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.