The one that hit me hardest

 

Code times notes as my mousepad

It was a Saturday overtime shift, 9a-9p, and I was in the critical care pod. It started out like a chill day. I had 3 only 3 patients at 1130, and none of them sick. 

At 1145 EMS had brought someone sick and I was pumped. The had patient called 9-1-1 for flank pain and shortness of breath. Upon EMS arrival, Pt was awake, speaking short sentences, but responsive to O2 via NRB, but when she was placed onto the ER stretcher she was nonresponsive with agonal respiration. Oh, and did I mention pulseless??

We coded this patient 7 times between noon and 1500. Yes. SEVEN. PEA arrest, 1-2 rounds of CPR and Epi and we got ROSC seven times. I had taken up both bays, we kept running out of epi. She was intubated, had an a-line, OG tube, central line. She was on an epinephrine and levophed drip. Her ABG showed a pH of 6.7 (no that is not a typo). It was a mess.

At 1500 I finally got a chance to pee. I left the room for literally two minutes, and when I came back in her eyes were open! She was absolutely mentally there, nodding to my questions, blinking on command, tracking my finger with her eyes. At this point I hadn't let any of her family members in the room because she was a mess (and her heart kept stopping), but her brother is one of our security guards. He walked in, she reached for him and I gave them a minute. I updated the family, told them that she had opened her eyes, and that my plan was to call report to the ICU, take her to CT scan then bring her upstairs.

I go back into the room and call report while in the room, instead of at this nurses station like I usually do. As I'm on the phone with the nurse upstairs, her blood pressure starts dropping again. ICU fellow is in the room, the techs are hooking her up to the portable monitor and I walk to get the chart from the secretary, as I walk back in room she codes again. 

We code her for 20 minutes and couldn't get pulses back. Time of death 1655. 

The techs, my manager and I started unhooking her lines and wires and I started shaking, my eyes were brimming. I told my manager I needed a minute, walked outside and texted one of the murses that was working and asked him to meet me.

 As soon as he stepped out side I lost it. I started bawling.We got her back. She was there. And now she's gone. She heard me giving report to the ICU and was like, "No, I don't think I want to go there...I think I'm done now." He gave me a huge hug and the perfect pep talk speech. "There was nothing  you could have done differently. This was physically and emotionally draining. You're upset because you care, and that's what makes you such a great nurse. You're awesome, never stop caring."

I gathered myself together, finished my end of life care, called the organ donation line, charted on 5 hours of coding, then went back to work and picked up another two patients. I went home, had a bottle of wine and cried. 

This day taught me a lot. I've been a nurse for a year and a half, and this was the first code where I felt like I knew what I was doing. 

No matter how hard you work, people die. And when they do, there's a whole waiting room full of living people waiting for your care. 

TL;DR: 5 hours, ROSCx7, Epix12, TOD 1655. Nursing sucks sometimes.

-K

A little about me

Why hello there! Let me start by saying that I don't even know if blogging is my thing. I made my anon twitter account in August of 2014 and it has been my sanity these past couple months. Interacting with people who share the same joys and troubles at work as I do is quite refreshing. It gives me an anonymous place to vent and talk about my day with people that understand all the nursey words, but I'm figuring there are stories I want to tell that are more than 140 characters- so I figured I'd give this a shot. (Also, my grammar and comma placement may suck, so sorry in advance.)

I am 23 years old and I work in the Emergency Room of a level 1 trauma center in a city that's always on the lists of of 'Most dangerous Places in America'. No-I don't get gun shot wounds every night. They go to trauma. Which is separate from the ER. So stop asking me that family and friends.

When I was in high school, I volunteered at the local fire department with my dad. My mom suggested I take an EMT class one summer, so I did and fell in love. At 16 I was an EMT in my small rural town, taking calls as a 3rd crew member since I was too young to legally treat patients on my own.
 
I went to college knowing that I wanted to be an emergency room nurse. I loved when I had clinical days in the ER and became obsessed with the organized chaos. A sick patient would come in and nurses, doctors and techs would rush in, everyone knowing what tasks needed to get accomplished to stabilize the patient. 

Midway through college I got a job as a tech on the mother-infant floor of the hospital. I stayed there a year, then needed per diem hours so I went pool. I hated everything about the medical-surgical floors. (Seriously though, no offense to the floor nurses- it's just not for me.) I hated walking into the same patients days and weeks at a time. I hated how everything was so scheduled, but nothing ever happened. 

On July 1st I sat for my nursing boards. I walked out of the building, turned my phone on, and before I could even call the boyf to tell him to pick me up, my phone rang- it was HR offering me a job in the ER! I was so emotional from literally just finishing the NCLEX, I'm sure I sounded like a nut job on the phone with the HR rep.

As much as I can complain, I absolutely love my job. I love the emergency room, even when we have 25 in the waiting room, a full admit board with no hospital beds and medics coming in the back door with STEMIs and strokes. I love working the urban setting, dealing with overdoses, psychosocial issues, and even their usual sassyness. I love (most of) my coworkers. I am so so lucky to have landed my dream job right out of nursing school. 


So that's my story in a nutshell. I've been a nurse for 1.5 years, so I'm still a baby. I hope I'm not too boring for anyone that might read this. Stay tuned for more if you feel so inclined...

TL;DR: I'm an ER nurse and I love my job.

-K