I’m (not) a people person

I’m a people person… until I actually have to deal with people.

I know, I know, I’m a nurse. Dealing with people is pretty much all I do. However, I am an ICU nurse. I want my patients sedated and intubated. I want the families gone home for the day by the time I get there at 1900. I want to get my patient bathed, medicated, and ready for sleep by 2200. I want to be able to keep my patient comfortable and repositioned for my shift and up in the stryker chair by the morning.

I don’t want to talk. Am I good with families? Absolutely. Will I answer questions and make sure the family has a good grasp of the medical situation? Absolutely. Am I rude? No. I just really don’t want to do any unnecessary talking.

I don’t care that your daughter is a CNA (congrats to her by the way) and told you what to be “on the lookout for” because you should “only trust doctors”. I don’t need to you come up to the nurses’ station to tell me the monitor is beeping, I can hear it. It’s beeping because he keeps taking his oxygen off and his sats are low, tell him to stop taking his damn oxygen off. I don’t need you to wake up out of your dead sleep in the chair in the corner every time I walk into the patient’s room to ask 14 questions that must have obviously been really important. It’s great that you know *insert important person here* but you don’t need to try and name drop every time I come in the room. I get it. You are the beautician of the CEO’s wife. Ok… I am not going to treat you any differently as I give all of my patients A-1 care.

I really, really just want to be left alone to take care of my patient. Is that too much to ask?

Advertisements

The end isn’t always the end

I learned a lesson not too long ago. The end is not always the end. I got to see this first hand more than once.

A few months ago we had a trauma, pedestrian-vs-motor vehicle, that came to our unit with severe head trauma. The patient had a head bleed along with swelling. The CT scans did not look good. The MRI didn’t look any better. The patient and family were refugees from a war torn country, they spoke little English. The team began having “the talk” with his family. You know that talk, the one where they are pushing for the DNR because the patient is not expected to have any quality of life. Yeah, that talk.

The family would have none of it. We managed to stabilize the patient. They got the standard trach/peg combo. The doctors continued to speak with the family about the quality of life and the family continued to hold out hope. The patient ultimately managed to be transferred out of the hospital into a long term care facility. We were pretty much under the impression that they would just waste away in a nursing home, with no improvement in neuro status.

The patient came back to visit us, along with the family. The patient still has noticeable deficits but was able to fully communicate and even thanked us for our care. We had given up but they didn’t.

dont give up

More recently, our unit had a very sick vascular patient that coded during their surgery. The OR team got them back and immediately brought them to our unit (STICU). They coded again, the second code was worked for an extended period of time and then the team called it. They died. And then they decided death wasn’t really for them and their heart started beating again… spontaneously… after the code was called… while the team were having a moment of silence for the patient.

The medical team spoke with the family and let them know that even though the heart is beating, the patient has been “down” for an extended period of time and neurologically there is probably nothing there. The family decides it’s in the patient’s best interest to make the patient a DNR. The family begins saying their goodbyes and leave in expectation that the patient would probably code again within the next few days. Everyone is pretty much preparing for this patient’s end of life…

gointothelight

Except the patient…

That night, they opened their eyes to painful stimuli. Then it turned into opening eyes to name but no purposeful movement by the next day. By the third day or so they just woke the fuck up and tried to self extubate! All of us were pretty much like:

heart attack

They were completely alert, oriented, and by the end of the shift able to write questions on a piece of paper. Needless to say we were all kinds of confused, surprised, and impressed. We ended up nicknaming the patient “Lazarus”. Are we going to Hell? Yes. We are all well aware. I have a time share there.

The patient had a rough course. They were intubated, extubated, and reintubated multiple times before finally being trached and pegged. However, as I am typing this they are alive and are being prepped for long term acute care out on the floor. That’s right, the patient that we basically pronounced dead is instead going to LTACH soon.

These moments have taught me that it is not over until the patient decides it’s over. It has also taught me that maybe I shouldn’t give up so easily. My miracle patients are showing me there are still some things that we in medicine don’t understand. We don’t know it all. I am glad for that.