the vein and then I break the skin and I scarcely believe my eyes. There it is dark red blood in the tubing! I grab the tubes and fill em to the brim before I wake up from the wonderful dream! As I label the tubes and drop them in the zip loc bio hazard bag I have the nagging feeling that something wasn’t right about that interaction. I send my sweet victory whirring through the tube system off to the lab and then it occurs to me. My patient never woke up during that whole interaction. Not so much as a flinch from the needle poke… very strange.
I hurry back into the room and grab my patients left hand. I instruct the patient to squeeze my hand. No reaction. There was definitely a squeeze in my previous assessments. Left foot? Same outcome. I try squeezing the nail to elicit a pain response. Still nothing. In near panic mode, I interrogate my patient about the left limb’s sensations. The only response is a shake of the right forefinger to symbolize, “No.” Okay the patient was talking earlier too. I rush into the hall and report my findings to the preceptor then find the phone number to call the doctor. While my preceptor assesses the patient I am already talking to the doctor who orders a STAT CT of the brain. My preceptor calls the house supervisor who initiates a stroke alert. A neuro ICU nurse is already assessing my patient while my preceptor and I ready the patient’s bed to head downstairs to CT. The supervisor arrives just in time to help us usher the patient’s bed into the elevator. Once in the CT room we all nervously watch as the grayscale image scans onto the screen. I suck in my breath as everyone in the room sees the giant white out in the middle of the right hemisphere of the brain. It is so large that the brain’s midline is actually shifting to the left a bit. Feeling dizzy, I barely remember the rest of the images or the elevator ride back to the ICU. I talked to the doctor and vaguely remember the words NEUROSURGEON. I couldn’t stop thinking about that family that I reassured and sent home hours earlier.
I was hoping someone had called the family, as I dialed the doctor for a 3^rdtime. The patient’s temp was now 102.4 and I was going to need an order for the cooling blanket we had already ordered from central supply. Somewhere in the flurry of activity I notice a familiar face in the hallway. There is the spouse standing outside my patient’s door. I usher them into the room and explain the new addition – the cooling blanket. Just as I settle down to my new desk the bedside table (you gotta be crazy if you think I am leaving my patient’s room) the doctor arrives. He is explaining the situation to the spouse when he is interrupted. The spouse tells the doctor that they understand what is going on and that he (the doctor) should have seen this patient’s nurse in action last night. The spouse goes on to tell the doctor, “This nurse came in several times during visiting hours last night to reassess {my spouse} and even took the time to write down her name and number so that I could go home and sleep easy. Doctor you do not have to convince me. I know that {my spouse} was in good hands.”
The rest of the shift is a blur. It was 0630 by the time the patient’s spouse arrived and after I gave report the neurosurgeon was on the way to see the patient. I cried on the way home that morning. I cried tears of sadness for my patient and their family and tears wondering what I could have done different. My preceptor reassured me before I left that I had done everything right, however; my only solace lies in that spouses confidence that their beloved was in good hands with me.
This night was just another reminder that nursing is not like any other career. It is not acceptable to have a bad day. You have to come in every day and give 110% people’s lives are in your hands. How many people can say that about their jobs? It is literal life and death and I have to bring my A game every single day.
“If I can ease one life the aching or cool one pain or help one fainting robin unto his nest again, I shall not live in vain.” Emily Dickinson
I am not a nurse because of the good pay or because of my ability to have 6 days off in a row without using a single day of PTO. I am a nurse because I was born to be a nurse. I love my job and I love taking care of people. It is the smile that one grateful patient or family member that makes everything worth it.

ICU training- CATH lab

So my second day of training was spent on day shift in the cath lab, which is pretty much one of my favorite places in the world. I remember cath lab rotations during nursing school felt like one place where everything was right in the world of nursing. Finally nurses are practicing the autonomy they deserve and doctors and nurses are co existing peacefully! So I was super excited about spending the day there and it lived up to all of my expectations!
Sheath pulling (the reason why I was spending a day in the cath lab)
So if the flow sheet is my first nemesis then sheath pulling is my second. As it turns out despite my intense enjoyment during my day in the cath lab, I am terrible at holding pressure after a sheath pull. I tried everything and no matter what all my little femoral arteries were oozing every which way! I stretched my hands and I pushed with all my might 2 cm above the insertion site directly over the site where I had felt the catheter just like the video told me yet I still failed. One patient even developed a nice sized hematoma on my watch! Not that I am proud of these poor results to my treatment but in my defense my teacher for the day would not help me! Every time something started oozing too much or a hematoma started my teacher would just take over the operation instead of helping me to reposition or figure out what the problem was. I only had the opportunity to actually pull 2 sheaths because you have to watch so many before you can pull. I see this as a challenge and am looking forward to meeting a sheath in a femoral artery at work (or in dark alley where I can really show em who is boss (J-lame I know hahaha)) again one day.
I got to have lunch with some of my dayshift people from A6. Furthermore, the hospital fed us for free in honor of hospital week. I made it home in time to snag some groceries and a nap. Overall this day gets a good review!

This is what is being done in the cath lab on the left there is a narrowing of the artery and on the right you can see it has been repaired.

not the lab I was in but this is a typical setup.

