It was early in my career and it was one of the most arduous nights I have ever had during my entire career. I was working the night shift in a fourteen bed ICU and as was usual there were three of us to cover the shift. Myself, the only RN, an experienced LPN and a competent nursing assistant. I reported for duty this particular night and found to my dismay an array of critically labile patients. All beds were full and four patients were on ventilators and I had three fresh post op patients, along with a number of cardiac patients who were fairly stable. After taking report I had notified the Supervisor I was going to need additional help as a number of my patients were very unstable. There was no additional help available as they were at bare bones coverage that night. Given the potential I quickly assessed my plan of care and related the information to Pat and Mary. Buckle up girls; we’re in for a ride tonight. I had one patient who had experienced multiple trauma from an auto accident several weeks before and was now hemorrhaging from his trach on a regular basis, calling for us to lavage his trach to clear away the blood clots which would routinely obstruct his airway. A post op cancer patient who had just had a revision of her trach in another room, a post op cranial hematoma evacuation, a post op partial lobectomy of his only remaining lung, an elderly woman with cardiac disease who routinely would go into V Tac on me but responded to a pre cordial thump and by morning had asked Mary why I didn’t like her as I kept hitting her chest when she was going to sleep., thank God she did respond, and various other patients who were regulated to a “stable” status by me. Remember, everything is relative. I remember saying at one point to Mary the nursing assistant, I didn’t have time for a code. We were too busy. Suddenly my post op lobectomy blew what was known as a pneumothorax of his remaining lung. In other words, his remaining lung collapsed and he was now patient number one for intervention. In the meantime across the hall my multiple trauma patient was clotting like there was no tomorrow and I would have to drop whatever I was doing to clear his airway. At this point you get the drift. We were out straight and all hands were on deck. I notified the Thoracic Surgeon and he would be there in ten minutes. Just enough time for me to set up for a thoracotomy. But, who to assist???? I didn’t have time to assist him and the only one left would be Pat the LPN. She had never seen a thoracotomy, let alone assist on one. Needless to say there was no choice. The surgeon had a reputation that scared the pants off most people. I didn’t have time for a prima donna either and told Pat she would have to assist him. I explained what she would need to do and proceeded to set up the room and told her not to be afraid, he would not yell at her or throw anything after I got through with him. There was an added adventure as I was out of suction equipment as well and would need it. So I Gerry rigged suction tubing from another patients room and trailed it through the bathroom to where I would need it. Upon arriving the surgeon says to me to get ready to assist. He was just about to get a reality check from me. I told him that Pat would be assisting him, the room was ready and it as Pat had never seen this procedure, let alone assist on one, it would be up to him to hold his temper and teach her what she needed to know to do. I didn’t have time and there was no one else. Interestingly, for the first time I could remember this guy was actually decent, especially when he saw what I was up against. I guess it was the multiple trauma hemorrhaging from his trach and it blowing across the room and my running hell bent for election to clear him that got this guys attention. He did say afterwards, your right Gail; you don’t have time to assist anyone with what is going on here. That’s when I mentioned not having time for a Code as I was to busy. I did ask Mary if our “transition” patients down back were okay and alive come morning. You see I didn’t have time to make rounds and never saw them all night, except for Mary. Thank God, as she filled in the gaps for me and Pat that night. Yes, we did survive the night along with all of our patients; but, what we went through that night has never left me. I am still in awe of what we accomplished and the fact that each of our patients was cared for and stable come morning and no, I didnt have any Codes that night. I didnt have time.
Posted on: Wed, 07 Jan 2015 07:22:20 +0000
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