Julianne Colella submitted 2015-06-29
He looked like someone’s father. Maybe one that drank a little too much or didn’t eat the best. I had seen this done in the videos in class and performed it on a plastic mannequin. The one that everyone tries to guess if it was a boy or girl. Nothing like a real person. My blue gloves cling to my hands. I pretend like I have done this before. In my head I am telling myself, I am a professional. The CPR line has two other people. One is a girl my size with dark brown hair, the other a larger man with a tattoo on his arm. It was my turn. I stand on the metal stool. I feel myself shaking. I remember my teaching; one and two and three. My hands clasp together. I push down, it is not as firm as I had imagined. I feel fluttering in his chest. There are so many people around yelling orders, but all I hear is, stop, go. His stomach is large. It moves with the rhythm of my compressions. I hear someone say his family has arrived. In my mind I’m thinking, is he really going to die. The doctor asks, does anyone else have any ideas. No one answers. The doctor goes through the list of interventions they have completed. There’s a command. Stop. I take a deep breath and look down one more time. His skin now mottled. His lips turning a blueberry blue. He’s dead.
I go back to the floor to look after the five patients still waiting for my presence. Not knowing I had just seen a man, a father, a son, a husband, die. Yes, die. But we are nurses. This is what we are taught to see. I can’t cry. I can’t let them see me be weak. I must be strong for my patients. I am their hope.
As a nurse of 7 years I believe experiences are the best way to really learn, but before experiences are made, these kinds of stories help guide new eager minds. I am returning to school to become a teacher, so I can help shape the future. That my experience may help others. Sometimes we save people, but the ones we don’t are the best learning opportunities. And then we tell these stories so that someone else might be able to see something we weren’t able to.
Everything is connected. The body has multiple organs that work together, one stops, the others stop. Multiple problems listed is always a big sigh when you receive your assignment. She is in her 70’s with “multiple problems.” She has high blood pressure, not controlled, and is anemic. She needs a blood transfusion. The first unit of blood infuses. I check her vitals. Her blood pressure has elevated. I call the doctor, Lasix is given. There is hardly any urine in her catheter bag. The second unit is infusing. Her blood pressure is still elevating. I notice her coughing. She states her chest is tightening. I call the doctor again. He doesn’t answer. She is deteriorating. I call a rapid response. The doctor sees her, it’s pulmonary edema. Her lungs are filling up with fluid. Quick thinking starts; Lasix IV push, bag her, get her to ICU. Code is called in the hall way. The doctor and I pushing the gurney like there is a fire behind us. Her heart is being squeezed. More Lasix. I leave her in the ICU.
She dies a day later.
As a nurse you review your day in your mind. What could I have done? Is this my fault? If I was a better nurse would this have still happened? It is ok to ask these questions. This is what makes a good provider. The modesty to admit that you could have done better, to learn. I could have pushed the doctor to intervene more. I could have called a code sooner. But I will do better next time.
My advice to another healthcare provider would be to be confident, but modest if you aren’t sure of the answer. Ask for help, or ask questions. Make friends and ask their opinion. It is important to know the skills of life saving techniques, but just as important to be a leader and assess every situation as a unique problem. There will be bad outcomes, but there will be good outcomes as well.
The patient rolls into the room. She’s had a femoral artery procedure with a catheter. The floor she needs to go to is closed. I am taking over care. As they drop her off and give report I notice a hematoma growing on her leg. I ask for their expertise. They say they will contact a doctor and call me. But it keeps bleeding. I hold pressure. This isn’t right and I know it. I call the surgeon notorious for yelling at nurses. He doesn’t answer. Her blood pressure elevates to an emergency level. I have to make a move. I grab a hospitalist. I actually grab his arm and lead him to the room. I remove the gauze and the bright blood erupts like a volcano in his direction. His eyes widen. We need the surgeon. We call rapid response and move her to the ICU. Her blood pressure starts dropping and blood pools at the bottom of her thigh. They had hit an artery. Soon she is back in surgery. If we would have waited to intervene she would have died.
So what would I tell other students to help them prepare? That there are moments you may want to forget, but shouldn’t. Those experiences and the knowledge you’ve gained will help you save someone in the future. Have empathy, but never sympathy. Stay close to your patients, but remain detached. Question yourself, but trust your instincts. And then rest assured that you are making a difference.