ICU night 1

o I get on the elevator and instantly reach for the number 6. Aw burn. Good thing 4 comes before 6 ( my first and only break of the night J) So I am feeling pretty confident as I stroll onto the unit and right into the female locker room – excited to see my promised large locker the assistant manager was supposed to clear out for me. Well there was no locker cleared out for me — “Welcome to your new home Melissa!! wooo we are glad to have you-or maybe not…” hhhmm okay just an oversight I’m sure. I will just leave my bag with all my prized nursing possessions and the photos I prepared for my locker sitting here in the open! Now to find somewhere to stash my lunch! hmmm no fridge here. Drat I guess I will have to meet someone already.
So after finding the breakroom with a fridge I found my preceptor. This is a good time to note that I had a very romanticized vision of my first ICU report. In this vision the nurse giving me report would WOW me with all the information efficiently reported to me in the most organized fashion while a little person massaged feet and another fed me grapes. Instead my preceptor handed me a blank Dr’s progress note form to write on and the nurse informed me that this patient had “JUST GOT HERE” and she was still trying to finish her assessment. In the wonderful world of nursing this of course is code for, “Sucks for you but I know nothing about this patient good luck with your shift tonight.” So after we got report on 2 patients my preceptor says, “Which one ya want?” after a short conversation she hooks me up with the “just got here patient” and hurries me in the room to show me how to use the monitors. After a way too fast tutorial on how to print my patients strips she hurries off to check on her patient since she is expecting the arrival of a not always nice doctor.
So turns out my patient was very confused and being treated for high ammonia. And for those of you who are not lucky enough to have experienced this first hand I will go ahead and tell you there is only one way to get rid of ammonia and its not pretty. But the patient is stable for now so I try to figure out the crazy long flow sheet where I document the patient ongoings. This flow sheet is the enemy- my new nemesis. It is one reaaaaally long piece of paper that consists of 4 8×10 sections on either side. It all folds up together and I am pretty sure that each section randomly switches places with the other sections while your not looking to make it virtually impossible to ever find the section you seek.
Just as I am feeling really defeated by this dreaded piece of paper the doctor shows up to see my patient. He decides to order the med as an enema since my patient is in no mood to swallow (HOORAY -I think- since I would prob never get an NG tube down her considering trying to listen to her posterior lung sounds was like wrangling a wild cougar). So the enema is Q12hours meaning we only have to give it once during our shift. WE of course decide to give it in the wee hours of the morning so we can give her her bath afterward.
Every hour I have to chart vital signs and urine output then every fours hours I have to do a full assessment. Now I know this doesn’t sound like a whole lot but you musn’t forget about the transforming flowsheet where I document this info. And then there are always the “Chores” assigned to each nurse, things like “Check the crash cart” or “Code team 1” or “Code team 2”. We got the awesome job of counting narcotics and I was nominated to count. I am usually very good at counting, as are most people > than 6 years old. But this particular night I was not very good at counting and after approximately 7 miscounts we completed the count only to find out- via a visit from our friends from the pharmacy- that we had still miscounted one of the drugs. Woe is me.
The rest of the night was pretty uneventful. I searched for the enema bag for like 20 minutes before admitting defeat and asking for help to navigate the carelessly organized supply room (earlier in the night I found urine specimen cups in the same drawer with soap, shaving cream, deodorant, razors, and non-slip socks!). We quadruple pad the bed give the enema and cross our fingers! After an exhausting bath that once again can be likened once again to a cougar (imagine giving him a bath) we get everything settled down clean sheets and all only to discover the enema was still making its reappearance into the world. I am pretty sure we did this 3 more times before we decided to not check for leakage for a while…
At 0630 just when we settled down to review our information for the morning report the shift coordinator called to tell us good morning and announce that there was a bed available so our other patient could be transferred to the floor! Being the over achiever that I am I insisted on helping with the transfer only to prove that I apparently need to go back to driving school because I CANNOT steer a hospital bed. I somehow wound up pushing the bed all the way back across the sky bridge to the Critical Care towers all by my lonesome. This adventure ensured that I would be red faced and drenched in sweat to meet all of the AM shift employees!
I felt thoroughly defeated during my drive home and I was pretty much loathing my existence so I decided there was nothing to do besides shop it out. So I took myself and my skanky scrubs into walgreens and bought everything I could find with a sale sticker and went home to drown my sorrow in lucky charms.

HELP ME! I am drowning in this flow sheet!!

ahhh sweet release!

Goodbye tele-nurse! Hello Critical care nurse!

On the eve of the complete mix up of my nursing career (from what it has been for the past 10 months), I am excited, scared, apprehensive, and did I mention SCARED?

I did get the opportunity to meet my preceptor on Saturday night while I was working. She was very sweet and seemed genuinely excited about me coming. So I feel a ton better about that part of this adventure. I remain scared mostly about my knowledge base. I am definitely going to have a lot of studying to do in my near future. I just hope that I have a stronger pharmacology reserve than I feel like I do!

Anyways my plan is to stick to the skills that I do know and take notes on what I need to study. My plan is to update the blog often so everyone can experience this new chapter in my life Thanks for reading!