Mommy Nurse Wife and 25!

Sunday, September 17, 2006

If these stretchers could talk

It is my observation that you can put people into two catergories, A)Those who love codes and B) Those who hate them. I am in the "A" column...I love a good code.

The first code save I was witness to happened in my senior internship at Dartmouth ED. 47 year old male decided to have his chest pain checked out randomly one day after having intermittent pain x 2 weeks(much to the dismay of his wife, a cardiac nurse). He came in, was placed on the monitor and within seconds his eyes rolled back in his head and we went into Torsades. My preceptor and another nurse promptly shocked him and brought him back to life. It was one of the coolest things I had witnessed in my life. I was in love.

After I became a nurse I became ACLS and PALS certified immediately (not only because of my love for that stuff, working in ICU it was required). Four months after that I became an ACLS instructor. I love it.

So you can imagine my excitement the other day when we had an interesting code. 90 something year old woman who was in the ED with nausea. She was tiny, about 80 lbs soaking wet, with diabetes, a cardiac history, and a bilateral above the knee amuptation, in addition to other medical problems. She was what we all call a train wreck. She developed chest pain, then SOB, then went semi-unresponsive in a matter of minutes. We moved her to a critical care room and hooked her up to the monitor. Not good. We all know that second we look up at the monitor and see those large and ominious tombstones. Not good.

But then, a PVC. And then another. Then a couplet. Bigemeny. Trigemeny. V-tach (with pulse). Shock. Tombstones, pulseless. V-tach, pulse. Shock. And so on and so on. It felt like we were in the megacode testing section of ACLS and someone was trying to trick us. We gave Lidocaine, Atropine, Epi, Retavase. By the end of it she was on Amiodarone and Heparin drips. It was a really good test of our teams skills.

But the whole time it felt like torture to me, and I had a flood of those old feelings from the ICU come back to me. These old, frail, sick people who are dying and we just can't let them go (usually because the family just isn't ready). When in that situation I usually feel very torn, as if I'm in a war and torturing someone for information. It's a very challenging situation for me because I know if it was my mother or father or husband in that situation I wouldn't let go of that hope that they might come back either...But I also know that most of those patients in that situation are ready. And for me, a situation like this is one of the most heart-renching and difficult situations we face at our jobs. When to draw the line between playing God and just letting things be as they are.

So amongst all of these feelings the daughter was there, crying and talking to her mom. Saying "oh mom, oh mom," while we're pushing Retavase. And then, we helped her understand that it was time, and since she didn't want us to intubate or press on her chest, we needed to stop. And we did. And she passed away.

Eventually the daughter left, the funeral home came and got the body, I cleaned the stretcher. Within five minutes there was another patient in that very same bed where another person had just passed away. The next patient was a happy, healthy 60 year old with a TIA. He was laughing, making jokes, and had a lovely wife and daughter at his side.

Not only thirty minutes ago I been struggling with my internal debate over letting someone go or carrying on with the code. How quickly we can shift gears and move on huh? The new family had no idea what had just gone on, the magnitude of what we had all just experienced, and the work day forged on.

This happens every day. Maybe not as dramatic as this but to some degree. We go from CPR to suturing a little girl with a lip lac. We put people in 4 points and then start an IV on a pregnant woman with hyperemesis. We are constantly switching gears, moving on, and to me that is just amazing.

So the new family, the TIA family, commented on how good the room smelled upon their arrival. It was funny because to me, that was the lingering smell of death, to the daughter, it smelled like brownies. If only those stretchers could talk huh?

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