I Am The Night(shift)

Me:

Vampire: *still struggling*

Me: look, I said I have tricky veins-

mRNA Vaccine https://t.co/ngCtNfxpTq https://t.co/FTzTqNflvD pic.twitter.com/pD3Y5RcKGq

— XKCD Comic (@xkcdComic) February 15, 2021

Alt text @ https://t.co/OdcsaTdzvE Title text: “To ensure lasting immunity, doctors recommend destroying a second Death Star some time after the first.”

some SuitPerson: haha well you know - thank God it’s FRIDAY amiright!!!!!!

me, who works the next three days and has entirely lost the concept of weekends as a time for rest and relaxation:

My patient’s family asked me to print this out and hang it in his room as we started discussing his discontinuation of life support.

Congratulations to the mother of this toddler for somehow simultaneously:

never vaccinating her child because of “all the chemicals”.

demanding an antibiotic for his fever (which began 2 hours ago, but resolved after a cool bath alone. Why only a bath? Because of

not believing in giving ibuprofen or acetaminophen for fevers because of [YOU GUESSED IT] “all the chemicals” and because “you have to let the infection register on his immune system”).

demanding to be allowed to wait in an exam room instead of the waiting room because “he might catch something from all these sick people”.

BONUS: smoking enough that the kid’s pajamas smell like smoke

Chemicals: they’re evil, unless they’re in antibiotics or cigarettes.

Me: So mom will be here for osteomy training around 3pm

Wound Care APN: Great, I’ll plan of bringing down…

Me talking over the phone to a coworker: Your kid is seizing. Me back to APN: Sorry I interrupted you

Wound Care APN: Uh….do you need to go deal with that?!

Me: Nah, it’s fine. It wasn’t my kid seizing

If providing information about birth control or even learning about it makes you super uncomfortable CHOOSE ANOTHER PROFESSION

If providing emergency contraception (Plan B, NOT THE ABORTION PILL) makes you uncomfortable, FIND ANOTHER PROFESSION

If serving someone of a specific religious belief, sex, gender identity, race (or some other personal identity) makes you uncomfortable, FIND ANOTHER PROFESSION

If giving patients Mifepristone (aka the “abortion pill” aka the pill that can also help push a dead fetus out of a woman’s body if it died early in the womb) makes you uncomfortable, FIND ANOTHER PROFESSION

If you refuse to be educated about different types of mental Illness, FIND ANOTHER PROFESSION (schizophrenia is not “demonic possession”, depression isn’t “mommy/daddy issues”, anxiety isn’t “a cry for attention”, etc)

A good nurse will listen to you and address you however you want to be addressed.

We do need to know some things to help you with your care such as:

- which organs you have, don’t have, and what has been removed. (surgical history)

- if you are on hormone therapy: what kind, how long? (Medication history)

- who is your support system and do you feel safe at home?

- are you satisfied with your sex life and do you feel safe with your partner(s)?

These questions seem super personal, but it is our job to make sure that we are providing the best possible care. A lot of things differ when organs are different. (Ex. A trans woman that still has a prostate can still get prostate cancer.) Lab values change, and we can’t risk a misdiagnosis because we didn’t know details. And we are bound by HIPPA to keep your medical information private.

It won’t be the vomit or needles or blood or urine or feces that turns your stomach. You’ll get used to that. You’ll come to accept it’s just part of the job and get to the point where you’re thinking of the 38 different things you have to do while absentmindedly cleaning up a bowel movement.

