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