#bouffant cap

You choose when to meet the patient:

Before the operation begins

If complications arise before induction

Once she is under anesthesia and intubated

She convinced herself that she could feel it now, somehow. The rapid bumping in her chest, thready and irregular and dangerous. She could feel it. Or, maybe it was the beeping of the monitor behind her that was doing the convincing. She couldn't tell, anymore. She shuddered, and a wave of sweat flushed over her. "Amanda, take a deep breath for me, honey." Doctor Mara was adjusting something next to the gurney. Amanda turned slightly toward her, the wires and tubes pulling at her body, and inhaled deeply, coughing once, violently. The monitor pinged urgently. "No, no," Mara placed her gloved hand on Amanda's back. "Through your nose, honey, I've got you on oxygen now. Always through your nose." Amanda took a moment to recover from the cough, her chest burning. What the fuck was wrong? She began to inhale through her nose, and a cool rush filled her nostrils, coursing down into her chest. "Slowly...slowly, now." The doctor was watching the monitor. "Let's see if we can calm things down." A petite young nurse entered the ICU bay as Amanda was concentrating on breathing, and handed something to Doctor Mara. "Thank you, Breann. That was quick."

"The labs understood the...urgency, doctor." The nurse said. Still breathing slowly, Amanda swiveled her eyes to look at the nurse. She had beautiful brown skin and wore her hair up. So pretty. Why am I being so observant? She thought to herself, her heart still fluttering. What must I look like right now? She frowned. A mess, I bet. Doctor Mara briefly looked at Amanda, as if she could read her thoughts. Her face was sympathetic. "Breathing ok now, Amanda?" Amanda nodded. Mara glanced at the labs report, paused, and spoke up to the room. "Well, Amanda, the labs look okay. Not great, but okay. No troponins - ah, cardiac proteins - in your blood yet, so that's good. Your electrolytes are all over the place, though." The doctor looked at Nurse Breann. "Ah, maybe hypokalemia?" Breann suggested. The young nurse stole a glance at Amanda, and held it for more than a beat. She has amazing eyes, Amanda thought. The doctor made an approving sound. "That looks to be a possibility, yes. What could we do or check next?" Breann looked at Amanda, again, taking in the details. "She's already on fluids, looks like an electrolyte bag. That's one...ah, BP is...105 over 75, so maybe no betas just yet. Are we pushing fluids?" Breann craned her neck to see through the visual maze of equipment surrounding Amanda's gurney. "Good question, Breann." Doctor Mara nodded. "Why would we?" She's teaching, Amanda realized. Raising an eyebrow, she thought, I guess I'm a final exam. "Betas could help the arrhythmia if an underlying condition exists, but can cause hypotension. We'd need to increase blood volume first. So, push electros and fluids and admin beta by IV?" Breann quoted the book. "Very textbook, Breann. Can we be sure? Are we ready for that step?" Doctor Mara was quizzing her nurse now. Breann thought a moment. "May I?" she said, motioning to Amanda. "Go ahead." Mara stepped back.

Breann approached Amanda. "Hi, Amanda, I'm Breann." "...hi, Breann." Amanda managed, her voice catching. She didn't know whether it was a cough or nerves. "I'm going to take your blood pressure, sweetie, ok? Just breathe normally for me. Keep your arm relaxed." "Ok." A buzzing and whirring accompanied the tightening of the cuff on Amanda's arm. She never knew whether to like it or hate it; the sensation was always something between pleasure and pain. She was getting a lot of that today, more than she wanted. After a long interval of puffs and squeezes, beeeep. "Hm, 137 over 95." Breann said aloud. "Not what you expected, is it?" Mara mused. "Maybe I didn't, no." Mara walked over, taking in Amanda's vitals with an experienced but cursory glance. "She's been variable all day, in and out of tach. I'm tracking the irregularities, particularly the QTc interval. I'm just not sure of the underlying causes yet." Breann tilted her head, looking Amanda over. Her face was sympathetic, and also intensely focused. God, she's so cute, Amanda thought. Her heart picked up for a moment, and she was mortified that they could tell. "There she goes again." Mara put her steth in her ears, pressing the bell to Amanda's chest. She had to pull the gown down, and Amanda's breasts were partially exposed. The bell was cold. "Deep breath, Amanda." In....out. Amanda kept her eyes on Breann. In....out. Mara pulled back as Amanda's heart came out of tach. "So, Breann, any thoughts?" "A few," Breann said, placing her hand on her chin. "Bi-lateral BP, for one." Mara nodded. "Mm-hmm." "...and push fluids, but I'd place a Foley and obtain urine electros ASAP. And then we wait." "Agreed. Do you think you could manage both?" Mara asked. Breann smiled, "Yes!...Ah, I mean, of course, doctor." Mara chuckled, and turned away. "Okay, get her cuffed and get to business. I'll be at the nurse's station. Amanda, you're in good hands; I'll be back in a few minutes and we'll learn more together, ok?" "...ok, doctor." Amanda watched her walk away, turning her eyes to Breann. "Amanda, I'm going to put another BP cuff on you, ok? Sorry about that, sweetie." Amanda raised her arm as Breann brushed the loose sleeve back. The cuff material was cool and smooth, and Breann secured it tightly. Amanda felt held down by both arms; a weird sensation she'd never had before. Breann moved to the foot of the gurney. "Now, I'm going to recline you a bit, because I'll need access for the catheter." Amanda took a deep breath - through her nose, as the doctor ordered - and began to shift her legs. This is new, she thought.

----- Hi from SMC! This is Number 01 in an experimental series called "ICU Scenes". We'd love to know what you think - let us know in the comments!

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