What will turn your stomach will be 40 shallow breaths a minute in a patient in respiratory distress

A freshly born infant that is limp and blue and hasn’t cried yet

Tripled troponin levels on your sweating and anxious patient as you realize they’re having a heart attack

Feeling cord during a cervical check, then trying to hide from your patient the shaking in your voice as you call for help

The pale skin of a Jehovah’s Witness with a hemoglobin of 4 as she declines a blood transfusion and says goodbye to her family because they haven’t found the source of the bleed and she’s running out of time

A blood alcohol level of .18 on a 4 year old who is barely responsive and being intubated after getting drunk on mouthwash and then hitting his head

An elderly woman in the ICU signing her DNR while her sobbing daughter begs her to reconsider, knowing if treatment is stopped then her mother will die

A child in the pediatric ICU who hasn’t had a visitor in months

Not being able to find the heartbeat on a pregnant mom who hasn’t felt the baby move in a while

 My heartbeat’s rhythm is a lonesome sound Just like the rubber turning on the ground Always lost and nowhere bound

~Chris Stapleton

I can’t count how many times I have been in this situation. But, I know it’s been hundreds . Maybe, if I am really digging deep… thousands.

She was a cardiac arrest with a long down time and multiple subsequent cardiac arrests. My optimism for recovery was a zero. She had periorbital edema and her pupils were questionable to respond.  A breathing tube, temperature probe and gastric tube all crowded her mouth and pushed her swollen tongue listlessly to the side. A central line hung out of her groin and allowed the IV pumps to carry lifesaving anti-arrhythmics and blood pressure medications to her blood stream. Her body was swollen with fluids meant to save her life. Her kidneys, that had been tenuous on a good day, were no longer functioning to get rid of all the medicine and fluid we dumped into her.

I wrote report in the same short hand that I used for everyone. Another experienced nurse would understand, but many would not. A few steps from where I blankly absorbed a litany of information, my orientee stood scribbling madly. His eyes were alight with interest and his posture was one of barely contained energy.

The day before we had decided to give up our continuous renal replacement patient (CRRT) and take something more acute. He had said multiple times throughout the day, “I want a code. I need a sick patient.”  

So, as I took report I looked at him and shook my head. The patient had been coded for 35minutes in a sister hospital before transferring to us where she got shocked 12 times during the night. By 7 am she was pseudo-stable and we were supposed to fix whatever mayhem was remaining. I was less than thrilled.  

After 8 years in an ICU, I like to have the same patients for days. And, I may be shunned for saying it, but I like the sedated intubated ones. I like the control I have over them. I like that no matter what is happening with them- I am 100% in charge. Awake patients can muddy the water with meaningless complaints that are benign. A sedated, intubated patient can’t. If their body does something- it is a true blue symptom needs to be addressed. 

Instead of the stable patient we had the day before, we found ourselves knee deep in this cardiac arrest patient. We talked about pressors and doing thorough neuro exams. We talked paralytics and vent dysynchrony. We talked… we talked. As the day went on, though the patient did not cardiac arrest, I was less than optimistic. My orientee surprised me though… As sure as I was that she wouldn’t wake up, he was just as sure she would.

“She turned a corner” he said many times through the day as we turned, cleaned and treated her.  I smirked at his sweet naivete and shook my head. I had seen my share of surprises in this job. But, an elderly individual with multiple co-morbidities and multiple arrests? That was something that was usually a direct recipe for anoxic brain injury.

At 1600, when we went to turn her, we both jumped when she turned her head to our voices. A few moments of talking to her elicited a slight but very present nod of her head. We exchanged a look and walked from the room.  I looked at the young new grad before me and felt a sense of sadness. I missed those days. The days of endless hope and optimism for every patient that came through.  The feeling that you saved people and made a true difference. The feeling that death wasn’t a given.

These days I distance myself from patients.  It is almost like I see them as time-bombs waiting to go off.  They may not die this minute… but they will die. Patient’s like the one we had, in my experience, rarely wake up… let alone leave the ICU alive.

But, there was a time when I believed it could happen.  A time before death after death hammered my soft heart into something unrecognizable. Something hard and yet brittle. Something I keep hidden from my patients now. Something I feel jolt when a new nurse with wide expressive eyes and an earnest heart reminds me of how I used to feel.

I don’t know if the patient will leave the ICU. I don’t know if she will survive this horrific ordeal her body has been subject to.  But, I do know, if she does it isn’t because of me.